Clinical. Clinical. Clinical. I had several experiences in the different hospital rotations, both good and bad. My first semester of clinical was horrible. I hated it. After having a patient choke, I was nervous every morning. I found after speaking with other students I was not the only one to feel this way. By the fourth semester, everything came together. All the hours of lectures and clinical experiences started to make sense.
#1 Trust Your Gut
When you are the student you trust the nurse around you, your program’s faculty, and your textbook. Most students have no confidence in their gut feelings in regards to a patient. When you’re a student and something doesn’t seem right, pay attention. The slight change in your patient’s personality or alertness may be caused by severe medical issues. One patient I had during nursing school, had orthopedic surgery on their legs. I had this particular patient two days in a row. The first day the patient was cheerful and talkative. The second day, the patient was different, distant, and insincere. I began the assessment by establishing his orientation, asked the patient the who, where, when, and why. The patient answered everything correct, but the response came across as rehearsed. He had a change in personality. I expressed my concern with the primary nurse. The patient’s family member also expressed similar concerns. The patient had told the family they wanted to go home, that they were not in a real hospital, and the hospital was performing experiences on the “patients.” The family member was hysterical, informing the primary nurse that the once intelligent patient is now irrational. The patient had a subdural hematoma.
A classmate had a patient whose baseline personality changed between the beginning of our morning and lunch. By lunch, the patient hallucinated jellyfish on the ceiling. A removed Foley caused a urinary tract infection. The nurse became aware of this new development. The next day the patient was on new medication due to the infection.
#2 Medication Cards
Every nursing program has a different design in curriculum and format. My school divided pharmacology into three semesters, coinciding with the medical-surgical class. Our first semester we were asked to make twenty medication cards from the most common medications seen at the hospitals. Each week we had care plans and medication sheets due based on the patient that week. I wish throughout the program I had kept them. Each week having to research the same medicines becomes time-consuming, especially if you’re like me and need to go to multiple websites to find all the information. There were many weekends I wished I had kept the cards to make things easier. When going to a nursing lab session, simulation, or completing paperwork, continue to make the medication cards and keep them together for reference. It will be easier and more accessible in the long run.
#3 Beware of the not so friendly nurse
When assigned to a patient with a primary nurse that wants nothing to do with students, it can ruin a day or a week of clinical, but at the same time a real learning experience. I began my day at one particular hospital trying to receiving a report from the primary nurse. One experience I had was a male nurse, notorious for the hatred of students. Keep in mind this particular hospital was a teaching hospital with many colleges represented in all fields of healthcare including radiology, nursing, nutrition, and physicians. I walked up to this nurse to receive the report on the patient, “I have Mr. X in the room …” he cut me off putting his phone to his ear and walked away. His phone didn’t ring or vibrate. I walked back to a small number of my classmates who witnessed the event; they stood in amazement that a professional would treat a student that way. Grateful that the patient was uncomplicated in diagnosis and personality and it was not my week to administer medications. I assessed the patient, tidied the room, assist them in ordering breakfast, and checked suction. The nurse never gave me a report, in fact, the only time I had any contact with him was when we were leaving the unit, and made sure the patient was comfortable than gave a quick hand-off to the primary nurse. Other than administering medication the patient was entirely in the hands of the technician and myself without any communication from the nurse.
Another nurse that typically did not work the days my clinical group were at this unit. I had a patient whose height was at least six feet tall or taller; he was blind, confused, and unsteady on his feet. He came back to the floor from a procedure. This patient had a history of jumping out of bed, ripping out IV, had a sitter, mittens, and an enclosure bed. I told the nurse that he had returned from the procedure, she merely replied, “get him back to bed”. I was having trouble getting him to sit up. The patient towered over me and outweighed me by quite a bit. The nurse never came to help. I struggled to try to balance and keep the patient safe until the tech came over to help me. The tech was not happy and commented that the nurse should have come over to help the patient. My clinical facilitator was not happy to hear about the comments or the event.
#4 Realize the gold in a good nurse
In my experience for every nurse that is not great with students, there are so many more nurses excellent with students. These are the nurses that explain what they are doing and the rationale. Other nurses that try to seek out students to witness bedside procedures even if it’s not their patient, such as the debridement of a diabetic ulcer on the heel, then packing and wrapping of the foot. Most specialists loved to teach while they work. One wound care nurse was systematically documenting an admitted patient with severe wounds; she described her methods, the measuring, description, and the importance of recording.
Clinical can be very frustrating to a student. Clinical is where the textbook comes to life. By the fourth and final semester of school. The light bulb would flash, as fundamentals, medical-surgical, pharmacology and psych began to-all-come together.