First clinical: things I wish I’d known
I need a study break so I decided to write a “things I wish I’d known BEFORE my first clinical day” list. It’s that time of the semester, so maybe the list will actually be helpful!
First, stuff to bring:
1. Ugly nursing shoes. The cute ones are NOT COMFORTABLE. Crocs are NOT COMFORTABLE (when you have to swivel with patients and so on). I got a pair of Nurse Mates Dove shoes, and my feet did not hurt after a 12-hour clinical. I didn’t even break them in first!
2. Alcohol hand rub in one of those tiny containers (if you’ll be at a nursing home). Nursing homes don’t have that stuff scattered everywhere and have almost no available sinks, for some reason.
3. Stethoscope. Blood pressures are rarely taken in long-term care and when they are they’re taken automatically, but some residents will let you listen to their hearts, and wowza! You can hear some cool stuff, and the residents like the attention.
4. Black clicky pens (you will lose pen caps) and a few folded sheets of blank paper (skinnier than note pads for scribbling stuff down).
5. One of those nylon scrub-pocket organizers. They have metal clips on the back and can be conveniently worn tucked over the top of scrub pants if your pockets are already bulging with gait belts, pens, folded papers, lip balm, Kleenex… (take the organizer off when you use the bathroom, which you will have time to do approximately twice in a 12-hour span).
6. PDA! Yes, nursing stations have all the reference materials you might need. But are you going to walk all the way there and ask people to move so you can get to them? With a PDA, I can sit down with my resident’s chart and get all the medication, procedure, and disease-process information I need AND get the nursing diagnosis and interventions, all without having to drag around a giant pile of books or do it at home.
Second, stuff to know:
1. The CNAs you will be paired with hate you. Hope for a passive-aggressive one (vs an obviously aggressive one).
2. When you start to wipe butts your tendency will be to breathe through your mouth. Do not do this if you have any hints of allergies or cold symptoms because your nose will start to run and…you will have to sniff. Deeply. Need I say more?
3. No matter what you do, something about it will be wrong.
4. I found it’s better not to ask patients if it’s OK for me to work with them. “I’m a student nurse, and I’ll be helping you to bed” worked better than “Is it OK if I work with you for awhile?” (Some said they wanted their regular CNA instead.)
5. The horrors of chart review cannot be overemphasized. I was unprepared for how difficult it was to find information in charts. I almost cried after about an hour of this and wished someone had warned me. So, readers, consider yourselves warned!
6. Most of the staff talk to the elderly in this weird patronizing falsetto type of voice and address them as “honey” and “sweetie.” I don’t think they like it. They also don’t seem to like the “Mrs. So and So” touted in school so perhaps just first names are best. I ended up having to try really hard to use a regular speaking tone with them because its easy to fall into addressing them as though they’re not only 3 years old but also slow for their age since everyone does this. Also, not ALL elderly are hard of hearing! They don’t like it when you automatically go up and start shouting into their ears.
Last words: I felt really ready for clinicals before I went. After about 10 minutes I felt hopelessly out of my league. Transferring patients was no problemo in school when I had all the space in the world and the “patient” wasn’t about to wet herself. When you’re in a hurry and crammed into a 4-foot-square bathroom with an agitated elder and a wheelchair it’s really different. Dressing a mannequin was also no problemo (oddly). Dressing agitated residents is not that way; they will fight you or start to cry. Practicing catching a falling student was way easy…she slid gracefully to the floor. Walking next to a frail elder who started to sway caused my bowel contents to liquefy (what if she falls, breaks a hip, and dies all because I couldn’t ease her to the floor correctly?). I mean, it’s not rocket science, but there are just a lot of new things at once!
I’m sure I left a bunch of stuff out. Readers: please add comments with more tips!
Eat a big meal before going to clinical. You may not have time to eat when your working.
You’re right about CNAs not liking you. They hate you because they know that one day you may be their boss.
MJ
Bring a ziploc bag with nuts in it. Not carbs, protein. This is an alternate suggestion to MJ’s excellent one to “eat a big breakfast.”
Don’t ask a patient/resident if it’s ‘okay to work with them.’ It’s like asking a four year old if they want vegetables or not.
Walk in like you own it. That’s my best suggestion. If you don’t know, you say, “I don’t know. I’ll go ask.” That doesn’t mean you can’t own it.
CNAs hate students. Be respectful and a little more deferential than you might, and ask them questions about their area of expertise…transferring, tips for bed changes, even taking vitals. They know more than you do. Most of them know more than some nurses about how to do a proper bed change, too.
Your scrubs should have pockets. I keep the same things in them, and on the same side so I don’t have to waste time digging. Red pen, black pen, calipers (I’m in ICU) on my right. On the left, a thick wad of alcohol wipes, gum, chapstick, scissors. I have a glow in the dark upside-down watch pin. My badge rings also hold a small black sharpie (you need this), small yellow highlighter, drawer key (just for my unit) and my BSN pin. My stethoscope never leaves my neck. Ziploc of cashews, coffeemug, calendar and nice-smelling handcream (which you can’t have as a student but will acquire immediately after you get your RN and have your first GI bleed or CDiff patient) are always at the desk.
If you’re not on a unit where each patient has their own clipboard, you need a clipboard. If you can’t do math in your head, you need a clipboard with a calculator. As a student, yes to the PDA (I had a pants pocket for it), or to the drug guide (which I have and keep in my locker).
Long list. But I wish someone had told me their little system early on.
/jo
Oh, NNR, you know I’m full of opinions. First off, my condolences for starting out in long term care. Ick. It’s so depressing. (People say the same thing about ER when it’s bad – different strokes I guess.)
On shoes. I couldn’t live without my Danskos. Expensive, yes. But well worth the $110 or whatever a pair is running these days. I definitely notice a difference in the way my back and feet feel after a 12 with no sitting. (And wow – don’t get used to getting two pee breaks in that 12 hours!!)
On stethoscopes: In addition to the very good clinical reasons you mention, it also makes you look and feel more official and credible.
Couldn’t live without my PDA. You’ll be glad you’ve got it.
Stuff I recommend having handy, in addition to Jo’s great suggestions: (Maybe not in a pocket, but at least in a bag at the desk)
- a little container of Vicks or some similar strong menthol goo. put a dab under your nose before those code browns and you’ll be glad.
- a bottle of brush-on super glue. With all that handwashing and alcohol gel, your fingers will take a beating. Spackle cracks and hangnails-gone-awry with super glue, the same thing as Dermabond but way cheaper, and you can still wash your hands without destroying your germ barrier like you would if it was a band-aid.
- trauma shears or bandage scissors
- a hemostat – very handy to clamp IV tubing, clasp blanket sides together if you’re burrito-ing a patient, etc. What I do is tie a tourniquet through one handle of the hemostat, slip a roll of tape over the business end, and then clamp the whole works on the side seam of my scrub top just above my waist. Three handy items within reach but out of the way.
-Always keep a dollar or two tucked inside your name badge holder – you never know when that vending machine Snickers & Pepsi will be the only meal you have time for.
-You’ll find that as you develop your own clinical style more and more, you’ll streamline the amount of ‘stuff’ you actually carry on your person. I started out as a new grad with one of those honking organizer belts, and now I’m down to my stethoscope around my neck, trauma shears tucked into the back of my waistband, a pen and chapstick in my shirt pocket, my PDA in the pants pocket, and the aforementioned hemostat setup on my side seam.
And a couple of tricks you’ll be happy you knew:
-Block the feet. When you’re transferring anybody, and I mean anybody, into or out of bed or a chair or wherever – for pete’s sake put your foot in front of their feet so they don’t slide. If they start to slide, you’re going with ‘em – but if you’ve got a perpendicular foot in front of theirs and your knee in front of theirs, you’ve got much better control of the situation.
-If that frail elder starts to sway and makes you nervous, holler for help. You’ll be amazed how fast we’ll move to avoid extra paperwork.
-And I agree with Jo on the ‘pimp your CNAs for their wisdom’ front. They’re used to nursing students acting snotty and superior – prove that stereotype wrong and you’re bound to learn a lot from them.
-Lastly, don’t hesitate to ask the nurses you work with and those you know for their advice too. It makes us feel good to be able to pass along a little bit of what we’ve been handed or figured out for ourselves! Not all of us are out to eat our young…
Continuing good luck in clinicals!
Very good information, and I wish I had seen your blog before I started my clinicals. I have a similar post about being in the OR for when you find yourself getting to that rotation. (http://markontheworld.wordpress.com/2007/02/20/how-to-get-by-in-the-operating-room/)
Enjoyable read, and I’ll be visiting again.
Ok, this is an awesome post. I start at LTC in about a month…thanks for all the insight!
I am an instructor and I plan to read your article about clinicals to my students before they start. I think they will appreciate your helpful advice and sense of humor about a very nerve-wrecking day!
I start nursing school in December (at age 40! What the hell was I thinking…). Thanks for all the fantastic advice! And even if I don’t remember everything you said here, at least I did get a flavor of what it’s like, based on the types of advice…
I second the bag of nuts and chapstick. Find a way to drink water and pee…find the time. Gel insoles and compression stockings rock my world.
For all of you folks suggesting eating nuts during clinical/work, don’t you worry about using your hands to eat food after all that germy exposure? I know they get washed and sanitized like crazy between patients, but even still, it seems kinda icky. Is that something you just eventually get over?
I worry about it. I purposely take food that can be eaten without having to be touched, and even then I practically BOIL my hands before I eat anything. I may get over it, because most people seem to take a far more casual attitude than I do toward germs, but maybe not. My phobia runs deep.
My first placement was like that. I could do nothing right at the beginning. Then I asked one woman what she wanted me to do for her and she walked me through it. It was an odd day.
It’s better now, although I keep wondering what has happened since I left.
I hate passive aggressive people. They stab you in the back. I’d rather confront people up front. Confrontation, is the key to a happy marriage, btw.
Those couples who fought and got it all out in the open, are happier and married longer than those who don’t.
I know you aren’t married to the CNA, but I think it’s always better to get it out in the open. Usually, that’ll difuse the situation and things can be on a better footing.
I came across this through another post when I was googling nerve damage caused by blood work. (Numbness that faded to dull aches.. I wanted to see if I were the only one who had this problem before rolling into a Neurologist’s office).
But I must say, this has been extremely informative, and I’m glad I stumbled into it. I’m an aspiring nursing student, aiming to get into Stevenson University (Maryland) for their three-year accelerated BSN program.
I think all nursing students should keep daily blogs about their encounters and experiences. I strongly believe it would be substantially beneficial to future nursing students.
)
Good job!
I just found this post via a whole bunch of other people…
I realize it’s old but I just started nursing school a few weeks ago and was put into long term care for my first clinical. I really wish I would’ve found this earlier. EVERYTHING you said was right on the money.
I didn’t hate *all* nursing students when I was a CNA. I only hated the ones who stood idly around swapping school gossip with each other as I rushed around with sweat dripping down my face trying to single-handedly manage 9 total-care patients. And I confess to having all-out murderous thoughts toward the one who informed me in superior and critical tones in the midst of my toileting/showering/dressing/getting them all to breakfast in the 45 minutes allotted daily morning nightmare, “Do you realize you’ve left that patient in her chair for TWENTY MINUTES without repositioning her?!”
CNAs generally deserve a lot more appreciation than they get. Remind yourself that the real world doesn’t have much “ivory tower nursing” in it. Check out their list of responsibilities and do a little math sometime; you’ll be amazed. Appreciate what they do (not to mention how very little they get paid for doing it!), pitch in and help, and you’ll learn things they don’t teach in nursing school that will serve you well in your nursing career.
I didn’t hate *all* nursing students when I was a CNA. I only hated the ones who stood idly around swapping school gossip with each other as I rushed around with sweat dripping down my face trying to single-handedly manage 9 total-care patients. And I confess to having all-out murderous thoughts toward the one who informed me in superior and critical tones in the midst of my toileting/showering/dressing/getting them all to breakfast in the 45 minutes allotted daily morning nightmare, “Do you realize you’ve left that patient in her chair for TWENTY MINUTES without repositioning her?!”
CNAs generally deserve a lot more appreciation than they get. Remind yourself that the real world doesn’t have much “ivory tower nursing” in it. Check out their list of responsibilities and do a little math sometime; you’ll be amazed. Appreciate what they do (not to mention how very little they get paid for doing it!), pitch in and help, and you’ll learn things they don’t teach in nursing school that will serve you well in your nursing career.
Good pair of trauma shears! -Like Adroit FlightShears.
Great list of stuff. You have to be prepared. You just can’t walk off to get the thing you forgot. The only thing I would add is to have everything with your name on it. Other people can forget their things!
Index cards are a great tool – easy pocket-sized ones are cheap, tough, you can clip them together into a sort notebook if you want – makes it rigid enough to write on in your hand, and keeps blanks handy. I still use them, but not that I’m rich & famous (snort!) I splurged and got a black leather index card holder, which I use in everyday life.
Mean people? Just remember, lots (likely most) of their attitude is nothing about you, you’re just a great target – available at point-blank range, vulnerable, nice, and safe to attack – take any meanness as a compliment in that sense.
Nurse Power!, and Keep Plugging…
Bring your smile and as much confidence as you can muster or fake! If you can seem loose and eager and happy, it will rub off on other people & smooth things for you more than you might think, AND it will rub off on you. Much research has clearly shown – your mind doesn’t just influence your affect and behavior, it goes the other way too – smiles and acting happy improve your mood. Hence the old saying, “Fake it until you make it” – sound neuroscience and cognitive psychology.
Make a mantra – a brief statement you repeat to yourself – out load if possible – on waking and going to sleep at minimum, and whenever you’re feeling shaky. No something-for-nothing stuff, but a promise to yourself: what you’ll invest, and what your reward will be. You can motivate yourself, and actually train your subconscious mind to believe in it, with repetition – but say it as convincingly as possible, with confidence & enthusiasm. Write it down, post it on your bathroom mirror , in your car, wherever you can’t help seeing it. Keep it seem, e.g.:
“I’m going to be great – I prepare, and I care”
“I succeed, because I do the work”
“I study hard – gonna spank this test!”
Etc.
Corny? Of course
Effective? Absolutely – the man who taught me this spent years interviewing many of the most rich & successful people of his day, and most of them had a habit something just like this. Who doesn’t do this things – most of the rest of us – the results speak for themselves.
I’d say good luck, but I doubt you need it – you’re making plenty of your own.
A Mr. Gitomer said something like this: Desire isn’t enough, everybody has that. To succeed, you must have enough desire to convince yourself to prepare adequately. Then you’re way above average, and success will come.