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How to Prepare for Nursing Clinicals: Insights from a Clinical Instructor

Updated: Jul 6, 2023



Nursing programs usually require students to pass three components for every course- theory, lab, and clinical. Nursing clinicals provide students with hands-on experience and the opportunity to apply theoretical knowledge in real-world healthcare settings. As a clinical instructor, I have witnessed firsthand the challenges and rewards that nursing students encounter during their clinical rotations. Here are my insights and guidance to help you get ready for the day.

 
 
Orientation

Most programs begin with a clinical orientation. Your professors will go over expectations and requirements for all students. This will include your clinical schedule, skills you will learn, health clearances, nursing uniform, required equipment, professional behaviors, policies and procedures, how you are evaluated, how to succeed, assignments, and important dates. This can be overwhelming for your first clinical so TAKE NOTES so you don't forget the important dates and requirements.


Skills Practice

Usually, your first days of clinical will be spent in the school lab where you will be taught the nursing skills you need to know for clinical and for your course level. For example, first semester students will be taught everything from verifying patient identity to bed bath to taking vital signs to doing a head-to-toe assessment. Depending on your program, you might learn medication administration in your first or second semester. In your later courses you will learn skills like catheter insertion, trach care, dressing changes, and administering IV fluids. Your nursing professors, lab staff, or clinical instructor will be teaching you the skills and you will likely be provided with access to videos and step-by-step instructions for each skill. Take full advantage of this time to learn and practice in the lab where you have access to all of the items you need to perform the skills. Otherwise, practice at home with your skills kit/bag which will have most of the items you need to perform the skills at home (re-pack and re-use as needed). Practice on your family members or teddy bears until you can do the skill without looking at your notes. Remember, you will be performing most or all of the skills on actual patients at clinical so you want to be prepared. But don't worry, your clinical instructor will be at your side, walking you through the steps if you need help.


A Clinical Day

Now that you've learned the necessary skills, you will need to prepare to go to your clinical site. Either the site will provide a site-specific orientation, or your clinical instructor will. Your clinical instructor will let you know the facility's policies, procedures, safety protocols, where to park, what time and where to meet them, what you need to bring with you, and what to expect on your first day. I always have a Q&A session with my students on our last day in the lab and tell my students the plan for clinical and then again via email a day or so before. Here is an example of an email to my students:

Here is the plan for clinical this week: READ ALL CAREFULLY.

  • Meet Professor C at 6:50 am on _____- get patient assignment, put bags/coats away.

  • Find the day shift nurse for that patient. Say, "Hello, I am _______, nursing student. I am taking care of patient _____ until 3:00 pm. I will be giving them medications, doing AM cares, and taking vital signs. Do you mind if I listen to report?"

  • Find the nursing assistant for your patient- let them know you are doing AM cares, ask if your patient needs a bath/linen change, let them know you are taking vital signs and documenting them.

  • Once you get report, give report to me!

  • We will look at the patient's chart together and look up meds. Let me know the plan for today.

  • Get vital signs, do your AM cares, help patient order breakfast if needed. VITAL SIGNS need to be documented with me by 7:30 am. Physicians and nurses are looking at these early.

  • Complete head to toe assessment with Professor C.

  • We are documenting together! Do not document under another nurse or nursing assistant or with your own badge.

  • Administer medications- when you are ready with your drug cards find me to give medications at the right time. At this facility we can give meds 1.5 hours before or after the due time. The exceptions are antibiotics, and anticoagulants- these need to be on time. Bring your drug book if you have one. I am going to ask you what it is for, why your patient is getting it, and side effects to watch for.

  • DO NOT give medications without ME.

  • IF your patient needs anything, you will get it for them- water, extra blanket, etc.

  • IF your patient has a catheter/drain we will empty and record the output.

  • IF your patient needs to be transferred and they require assistance- you will find me and we will move them together.

  • Complete CJMM worksheet (I will give to you)

  • 2:00 pm we will wrap up, give report to the nurse, say goodbye to patient, say thank you to everyone, and get lunch.

  • 3-4:30 pm Post Conference at _____

Please be patient with me and each other. There is 1 of me and 5 of you. Do not get in the way of the health care team. If they need the computer you are on, get up and move computers. If you are not sure about ANYTHING please ASK ME first. No question is a stupid question.

This is just one example. These directions vary from site to site and day to day. In fact, these directions were right after covid restrictions were beginning to be lifted and we did not have a conference room to do pre- or post- conference. We could only do post-conference at a different location.


Pre- and Post- Conference

Pre-conference is a vital component of nursing clinicals where nursing students gather with their clinical instructor before their assigned clinical shift. During pre-conference, the instructor sets the stage for the clinical experience, ensuring that students are prepared and oriented to the upcoming clinical day. We review patient assignments, set goals and review the learning objectives, and address questions and concerns.


Post-conference takes place after the completion of the clinical shift and serves as a debriefing session for nursing students. This is where the LEARNING happens and connections between theory and clinical are solidified. We reflect on patient care to help identify areas for improvement, share experiences to gain insights from other students, discuss case studies or scenarios based on patient encounters, discuss the rationale for nursing interventions, and explore alternative approaches to patient care. The instructor provides feedback on students' performance, highlighting areas of strength and areas that require improvement, reinforces learning objectives, and assigns homework such as case study or concept map.


Unprofessional Behaviors

Depending on your program you can get written up for being unprofessional or serious infractions. Make sure you review those reasons.


Being on time is one professional behavior that I take very seriously and let my students know on day 1. When I go to the clinical site 45 minutes early, I look up all the patients on the floor, think about which patient to give to each student, and notify the nurses and staff that we will be caring for those patients. The nurses and staff plan accordingly, so when a student comes late, or doesn't come at all, it inconveniences everyone's plans. Do NOT be late! If you are someone who is always late, make arrangements to ensure you are on time: Set your alarm earlier, leave your house earlier if you will hit traffic, sleep over someone's house who is closer to the site, have a back-up to your back-up babysitter, carpool with someone. Do NOT be late!


Other common infractions are breaking uniform requirements (uncovered tattoos, acrylic nails), entering or leaving the patient's room without performing hand-hygiene, not returning the patient's bed to the lowest position before leaving, and forgetting to follow the rights of medication administration. Now you won't be kicked out of the program for these, but students have been kicked out of programs for things like administering medications without supervision and being seriously rude to hospital staff. You are a guest at your clinical site and you are representing your school, please be polite and practice safe behaviors.


What to Bring

Verify with your clinical instructor, but here is what I recommend:

  • Student ID- school and facility

  • Stethoscope

  • Penlight

  • Pen- black and red

  • Small notebook that will fit in your pocket

  • Drug book

  • Water

  • Snack

  • Here is a FREE download for a Drug Card template and a Concept Map template

Templates
.pdf
Download PDF • 38KB

Do you have other questions about clinical? Let me know in the comments!


Good luck!

Professor C.



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