Nursing Clinicals

It recently came to my attention that my family has absolutely no idea what I do for my nursing clinicals. Most people don't actually, and it is a common question I get asked. What can I expect? Heck, I didn't even know what to expect until the semester I started clinicals, and I wish someone would have told me, or I would have asked. Although I can only speak for my school, this post will detail what I have done for a few types of my clinical rotations throughout my schooling.

So first, we have inpatient clinicals where you are on the same unit for weeks at a time (often 5 - 8 week blocks), and other clinical sites you attend only a handful of times before moving to a new area. Some clinical rotations require prep work the night before, aka: "clinical prep," specific to a certain patient, as well as post work; while others require an assignment be done prior to attending your clinical site shift that is general to the unit/area you will be in for the day. I will walk through both types of clinicals and what they both entail so you have a better look into the life a nursing student, or so that you have a better idea of what to expect if you are applying to the nursing program at my school.

Classes that we have clinical for include: 160 lab hours total, and 43 - 86 clinical hours per course in healthcare settings, depending on the course.

Classes with Lab Hours:

- Fundamentals of Nursing

- Health Assessment

- Medical-Surgical I

Classes with On-Site Clinical Hours:

- Medical-Surgical Nursing I

- Mental Health Nursing

- Medical Surgical II

- OB/L&D+PP Nursing

- Pediatrics

- Community Health

- Medical-Surgical Nursing III

- Long-Term Care Nursing

We complete a 120 hour practicum experience in a specific unit as well, during our last semester of nursing school.

General Clinical: One Time Visit

These clinicals for my school included but are not limited to: OR, NICU, ER, PACU, LTC, certain mental and community health agencies such as rehab centers, occupational health centers, and screening facilities. For these clinicals the prep was to complete a previously posted assignment and/or post work on your day(s) that you spent there, what you learned, making care plans, nursing diagnoses, and reflection on specific questions that are related to the unit you are doing your rotation at. The work for these clinicals honestly depended on the professor, with some requiring extensive work prior to/following the clinicals, and some not requiring as much prep/post work, especially since our other clincals required so much of us. These clinicals were fun, as you got to see different areas and things never got stagnant, but you never really got to establish a relationship with anyone since you were usually not returning for a second rotation.

Unit-Specific Clinicals: Recurrent Visits

Unit-specific clinicals we have include but are not limited to: Medical-Surgical Nursing, Long-Term Care, OB/L&D + PP, ICU, Pediatrics, and Mental Health Nursing. For these rotations we are on a specific unit for anywhere from 5 to 8 weeks usually twice per week. During the actual clinical you have a clinical instructor (a nurse who is hired through your school to give you assignments, perform skills with you, and be your support leading your clinical day). This same person goes to the unit the day before, looks at the patients that are currently on the unit and pairs student-appropriate patients, with each clinical student (me and my classmates). Then at around 3 pm - 5 pm depending on your clinical assistant, you go up to the unit to see what assignment you got for the next day. You will be assigned by the diagnosis you are supposed to write you prep up on, and their age and sex, then you go introduce yourself to the patient, ask if it is okay if you are part of their care the next day, and then look through their chart to get information for your prep on them. You then leave the hospital and go somewhere comfortable to do your prep. I usually came home, grabbed a snack and changed into sweats before driving to school to complete my prep work.

Prep work entails: Pathophysiology of the general diagnosis you were assigned, highlighting (with a highlighter after it is printed) key information relevant to your patient, medication profiles for each medication your patient is on that is scheduled, any prns that have been given in the last 24 hours, and any IV medications/drips. You then add to these med profiles specific nursing information specific to why your patient is getting the medication, considerations, adverse effects, therapeutic effects, and anything else that is relevant. Then depending on the class you will need to write up 2 care plans on your patient, as well as complete a concept map on your patient. You then need to write up labs your patient has gotten / will receive relevant to their diagnosis and history, and highlight key information that is pertinent to your patient. Labs and concept mapping is excluded from senior level prep work, as it is expected to be integrated and applied into the other areas of your prep. Honestly, this takes a lot of time. I usually do it in the order I just listed, and often it took for 4+ hours when I was starting, and about 2 when doing my last preps, a year later. But my goodness did it get easier the more I did it! Then you print it all, highlight what you need to, staple it all neatly, and put it in a folder labeled with everything to be brought with you to the hospital the next day to be turned in.

After you prep, you go to bed for clinical the next day. I have always had morning clinicals, so I will speak to that end. I go to bed and get up often with very little sleep, at 4:30 am in order to get breakfast and a cup of coffee consumed before heading out. You have to be at the hospital by 6:15 am, where your clinical instructor will meet you, you turn in your prep work, and you find out which nurse you are paired with around 6:30 - 6:45. You then look up information that has come in on your patient such as new orders, changes in care, etc. since you looked at their chart for prep, and then meet for team huddle at 7 am in the nurses station. After huddle you go with your nurse to get report on all of their patients for that shift, and to see your patient. Then throughout the day you follow your nurse around, doing skills you are signed off on, either with your buddy nurse or with your clinical instructor. Excluding specific skills, every clinical, no matter the unit, has you doing patient assessments, charting, and everything in-between learning hands-on throughout the shift. Our clinical days are scheduled from 6:30am-3:30pm usually, with a half hour lunch break, the rest of the time, you are with your nurse.

Honestly this is one of the biggest things I will take with me into my nursing career is how the nurse makes or breaks the student's day. They are simply trying to learn, and they are out of their comfort zones. I have had fantastic nurses that make me remember why I went into nursing in the first place, that helped me learn and grow, giving me confidence and helping me feel comfortable. I have also had nurses that obviously don't want a student, are rude, and unkind, as well as unwilling to teach. If you are a nurse, I urge you to remember what it was like when you were a student, and think about what kind of nurse you would have liked to be stuck with for an entire day. Buddy nurses can make all the difference, please make it a positive one. :)

At the end of the day (3:00pm) you meet up for post clinical for the last half hour to debrief about your day, and connect with your clinical group again. Some clinicals your nurse evaluates you, you evaluate them, etc. and then you go home! Congrats, you made it through another clinical day! Some clinicals you are then expected to take your prep work and make any corrections / do a post work assignment, other clinicals you do not have to do any corrections or post work; it just depends on which rotation you are in.

Then you go home, shower, and try to get some rest, because often you are doing it all over again in 48 hours. Plus you will have 4 lectures to do homework for and attend. It is a grind, but I have made it here, along with my classmates, and honestly, I am so proud of all of us for accomplishing this for the last 2 years, plus the 2 years prior of generals and prerequisites.

With less than a month until graduation, I am so proud of how far we have come and how much we have accomplished. Nursing class of 2020, we are almost there, we have come so far, and I know we are going to all do amazing things!

And if you aren't in the class of 2020, just know we have made it here, and you will too. Sometimes the biggest comfort is knowing you will not have to be the first to take on nursing school, and you will not be the last. There is power in togetherness, and in walking alongside and behind incredible and capable people.

We all have made it here, and I know we all will make it far further.

you are blessed. you are gifted. you are loved and appreciated, just as you are.

mindfully, molli