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Nursing School Clinicals- Guide to Success
Clinicals in nursing school can be exciting but nerve-wracking. The time in clinicals is the hands-on learning time for nursing students to practice skills and learn the flow of working as a nurse.
It can be a struggle to succeed in nursing school clinicals, but I’m going to provide some tips from my personal experience to help boost your chances of getting the most out of clinical rotations while also impressing your instructor.
In this post I will cover the most important aspects to focus on in nursing clinicals. Then I will offer some general tips to increase your learning potential as well as help you stand out!
Here is what I will be exploring:
- Medication knowledge
- Effective communication
- Assessment skills
- Review the EHR
- Time management
- Volunteer for everything
- Be a team player
But before we dive into the meat and potatoes, I wanted to briefly talk about what nursing clinical rotations are for anybody who is not already familiar. (If you want to skip to the starchy goodness, just scroll past the “general nursing clinical info” paragraph.)
General Nursing Clinical Info
In nursing school, clinical rotations allow nursing students to obtain hands-on experience in the hospital setting. Students will get to experience several different specialties in nursing, but most of the clinical hours will be spent in the med-surg rotation.
Some of the specialties that are included in clinical rotations:
- OB
- Pediatric
- Psych
- Surgery
- ICU, ER
- LTAC
Nursing students will spend a designated amount of time in each rotation. Every school differs in how they break up these clinical hours, so it is best to refer to the school you are interested in attending to see how they schedule their clinical rotations.
The bulk of clinical hours will be divided among med-surg, OB, and pediatrics while specialties such as ICU and ER are considered “special” experiences that students will experience less frequently.
In nursing clinicals, students are learning hands-on nursing skills.
This runs the gamut and can vary according to which unit you are located. Nursing students will begin by caring for one patient and will provide all the nursing care for that patient.
- Medication administration
- Procedures- foley, IV, etc.
- Toileting
- Bathing, showering
- Vital signs
- Physical assessment
- Fulfilling doctor’s orders
Throughout the nursing school journey students will increase the number of patients they care for. Typically, students will assume care of 3-4 patients by the end of their program.
During the specialty rotations- ICU, ER, pediatrics, OB- the role the student plays will differ. Typically, students can help with tasks aside from administering medications.
To do well in nursing clinicals, you must prove to your instructor that you can provide safe and competent care for patients. One large component of this is the administration of medications, which we will talk about shortly.
Instructors will also want to see that you can assess patients properly and monitor for the development of issues that could potentially arise based on their admitting diagnosis and comorbidites.
It is also often a requirement that students assist their patients with showering or a bed bath; fresh linens should also be provided for the patients.
Now that we covered some of the basics, let us move onto the tips!
Medication knowledge
One of the big parts of working as a nurse is the administration of medication. For this reason, there is a huge focus on “med pass” as it is often called in nursing school.
During med pass, you will be required to administer medications to your select patients. You will administer medications via the various routes- PO, IVP, IVPB, SQ, etc.
Instructors are often strict and particular during these med passes. That is why it is important to be up to par with your medication knowledge.
Medication knowledge includes:
- Factors to consider during various routes of administration
- Vital signs or labs that should be assessed prior to administration
- Mechanism of action for each medication
- Materials needed for administration (syringes, tubing, med crusher, etc.)
- Education to provide for the patient/patient’s family
- Vital signs or signs/symptoms that should be monitored during/after administration
Basically, you want to know as much as you can about each medication you will be administering. It seems overwhelming but there are many resources to help you with this task.
You have your drug handbook and IV infusion guide that will do most of the heavy lifting for you. Refer to these books whenever you are initially gathering information about medications. If you still have unanswered questions, you can always call the facility’s pharmacy or access medication information in the intranet.
The main takeaway is to be on top of your game when administering meds.
For instance, let’s say that one of your patients has the following medications for their 0900 med pass:
- Furosemide IVP
- Vancomycin IV
- Lovenox SQ
- Labetalol PO
First off, you will want to know the mechanism of action for each of these medications. How does the medication work in the body? Your instructor will want you to be able to verbalize this to him/her.
Second, what lab values or vital signs do we need to check for this group of meds?
We need to check the potassium level since we will be administering furosemide.
We should check the most recent vanc trough since we will be administering Vancomycin.
We need to check the platelet count since we will be administering Lovenox.
And we should check the blood pressure and heart rate since we will be administering labetalol.
Be sure to look up all this information before you tell your instructor that you are ready to administer medications.
Next up, we should gather the supplies that we will need for each medication. For IVP furosemide we will need to get the syringe and needle to draw up the medication, saline to dilute the medication, saline flushes to flush the IV, and alcohol swabs to clean the IV port.
For Vancomycin IV we will need to ensure the patient already has IV tubing in the room or grab fresh tubing if there is none present or needs to be changed.
Lovenox SQ will require the use of an alcohol swab to clean the site of the injection. Labetalol PO will require a medication cup and a glass of water if the patient is able to swallow their pills whole.
I would strongly recommend you have all the materials ready before signaling to your instructor that you are ready to pass medications. Getting all the materials organized will make the med pass go much smoother and save you time and stress.
Once you are done administering the meds to your patient, your instructor may quiz you on what to monitor for after administration so be sure to have that information at the front of your brain.
I know this all sounds like a lot, but like I mentioned, medication administration is a huge part of nursing. Your instructors want to ensure you can pass meds safely and effectively.
If there was a skill that I wanted to shine the brightest in as a student, it would be medication administration.
Effective communication
Communication in healthcare is a skill that is perfected over time.
There is a preferred way for information to be communicated. For instance, during shift report or a call to the doctor you will need to communicate efficiently and directly.
This takes practice but there are some templates you can use to help.
If you need to report something to your instructor or to the nursing staff, then you can use the popular SBAR method.
SBAR stands for situation, background, assessment, and recommendation. You can use this format as a framework to help ensure you are communicating in an effective manner.
This will allow you to begin practicing what it will be like to call doctors in the future. Calling a physician can be a nerve-wracking experience for new graduate nurses. If you start practicing the commonly used SBAR format during your clinical rotations, then you will likely be much more confident once you are a working nurse and need to call the doctor.
If your instructor requires you to give them report about your patient at the end of your clinicals, then you should organize the information in a cohesive manner.
A report sheet or “brain can be helpful for this.
I have mentioned before how I utilized some of the report sheets over on Nurse Nacole’s website. This is the one that I used whenever I was in nursing school. I found that it really helped me keep my information organized.
Your instructors and the nursing staff will appreciate and be impressed with your direct and effective communication skills and it will set you up for success in the future.
Assessment skills
In nursing school, especially during the beginning, you are not expected to be perfect at completing head-to-toe assessments. In fact, during your first semester or two, your instructors will help you classify adventitious breath sounds, stages of wounds, neurological status, etc.
The time spent in clinical rotations is your time to learn, so use that time to learn as much as you can. One of the best ways to do that is to practice your assessment skills.
Complete a head-to-toe assessment on all the patients you care for during nursing school. Assess and care for the patients as if you were their primary nurse. Leave no stone unturned when assessing your patients.
If during an assessment you do not know how to classify a finding, then you can consult your nursing instructor or the primary nurse. They may be able to give you some helpful tips and tricks on classifying certain findings in the future.
In addition to practicing assessment skills, you should also practice how to document the completed assessment. Don’t rush through your documentation either. Especially if you are planning to work at the facility in which you have your clinical rotations.
Review the Electronic Health Record (EHR)
The electronic health record is a goldmine of information! Do not skip this important step of gathering information about your patients.
The electronic health record will have the patient’s history and physical, lab work, medication profile, demographic info, eMAR, and nursing and physician assessments from the hospital stay.
Information you will want to pay close attention to:
- Past medical history
- Past surgical history
- Medication profile
- Lab values
- Diagnostic procedures
- Change in patient status (as indicated in nursing and physician assessments)
I strongly recommend digging into the HER for all your patients to the furthest extent possible. It not only paints a bigger picture for each patient, but it is a huge learning experience for nursing students. You can learn a lot just by reading the EHR.
Nursing instructors will often grill you on your patients and you’ll be up to the test if you take the time to read through the important information for each patient.
Time management
Oh…time management.
The nursing skill that is one of the most difficult to perfect. In fact, I don’t think it’s possible to perfect it, but over time nurses learn ways to better manage their time.
Nursing school is the time to begin working on your time management skills. It is the time to learn what workflow works best for you.
Every nurse is different, and every day is different, so it is a game of trial and error.
Ask the various nurses what their approach is and integrate what feels best for you. Like I have said many times before, nursing clinicals are the time to learn. Learn what works for you and what does not work for you.
As you progress in nursing school, you will learn about prioritization and delegation, so be sure to use those principles when at clinicals. They can help save you time and will improve the patient experience. You may not be able to delegate any tasks to anybody, but you will be able to prioritize the tasks that you must complete during your clinical time.
If you are administering medications, prioritize time critical medications such as insulin, antibiotics, and anticoagulants. These medications should be administered as closely to the time that they are scheduled. If you have to choose between administering insulin in one patient or pantoprazole to another patient, then you should give the insulin first.
Volunteer for everything!
The best way to gain skills experience is to volunteer for all the skills! If you overhear your primary nurse saying that their patient needs a foley catheter, ask the nurse and your instructor if it is ok for you to do it.
If an IV needs to be inserted, volunteer to insert it. If a patient needs an NG Tube inserted, volunteer to do it.
You get the picture.
Volunteer for everything! Let the nursing staff know that you are willing to help out with whatever procedures you are able.
It can be nerve-wracking to try a skill on a real patient when you first start out, but you will never perfect your skills if you don’t practice.
Volunteering for everything will allow you to gain experience but it will also signal to the nursing staff and to your instructor that you are a go-getter and that you take initiative. This is a great message to send if you are hoping to get a job on the unit in which you have clinicals.
Be a team player
As a student, some days in clinical you will stay busy with your patient assignment. You may run around like a chicken with your head cut off just trying to care for your couple of patients. However, some days will be more relaxed, and you will have “free” time.
The best way to utilize this “free” time is to help your fellow classmates with their outstanding tasks.
It is great to help your clinical group to build camaraderie, but you also might learn something new when helping others.
This also signals to your instructor and the nursing staff that you are willing and able to work with others.
Plus, you never know when you may need help from a classmate in the future.
It’s also a great idea to help out your primary nurse or other nurses on the unit that need an extra set of hands. Nurses are often very glad to have nursing students on their floor and are willing to accept help from those who offer it.
That’s gonna wrap things up for this post.
I hope you learned some helpful tips on how to make the most of nursing school clinicals.
You will make it through and you will be successful!
If you want more nursing school tips, be sure to also check out my guides on how to study in nursing school and how to pass nursing school exams.
As always, if you have any questions or just want to chat, feel free to contact me.
Happy Nursing!