Let The Nerves Begin

Class hasn't even started yet and I am already a ball of nerves.  I've been googling and researching ways to get prepared for the first semester of nursing school and its all kind of scaring me.  You are expected to know quite a bit but, i will share with you, the information that I have found.

Surviving Clinical—Strategies You Should Know Ahead of Time

by Angela S., Sponsored Elsevier Ambassador

As a senior nursing student, I can say that the fear that you feel in the very beginning eases very quickly because of the nature of the workplace. You are submerged in patient care that requires so much of your attention that you tend to forget that you were nervous. On the other hand, nerves can be worsened by being unprepared, and can cause your instructor to think less of your ability.

I am going to offer some advice based on what I have learned to be prepared for clinical that has gotten me through so far.


The following is a note on how to prepare for your first clinical.

1. As nursing students, and nurses in general, our duty is to carry out each and every doctor’s order.

It is important to know the orders inside and out and not disregard them. If a patient has neuro checks ordered every four hours, be sure to perform them on time. Although this procedure can seem tedious and unnecessary in certain cases, it is crucial in others.

2. In carrying out orders, it is important to know a patient’s first and last names.

A way to really get to remember to the patient’s names, because as an RN you will be caring for 4 or 5 at a time, is addressing your patient by their name each time you encounter them. It will help you in not mixing up orders or medications, which is something an RN is liable for. Also, your instructor will expect that you know your patient’s first and last names, and will ask you to recall them while pulling medications. This is very important, but an easy thing to disregard. I was caught off guard a few times, and all I knew were the patient's initials.

3. Know your patients’ diagnosis and everything it entails.

If you go to the facility in which you are working the night before clinical, it will give you the whole evening to do your research. Things to focus on that your instructor will be looking for include the diagnosis, the pathology, diagnostic tests and treatments, medications, and associated laboratory values. Knowing your lab values and how they pertain to your patient will really impress your instructor. An example of lab values that pertain to a patient’s diagnosis would be a person having dysrhythmias related to hypokalemia. In this situation, the instructor may ask what their potassium level was, and you would be expected to know.

4. Medication administration tends to be a very stressful part of the day during clinical.

My advice is to know the class of the medication, whether your patient is on an appropriate dose, any adverse effects you should be watching for, what YOUR patient is on it for (not just what the medication does), and any baseline assessments you should be doing for your patient.

For example, if your patient is on digoxin, you want to assess their heart rate 15 minutes or less before you administer the medication. Another example would be a blood pressure medication, such as an ACE Inhibitor. You need to measure your patients’ blood pressure 15 minutes or less before administering the medication. In fact, some facilities document these measurements on the medication administration record (MAR) or elsewhere before the medication is even pulled. In addition, the physician may prescribe certain parameters in which to hold a medication. An example would be systolic blood pressure below 100, hold the patients’ order for lisinopril or other antihypertensive.

5. An area that seems simple but is easily overlooked by students is the patient’s diet and activity orders.

It is important to know these areas in case, for example, a patient on bed rest tries to get up to go to the bathroom (which could result in a fall or other events that could complicate the patient’s condition), or if a patient has a tray delivered who is NPO awaiting surgery. In addition, a patient may be on a dysphagia diet with thickened liquids who could potentially aspirate if given the wrong meal order.

6. Getting your patient cleaned up and out of bed if orders permit is very important.

Instructors look for this. It is a good idea to try to get started as early as possible, especially if you have more than one patient. Gather all of your supplies ahead of time and bring them in the room so you don’t have to go back out, particularly if your patient is on precautions.

7. A few other tidbits include always carrying tape, alcohol wipes, and saline flushes.

These things commonly used and will be very annoying if you realize you forgot to grab some in the beginning of your shift.

The most important thing is to have confidence in your abilities. You learn all of the material by reading the textbook, and clinical is the arena in which you apply your knowledge. Instructors can sense it when you are confident in yourself, and so can patients and their families. This will help you be a better student and become a better future RN!