Yesterday (Friday) was my very first clinical!! To recount the experience, however, I have to start from Thursday afternoon when my entire clinical group met to complete our pre-clinical.
Pre-clinical basically involves going to the hospital to “pick” out a patient (the charge nurse assigns one to you) and accessing their chart to get some required information on them. We have to be able to complete part of the patient’s care plan before going to clinicals the next day so knowing their information ahead of time is essential. After our clinical instructor led us through some directions she released us into the hospital to go to our respective floors and we were then…on our own. Gulp!
One of my classmates was in charge of getting 5 patients from the charge nurse, and once we each had our room numbers we were free to get on the computer and access their charts.
It took me forever to get on the computer!! The first computer I picked out just wouldn’t work with my username and password, and so after about 10 minutes of trying every different password I had been given for different systems (the computer, the workstation on wheels, and the omnicell), I approached the charge nurse and asked for her help. She came over to me and then told me that the computer I was on just hadn’t been working in awhile. Oops! So I changed computers and was finally able to get on and access my patient’s chart.
I had to find my patient’s admitting diagnosis, the history of their present illness, their past medical history, any current or past surgical history, the meds they were on while in the hospital, their lab values, and any diagnostic tests run on them while in the hospital and the results of those tests. It took me about 2 hours in total to navigate the computerized chart, find the information I needed, write it all down, and then read the attending physician’s progress notes to get any additional information that may help me while dealing with my patient. It was a lot! And let me tell you, it is TRUE when you hear that physician’s handwriting SUCKS! I couldn’t really read the progress notes because they seriously looked like hieroglyphics…which is why most hospitals are going with completely computerized charting. My hospital, however, is in the midst of making that transition so while everything else was on the computer chart, the progress notes were unfortunately still handwritten.
By the time I got home, it was already 1930. I ate quickly and then got to work on finishing the part of my care plan that I had to have finished by morning. Because I had to write out the pathophysiology of the patient’s admitting diagnosis and relate the pathophysiology to the symptoms the patient was having, using that pathophysiology to find 5 nursing diagnoses and their rationales to apply to the patient – as well as look up EVERY SINGLE MED they were on and describe the adverse side effects, and implications of those effects that I had to be watching for during the clinical – finishing my care plan took me until 0230!! (And I’m sure there was a better way of wording that sentence so that it wasn’t so long and convoluted; however my head is tired and not quite working right now.)
And then I had to get up at 0430 in order to get ready to leave the house by 0545 so I could be at the hospital by 0630 – so I only got 2 whole hours of sleep the night before. Needless to say I was moving extremely slow Friday morning and coffee was my best friend.
We were all at the hospital by 0630 and because it was dark outside the hospital was still lit up – and gorgeous!
So we went up to our floors – 5 in our group on floor 10 (med-surg/gynecology) and 5 in our group on floor 6 (med-surge/telemetry) – and began our day! Mine started off really hesitantly because I just seemed to freeze once I was on the floor. Man I wish that would stop happening. I went into my patient’s room and introduced myself and we had a great conversation about coffee…and then I told them I would be back. I still had no idea who their nurse was and I needed to introduce myself! About about 10-15 minutes of rabbit trails I finally found the nurse and introduced myself to them, hoping with crossed fingers that my nurse wouldn’t be one of those who “eat their young.” They weren’t – in fact they almost seemed to welcome to fact that they’d have a student – and I let them know which patient I would be helping out with and also the fact that I was available to do vital signs on all of their patients for the day. They seemed to appreciate that fact and went on about their business.
And I was left to do my business…except I had no idea what that was. What was I supposed to do now? For some reason I completely forgot that I was supposed to do everything on my care plan for the day and I just kind of faltered outside my patient’s room for a couple of minutes completely unsure of what to do next.
I finally texted my clinical instructor to come find me, and once she was with me she gently reminded me that I had a full assessment to do on my patient, plus I needed to look in the patient’s chart for which meds were due and at what time they were due. Then I needed to do an interview and a complete history on my patient (if I had time) and help out with any tasks that came up such as bathing, linen changes, etc.
Ok! I had a game plan now and I set about to accomplish it. I looked up the patient’s chart and there were a few things that had been added/changed since the previous night so I wrote that down, made a list of the meds that I needed to give my patient, and then went back into my patient’s room and did my full assessment on them. They were the best first patient a student nurse could ever ask for! I was very blessed and lucky because they were so awesome, sweet and patient, and let me do anything and ask anything. After the assessment I was fortunate to have physical therapy come in immediately after and work with my patient. That gave me the opportunity to assess their musculoskeletal/physical abilities and strength; also while they were out of bed I took that opportunity to change the linens and make their bed.
By that time it was around 9am (yes all of that took FOREVER! I’m slow) and my instructor came to find me so she could help/observe me give meds. She walked me through getting all my supplies for a sub-Q injection, working the omnicell to get all my meds, doing the first and second medication administration checks, and pulling up the medication for the injection (Heparin). After that we went into the patient’s room, did the third administration check of comparing the meds to the MAR, scanned the patient’s armband, and I put all of their meds into a cup for them because they stated they could swallow them all at once. I informed the patient of what meds they were about to take and why, and then they certainly did swallow them all at once!
Then I prepared them for the heparin injection, took a deep breath…
…and gave my first ever injection!!!
It wasn’t weird, but yet at the same time it was. I mean, I was purposely stabbing a sharp object into another human being’s skin! How can that not be weird?
I then helped clean up my patient’s room, get them comfortable in bed (they were in a chair since having walked with PT), and made sure they had everything they needed. I watched the PCT draw blood for some laboratory tests, and by that time it was time to start rounding on my nurse’s other patients in order to take vital signs. I started with my patient first, of course, and then got everyone else. And by the time I was done taking vital signs and documenting them on everyone, it was time for lunch and post-conference with my clinical group!
My clinical day started off slow, but it got much better and by the end I didn’t want it to end! I finally felt like I was getting into a good groove. But WOW. The amount of work that nurses have to do and the knowledge that they must always know in relation to their patients is astounding. I only had one patient and I certainly wasn’t able to get everything done with them that I had wanted to do for the day (like giving a shower); I can’t imagine what my nurse was going through trying to care for and give meds to 5 patients!
We were all still smiling by the end of the day though so that’s good. I can’t wait until next week…hopefully I’ll be way more prepared and know exactly what I’m supposed to be doing, and maybe I’ll even have some time to shadow my nurse and watch them care for their patients and do procedures with them that I’m not able to do yet!