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Heather writes: other, then we go to patients at the hosp. Is that about right? I am a planner, and I would like to get an better idea of how theses things work. We always work with an instructor or nurse, even the 8 hour clinicals? How much do we practice on each other?" Students answer: Hey Heather, Yep, that is about right - lol! I think each nursing program does things a bit differently. Your best bet is to read over your clinical syllabus, chat with NSs ahead of you who have had the same instructor(s), and email your instructor(s) to get an idea of how he or she will run their clinical's, which units you will be in, etc. Here is how clinicals ran in my program... We were taught almost all nursing procedures expected of an entry-level RN during 1st semester minus IV insertion, CT (chest tubes) and ICU stuff like a-lines and drips. The philosophy of the nursing dept was "Our NSs will be able to assist and/or perform procedures as the need arises." To prepare us, we attended intensive classes (Are there any other kind of RN classes?!? LOL!) and labs x 6 weeks. As you can imagine, it was hellish, but exciting as well. The nursing dept did not allow us to practice injections/IVs on one another. (In the Army we did practice IVs and shots on one another.) A couple of instructors allowed their 1st semester NSs to insert IVs on pt's– Shhhhhh! – LOL! (Many of us practiced IVs on one another at the hospital in 2nd – 4th semesters. Some instructors allowed IV insertions on themselves if the opportunity to insert an IV didn't come up during clinicals in 3rd and 4th semester.) We practiced in the NRL on mannequins
– full bodies (complete with interchangeable male or female
parts and wigs - lol!) in a hospital bed, Any extra time was spent studying our buns off and practicing procedures in the NRL. We were tested individually on "Practicum Day" before clinicals. The NRL was secretly set up in scenario stations (we were not allowed in the NRL the day before the practicum). We entered the room in groups of 4 and drew slips of paper from a bed pan to see which station we would go to complete. The stations were something like Med Admin (tabs, caps, and injections), NGT Insertion & Maintenance, Enemas & Body Mechanics, Catheters & Maintenance, and Suction, O2 & Trach Care. We were all so darn nervous. Some of us did not pass the practicum the first time. They had to take remedial training and re-testing prior to attending clinicals. No biggie – everyone my class passed the practicum. I think some people were a little overcome by nerves. Prevention of nerve overload is practice, practice,and practice during your free time. Most of us went to the NRL in study groups. Go in prepared and you will do just fine. Our class was split into clinical groups of 10-11. Skill check-off books were signed off after completion of each skill during clinicals by the clinical instructor. Med admin was witnessed by the nursing instructor only during 1st semester which was difficult because there were 10-11 students and only 1 instructor. Needless to say, we did not pass med's every clinical day during 1st semester. Clinicals were 6:00am - 2:30pm, 2/week. (After the 2nd semester instructor witnessed each of us safely giving med's 2-3 times, she allowed us to give med's with our assigned RN. During 3rd and 4th semesters, we gave med's with just our assigned RN.) We called the instructor when we
were READY to do a procedure (more so in 1st semester). If you didn't
have all of the equipment and supplies required for a procedure,
the instructor gave you an earful – LOL! (The following semesters
we could perform procedures with our assigned RN or with another
staff RN. During 4th semester's preceptorship and team leading clinicals,
we were allowed to perform We were alone with pt's during 1st semester, but mainly when taking VS and other non-invasive stuff. My 1st head-to-toe physical assessment with a pt was completed with the instructor. After that, I did them with or without an RN. A lot depends on what I call your
"comfortable factor" - If it doesn't feel safe or if it
feels wrong, then always, always, always ;o) Tina Each program is different. In fundamentals we had lab for 6hours a week and then we did four 4 hours shifts at a nursing home. The things that we practice on each other are assessment ( listening to heart and lung sounds, bowel sounds, skin assessment etc.) The only thing there that made some uncomfortable was the the ladies had to wear a sports bra because you did need to take your shirt off. In Fundamentals we practiced basics on each other, bed bath, brushing teeth, restraints, transfers, ted hose. We had to sign a contract that we would not practice on each other, family members or our pets. IV's, injections, catheters, enemas ( pretty much anything invasive) we do on the sim-man, the rubber arms or the "pound of flesh". I just started my first clinical in the hospital last week. They threw us in the deep end. I assisted with 4 PICC line placements, gave my first 4 injections, hung IV fluids and TPN, did a dressing change, emptied jp drains, did a head to toe assessment and was in charge of all care for my patient ( shower, oral care, making the bed etc.) All meds are delivered by us. I am now checked off for med's. I have to double check with my nurse on insulin, heparin and narcotics, but can access all of that from the Pyxis (a widely used med dispensing system.) I am not allowed to push IV meds alone, administer blood products or do things that I have not checked off in lab. My fellow students have started IV's, removed staples, observed surgery, inserted foley catheters. We are all completing care plans, our drug prep sheets and documenting, vitals, focused assessment, I&O, and meds. I am in an accelerated program so ours is very different from others. We are in week 12 and I am halfway through my med/surg clinical. Next is OB, Community health, mental health, peds, med/surg 2 and our preceptorship. Ask questions, the nurse you are working with was once a clueless > student too. If you don't know what you are doing, make sure someone talks you through it and supervises to make sure you don't hurt your patient. Don't let the patient know that you are completely freaking out. It is scary going in, but after the first day I came home and told my husband that being a nurse is awesome. Then completely grossed him out with all the details of my day. Most of our clinicals are 2, 12 hours shifts a week. Some are 3, 8 hour shifts. One OB rotation is 1500- 2300. Stacy I haven't started school yet myself, but I have already looked over our lecture and skills/clinical calendars for this semseter and can tell you a little about what ours will be like. For the all but the last 3 weeks we will be having "clinical" in the skills lab 2 days a week where we will be learning basic skills on manikins, models, and each other. We will often times have skills demonstrated for us on Wed. and then have skills check-off on Thurs. Finally in the last 3 weeks we will have one week of orientation for clinicals, then 3 clinical days from 7am - 4:30pm. I have no idea what the schedule will be like for subsequent semesters, but at least I have an idea what is coming this semester. Maybe you could ask someone at your school if there is a skills/clinical calendar available. It has been a real stress reliever to know what's coming. Blessings, (: Amanda :) Each school/program is different,
but this is what it was like for us. 2nd semester was the same, but in some ways we were given a bit more leaway, as we were more esperienced, but again, any new skill had to onserved once and passed. YEAR 2 4th semester we had 2 weeks of
lab then 13 weeks in medical-surgical unit (I was on an internal
med. ward). We had 2 patients after the first 3 weeks and a few
of us progressed to 3. We had to get the meds checked at first hen
when our clinical teacher deemd us "safe" we were good
to go. We had to have insulin checked by her though and anytime
you need narcotics, as students are NOT ALLOWED to have the keyes
EVER. Again any new skill had to be done once with the teacher to
be able to get it checked off/passed. YEAR 3 6th semester we do 4 days a week in the hospital. 7:30-3:30 have fun and good luck! See also: "Week Three Med-Surg Journal" Submitted by Leigh Ann Tatnall Watch the video below to see students practicing in the nursing lab:
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