Everything You Need To Know Before You Start Nursing Clinicals
We asked Maureen “Nurse Mo” Osuna, BSN, RN, to share her thoughts on what nursing students should expect during clinicals and how best to prepare for them.
Image via Unsplash.com/Yleidis Maldonado
The excitement is building. Nursing clinicals are approaching, and you’ll soon be doing what most nursing students say is their favorite part of nursing school. As you gear up, the anxiety of being in a real-world practice setting can also start building. Clinicals can be an intensive, nerve-wracking, fast-learning environment where you have nurses to please and patients to care for. To help you learn about the ins and outs of nursing school clinicals, we talked to an expert:
- Maureen “Nurse Mo” Osuna, BSN, RN, and owner of Straight A Nursing Student, an online resource for nursing students, who works in the medical intensive care unit of a large metropolitan hospital in California
The following prep list is full of tips and information Nurse Mo shared with us to help set you up for success.
Nursing School Clinicals: What To Expect
You’ll likely be part of a team of five to seven students working under the guidance of the same clinical professor. Things will typically start off slowly — you may just observe other nurses or participate a bit in patient care (like taking blood pressure or making a bed while the patient is in it). Gradually, you’ll gain experience interacting with patients, and you’ll begin to master your growing set of skills.
How Do Clinicals Work?
You’ll spend the day shadowing nurses and assisting as often as possible. Most programs will assign you one patient, then add a second once you get more comfortable. For each patient, you may be asked to study their cases, review all the medications they’re taking (i.e., the pharmacokinetics of these drugs, dosages, and side effects), complete a summary of each abnormal lab value and what each means for the patient, and complete a specific nursing care plan for the patient with six to 10 diagnoses — and five interventions for each diagnosis. Be prepared to answer questions on the spot about your patient’s medical history and pharmacology.
Your clinical professor will check in on you throughout the day while she makes her rounds. If you’re doing a skill for the first time, she’ll want to be present to guide you. When she isn’t there, you can ask a staff nurse in your department for help if you need it. At the end of the day, your group will meet this professor for post-conference, when you’ll discuss your cases, your challenges, and your problem-solving skills.
What Types of Rotations Will I Get?
A good nursing program offers a variety of clinical experiences so you can get a sense of the breadth of nursing specialties. Examples of some of the specialty areas nursing students typically rotate within include:
- Acute Care
- Adult Health (can be at a nursing home)
- Emergency Room
- Intensive Care
- Long-Term Care
- Maternity Nursing/Newborn Nursery
- Mental Health
- Pediatrics & Pediatric Intensive Care Unit (PICU)
- Psychiatric Inpatient Facility
- Public and Community Health
If you have an interest in a certain area, you may be able to request a rotation in that specialty, depending on your school’s program. That said, there are no guarantees.
What Will I Learn?
You’ll learn a ton! All the studying you’ve been doing will be put to use in real-life practice, and you’ll come away with an even better understanding of the concepts you’ve learned. At first, you may only be able to execute very basic skills, but you’ll eventually learn how to assess patients, give them medication, change dressings, fill out medical charts, care for families, and juggle several patients on the same shift. The list of tasks is endless because you never know what each rotation will hold.
Expect to become familiar with the rhythm and pace that comes from working on different units. You should have the chance to experience several different settings during clinicals, which can help you figure out where your interests lie. You’ll also grow more confident in your own skills the more you practice them. You may begin to volunteer to take on more tasks, or you may become proficient enough that you no longer need to be supervised for certain activities.
How Much Time Do Clinicals Take?
The amount of time spent in clinicals varies by the school, but it typically hovers between 120 and 140 hours per semester. For most of the semester, you’ll be at the hospital once or twice a week for four to six hours at a time (sometimes more, sometimes less). Many students say that between their lectures and clinicals, they put in way more than 40 hours per week.
How To Get Ready for Your Clinicals
Getting ready for nursing clinicals requires a bit of mental preparation on your part, as well as some practical planning.
Set Goals for Nursing Clinical Rotations
Before anything else, take some time to come up with a few goals you want to hit by the time you finish clinicals. This may seem unnecessary, but having clear objectives for your experience can help you stay focused and motivated, no matter what comes your way. Plus, the simple act of setting goals gives you the chance to take stock of the strengths you already have, as well as the skills you can focus on honing during clinicals.
That said, be thoughtful about the goals you come up with. If you set your sights on something that’s just not realistic or attainable, you’ll set yourself up for major disappointment by the time you’re done. To avoid this, try making goals that follow the S.M.A.R.T. framework. S.M.A.R.T. goals are:
- Specific: Clear and precise, rather than vague
- Measurable: Easily measured so you have a way of defining what “success” looks like
- Achievable: Challenging enough to be compelling, but isn’t impossible
- Realistic: Relevant to your current priorities and interests
- Time-Bound: Has a set timeline within which to accomplish it
Most schools also provide lists of skills you should master by certain milestones (i.e., by the end of the first semester). To gain a better understanding of your coursework, it’s also helpful if you can match up what you’re learning during your lectures with what you’re doing in clinicals. For example, if you’re learning about pneumonia, seek out patients with pneumonia.
Prepare for Your First Day
There are a few key things to prepare for and remember before you start your first clinical rotation:
- Be ready to observe and learn. Give yourself some time to get used to the fast-paced hospital environment. It can be overwhelming at first if you’ve never been that close to sick or injured patients.
- Study your department/patient. If you know what unit you’ll be on, you can study the common disease entities of patients in this ward. You’ll often be assigned a patient the day before you start, so you can review their medical history ahead of time. Be prepared to answer questions about their medications, side effects, and possible diagnoses.
- Be as helpful as possible. Sure, you’re new and likely have a limited skill set. So if you’ve only learned how to do three things so far, make sure you do those three things for as many patients as possible. If another nurse needs an extra hand lifting a patient or answering a call light, be there for her. Be proactive in asking how you can help.
- Stay positive. Positivity and enthusiasm around patients will also help you feel part of their care team. Some nursing students say they get negative vibes from staff nurses, saying they don’t feel welcomed. If this happens to you, remember that part of this onsite education is learning how to work with different personalities. You’re not there to make friends, and you might have to prove your abilities to earn respect.
- Ask questions. Be sure to ask questions and encourage constructive feedback among staff. After performing a new skill, ask the supervising nurse if there was anything you could have done better or differently.
What To Bring To Nursing Clinicals
You’ll want to stuff your pockets and pack your bag with a few essentials to get you through your day. Consider bringing the following:
- A pair of medical scissors
- Some pens/penlight
- Your care plan. Once you’ve been assigned patients, you will create a care plan for each person and share it with your professor before you begin.
- Sheets of paper or a small “field notes” notebook that can fit into your pocket, recommended to jot down vitals and assessment findings
- “Cheat sheet” to remind yourself of anything important (especially as you’re starting out!). One nurse said she used this to write her daily itinerary and the list of what she needed to assess on each patient. Once she started passing medications to patients, she kept her patients’ med schedule on this cheat sheet, too.
- Phone loaded with these nursing apps
- Pocket drug guide
- Folder/clipboard for your personal paperwork
- A healthy, energizing snack, just in case you get “hangry” after a while
As for footwear, make sure your shoes are comfortable. (Think: sneakers, clogs, Crocs, etc. The NerdyNurse.com blog has a solid list of nursing footwear that you should check out.) Since you’ll be on your feet for hours, you may also want to consider investing in some compression socks, too.
5 Common Questions Students Have About Clinicals
1) How long are nursing clinicals?
Since clinicals are required for your nursing license, the amount of time in clinicals will depend on the state where you attend school. For example, in Massachusetts, nurses need at least 540 credit hours of clinical experience. This breaks down to 40 hours a week for 13.5 weeks.
2) Do you get paid for nursing clinicals?
No, you won’t earn any money during clinicals. In fact, you’ll pay for the privilege of participating because it’s an essential part of nursing school. That’s why it’s important to advocate for yourself and jump at any opportunities to practice skills when they arise.
3) Do nursing students get to interact with doctors, residents, and interns?
As a nursing student, you’ll mainly interact with staff nurses, not physicians. As you already know, nursing students aren’t licensed, and they can’t take orders from doctors. They also don’t yet have the knowledge to fully and effectively communicate a patient’s problem to a physician. If you notice something and feel the need to escalate it, speak to the nurse you’re working with and then observe any actions they may choose to take.
4) Do you get graded?
Yes, most nursing clinicals programs are graded with a “Pass/Fail” or “Satisfactory/Needs Improvement/Unsatisfactory” rating.
5) Can you do clinicals at night?
Many nursing schools offer night clinicals. Some schools offer a mix of day and night hours, which can help you compare what it’s like to work at the hospital when most procedures take place and relatives visit, versus quieter hours when you may have more time to interact with patients but fewer opportunities to practice skills.
4 Tips for Surviving Nursing Clinicals
1) Practice your skills often.
Some nursing schools offer open hours in their skills labs; you can go there outside of regular hours and practice techniques on your own. It’s wise to go early and often so you become comfortable with the skills you’re learning. The more competent you are, the more likely you’ll be trying them out on patients during clinicals.
2) Invest in cheat sheets.
You won’t want to lug a cumbersome textbook around on your clinical rotations, but you might consider lightweight nursing cheat sheets. Pocket guides can be helpful to give you a quick snapshot of different conditions. Although there are apps with this information, some programs won’t allow you to have your phone with you for clinicals.
3) Expect to participate in simulations.
It’s challenging for some nursing schools to get enough hours to place all of their nursing students in clinicals. For this reason, schools may offer their nursing students computer simulations to learn certain skills. A percentage of hours spent doing simulations may count toward clinical hours, depending on your program.
4) Remember, you’ve got this.
You’re smart, you’ve done your research, and you’ll only get smarter with this experience. You’re a hard worker and will study and learn what you don’t yet know. And if someone is negative or dismissive toward you, that’s their problem — don’t let them get in the way of your career goals.
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