Clinical demystified

The other day I was talking with a friend and she asked what I did on a typical clinical day in the hospital. I explained to her that, in general, I'm assigned a patient and I provide the care for that patient that day. She seemed pretty surprised that patients would be okay with students providing a significant portion of their care and expressed some safety concerns, so I thought I'd take a minute to explain how this clinical situation works for those of you unfamiliar with it.

So, lest you think we students descend on the hospital in droves, pass medications willy-nilly, document our whimsies in patients' medical records, and perform whatever procedures we come across unassisted, I am here to tell you: that is not the case!

First, we register for the unit/floor we want in groups of 8-10 and each group is headed up by a preceptor. The preceptor stays on the unit whenever we are on the unit and is available for help, questions, supervision, etc. The patients on the floor are assigned unit RNs, just like on any normal day. Each of us students are assigned one patient (or two on a slower day), and we make sure that when we go into the patient's room in the morning to do our assessments, we inform them that we are their student nurse, and that they have an RN, as well. Patients at this hospital are told that it is a teaching hospital upon admission, and though they do have the right to refuse care from a student, most don't. The thing is, we are typically not the first students these patients encounter. This hospital also trains medical students, PT and OT students, pharmacy students, dental students, NP and CNS students, PA students, etc, etc, etc.

In effect, getting a nursing student to manage your care for the day can be a blessing. RNs on our unit typically have anywhere from 3-6 patients, and we get 1-2. Our patients get a lot of attention, and in addition to us looking over and questioning their orders, they also have our preceptor and their RN reviewing them. Everything we document as students is read over and verified by the preceptor or RN before it becomes an official part of the patient's medical record, and any procedures we perform are typically either supervised, or performed while assisting another professional. Before we can give any medication, we have to know its class and therapeutic range, the action of the drug, intended effects, side effects, and exactly why our patient is taking it (among other things). In general, there are a lot of people around to make sure these patients get very effective and safe care.

So next time you get a student in a teaching hospital, just remember that it's not the worst thing in the world :) We're looking out for you, others are looking out for you, but most importantly, ask questions and look out for yourself.