Making the Most Out of Clinicals in Nursing School

Three nursing students assisting a patient in a hospital bed.

By Dante Hatem, BS '19, RN

Want to make the most out of clinicals in nursing school? Here are five tips from Dante Hatem, BS '19, RN, medical ICU nurse at Upstate University Hospital.

1. Learn how to document.

Dante Hatem delivering a speech at the 2019 commencement ceremony.

Dante delivering a speech at the 2019 commencement ceremony as Multicultural Nursing Student Association president (2018-2019).

Documenting is a skill every nurse needs to develop. From writing notes to documenting hourly activities, becoming efficient in nursing school will set you up for success in the field. Documenting is tedious, but it’s necessary because it can save you if you ever have to go to court.

Additionally, I highly recommend not picking up bad habits like copying someone else's assessments. Doing that could result in errors being copied in a patient record, which could lead to patient care errors and disciplinary action if something bad were to happen to your patient. You need to get familiar with terms like rhonchi and crackles eventually, so you may as well take the time to complete assessments yourself.

Over time, you’ll notice that everything comes back to time management. One of the ways you can improve your time management is by becoming fast on the keyboard while still maintaining accuracy. This will allow you to focus on your patients more, especially in an ICU setting, which is my specialty (I like to think I developed fast fingers). For example, titrating a pressor on a pump may be easy—but documenting the exact time and reason you titrated a critical medication can be time consuming.

2. Learn to do a full assessment...thoroughly.

Obviously, you want a really good full-body assessment. But doing an assessment in nursing school in front of a professor on your friend is much different than doing one on a patient who has five different chronic conditions and is in the hospital for an exacerbation of four of them.

Here's exactly what I do every time I walk into a patient’s room:

  • First, I’ll tell them my name and ask how he or she is feeling. Immediately, you should be able to assess level of consciousness, their pain and what they are there for. (If the patient is sedated, it's a different story.)
  • Then, I’ll go from head to toe by asking them, while I shine a bright light in their eyes, if they can tell me today's month and year and why they’re here. This should give you everything you need neurologically (minus the extremities).
  • Next, I’ll tell them I have to take a listen to them. In nursing school, they want your stethoscope to touch every surface area of the patient’s body (which you should still do in class)—but realistically, there are only five lobes you need to find, plus one spot on the chest to make sure you don't hear muffled heart sounds or a gallop. Then, listen for bowel sounds in four quadrants and ask when their last bowel movement was and if they are having any belly pain.
  • Once I’ve listened and remembered what the lungs sound like (which is one of the most important parts of the assessment, in my opinion), I’ll check the radial pulses and ask the patient to grip my fingers, noting any signs of weakness in one hand over the other. Then, I’ll check for edema in the feet while I palpate for a pedal pulse. If I can't find a pedal, then I’ll move up proximally. While doing this, just ask the patient to dorsiflex and plantarflex against your hands.
  • Lastly, I ask the patient to roll over and check their sacrum for any pressure injuries because they won't know if they have one. If they develop an injury, and get an infection without it being documented, you might find yourself in the courthouses years later.

3. Be eager to learn.

Clinicals are what you make of them. One comment a nurse made to me (that I guess you can take how you want) was that I was “overzealous.” The nurse said it because I was always asking if I can help, even if it was a bed bath with someone else's patient. The preceptors saw that, and they would come to me first if they needed any blood draws or Foley catheters placed.

In my first clinical rotation, I put in three Foley catheters, which was three more than any other student in my clinical group—and it was because I was eager to learn. During your down time, I recommend reading through histories, physicals and progress notes. This is the best way to learn what the hallmarks are for each disease.

4. Find a nurse you click with.

When I was in my pediatrics rotation in school, I clicked with one nurse who not only made me love pediatrics, but got me to love showing up to the hospital on a weekend that I wasn't getting paid for.

I genuinely enjoyed and looked forward to working with this particular nurse. She challenged me in the right ways, whether it was critically thinking or prioritizing tasks. Because of her passionate teaching, I was a very confident nurse coming out of school because I felt like I had the foundations of time management, prioritization, critical thinking and compassion.

Not everyone gets as lucky as I was. But if you just be yourself, there will almost always be another nurse on your clinical unit that will appreciate it and vibe with you, and you'll then learn to love what nursing is all about.

5. Learn the foundations.

In a way, this brings together all of my tips. By foundations, I mean assessments, time management, prioritization, leadership, communication and compassion. Nothing is more attractive to an interviewer and nurse manager than a nurse who can show these skills early on in an orientation. And during an orientation, your preceptor will know how to bring these out of you (whether in a good or bad way).

Learning these foundations in your clinical rotations is the best place to start. Wondering how you can learn leadership skills in clinicals? You can start by asking your preceptor if you can do everything and let him or her know that you will ask for help when you feel that you need it. You can also learn to delegate tasks if you feel overwhelmed because you are both that patient’s nurse and care leader. This also ties in prioritization because you need to do the tasks that are most critical to the patient. For example, if there's a mess that needs to be cleaned up while you’re giving D10 to a hypoglycemic patient, that’s something that can be delegated to a tech.

Hear Dante share why his two favorite aspects of UBSON are the supportive faculty and his fellow nursing students.

You can also ask to can practice speaking to a doctor to work on communication and to become accustomed to the types of questions he or she will ask. If you don't know the answer, just be honest and say, “I'm not sure but I will find out.”

The key is to always find ways to learn more, whether you’re a student or on the floor as an RN.