How Can I Be Most Prepared for Clinicals?
By Tina Klasing, nursing student
Although a nursing student may never feel entirely prepared or organized when walking onto the nursing unit, here's some advice from someone who's been through it. Keep in mind that it's all a learning process, starting with day one of clinicals all the way through the end of your degree. Remember to take baby steps, try not to stress, get help from fellow students — working together helps things go a lot smoother. Ask questions and communicate with the staff on the unit — most are willing to help. Clinicals are great experience for what you will be getting into after completion of your degree.
Bring the resources you'll need.
Be sure to always bring necessary resources with you to clinicals such as a lab book, drug guide, drug cards, IV drug guide, and pocket dictionary.
Know your patient.
Some nursing schools allow you to go the day before your actual clinical and gather information on your patient. Take advantage of this opportunity and the extra time you're given to prepare.
Get the facts.
In other nursing schools, you'll find out the morning of clinicals who your patient will be. This gives you a very short time to gather information. Usually you will be given a printout of the patient's name, age, weight, diagnosis, date of admission, and doctor's name. You will also need a medication administration report for this patient to look up information about the patient's medications before administration. Be sure to review the patient's chart before leaving, making sure you have all the up-to-date information.
Do your research.
As soon as you know who your patient will be, begin gathering any information you may need such as your patient's diagnosis, how that diagnosis is treated, what you will need to do for that patient, what their vitals have been, and any lab values. Be prepared to state the medications your patient is on and why, as well as any side effects they may have. If the patient has a schedule such as PT/OT, OR, exams, or procedures, you should figure out how to schedule your day around these events. After evaluating lab results and identifying abnormal values, research how this will affect your patient physiologically and what clinical manifestations you need to assess for during your shift.
Take note of your surroundings.
During the first day on the floor, pay particular attention to where important things are located, such as assignment sheets, charts, vital sign equipment, medication room, and bathing supplies.
Know what's expected of you.
Find out what nurses on the unit expect of you, such as when and where the report on your patient will be given, as well as how vital signs, intake and output (I&O), and your nursing assessment are documented. You'll also want to find out the preferred pattern of care, including when to be ready for report, when chart entries must be made, when vitals are taken, when mealtimes take place, and when patients should receive baths.
Have relevant drug facts on hand.
Medication administration is probably the first thing you will do when beginning your shift, so be sure to have your drug information ready. The most convenient way to carry this information with you is to have a set of drug cards. Drug cards allow you to pull out cards on the drugs your patient is taking and carry them easily in your pocket. You can either make drug cards on your own, or buy drug cards that you can reference easily. Buying the drug cards is much easier, and ensures accurate information. You may also want to bring your drug handbook with you to clinicals in case your patient has started on a new medication during your shift. You will be expected to know the effects of any new medications.
Write down important information.
Locate your patient and the nurse you will be working with, and liaise closely with your patient's nurse throughout the day. Don't be afraid to ask questions. Use a sheet of paper, note card, or a school-provided paper to organize all the information you will need on your patient. This may include name, diagnosis, age, weight, vitals, medications and times, I&O, IV fluids and pump clearing times, and any report information. Do not make the mistake of thinking you can remember everything about the report. Write down all the information you are provided.
Prioritize.
Your initial head-to-toe patient assessment will be done in the morning. If you have more than one patient, look at your patients' histories and prioritize which patient you will see first according to diagnosis and/or needs. If you anticipate that you may need to spend more time with the patient who needs to be seen first, go in to check in on your other patient beforehand. Introduce yourself and let them know you will be returning to do their assessment.
Do your charting on notebook paper first.
Make yourself familiar with the charting for the unit you are on, and know what your instructor expects of you. It helps to do your charting on paper first, show your instructor, get it approved, then put it in the chart. If you have a lot going on and it is difficult to chart things done at any particular time, make notes on your own paper and refer back to them when charting later.
Be prepared for your off-going report.
Throughout the day, write down important issues and events so you can be sure to let the nurse know them. Report any findings and/or assessments that you made during your shift. Examples: vitals, labs, procedures, results, how the patient ate, I&O, medication changes, and any upcoming procedures that the nurse may need to do on her shift.
Protect your patient's confidentiality.
Remember that your patient's confidentiality is a serious consideration. Be careful not to leave your notes where others can see them, and never talk about patients in public corridors and/or elevators. You never know who is standing behind you — it just may be your patient's spouse or coworker.
A Typical Day
- Arrive at clinicals on time, copy the updated medications and look them up. Review your patient's chart for all information you will need in order to care for that person during your shift.
- Listen to the report and write all information down.
- Perform focused assessment/head-to-toe assessment and report findings. Chart per flow sheet according to the guidelines of that unit.
- Assist patient with personal hygiene, which includes bathing, combing hair, brushing teeth, etc.
- Perform or assist with ordered procedures and nursing interventions. These may be dressing changes, ambulating your patient, IV insertions, etc. Be aware of what you can and cannot perform with or without your instructor at the bedside with you.
- Take vitals according to unit policy and your patient orders. Chart those according to policy.
- Prepare patient for his/her meals. Chart amount eaten and fluid intake.
- Practice your charting on paper and get it approved by the instructor before charting in the patient's chart.
- Calculate intake and output, clear IV pumps, feeding pumps, drain foley catheters, etc. and chart all according to unit policy.
- Prepare and provide an accurate and comprehensive report, whether verbal or on tape, and give that to your nurse. Be sure all charting is complete and attend a post conference.
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