First clinical: things I wish I'd known

I need a study break so I decided to write a "things I wish I'd known BEFORE my first clinical day" list. It's that time of the semester, so maybe the list will actually be helpful! First, stuff to bring:

1. Ugly nursing shoes. The cute ones are NOT COMFORTABLE. Crocs are NOT COMFORTABLE (when you have to swivel with patients and so on). I got a pair of Nurse Mates Dove shoes, and my feet did not hurt after a 12-hour clinical. I didn't even break them in first! 2. Alcohol hand rub in one of those tiny containers (if you'll be at a nursing home). Nursing homes don't have that stuff scattered everywhere and have almost no available sinks, for some reason. 3. Stethoscope. Blood pressures are rarely taken in long-term care and when they are they're taken automatically, but some residents will let you listen to their hearts, and wowza! You can hear some cool stuff, and the residents like the attention. 4. Black clicky pens (you will lose pen caps) and a few folded sheets of blank paper (skinnier than note pads for scribbling stuff down). 5. One of those nylon scrub-pocket organizers. They have metal clips on the back and can be conveniently worn tucked over the top of scrub pants if your pockets are already bulging with gait belts, pens, folded papers, lip balm, Kleenex... (take the organizer off when you use the bathroom, which you will have time to do approximately twice in a 12-hour span). 6. PDA! Yes, nursing stations have all the reference materials you might need. But are you going to walk all the way there and ask people to move so you can get to them? With a PDA, I can sit down with my resident's chart and get all the medication, procedure, and disease-process information I need AND get the nursing diagnosis and interventions, all without having to drag around a giant pile of books or do it at home.

Second, stuff to know:

1. The CNAs you will be paired with hate you. Hope for a passive-aggressive one (vs an obviously aggressive one). 2. When you start to wipe butts your tendency will be to breathe through your mouth. Do not do this if you have any hints of allergies or cold symptoms because your nose will start to run and...you will have to sniff. Deeply. Need I say more? 3. No matter what you do, something about it will be wrong. 4. I found it's better not to ask patients if it's OK for me to work with them. "I'm a student nurse, and I'll be helping you to bed" worked better than "Is it OK if I work with you for awhile?" (Some said they wanted their regular CNA instead.) 5. The horrors of chart review cannot be overemphasized. I was unprepared for how difficult it was to find information in charts. I almost cried after about an hour of this and wished someone had warned me. So, readers, consider yourselves warned! 6. Most of the staff talk to the elderly in this weird patronizing falsetto type of voice and address them as "honey" and "sweetie." I don't think they like it. They also don't seem to like the "Mrs. So and So" touted in school so perhaps just first names are best. I ended up having to try really hard to use a regular speaking tone with them because its easy to fall into addressing them as though they're not only 3 years old but also slow for their age since everyone does this. Also, not ALL elderly are hard of hearing! They don't like it when you automatically go up and start shouting into their ears.

Last words: I felt really ready for clinicals before I went. After about 10 minutes I felt hopelessly out of my league. Transferring patients was no problemo in school when I had all the space in the world and the "patient" wasn't about to wet herself. When you're in a hurry and crammed into a 4-foot-square bathroom with an agitated elder and a wheelchair it's really different. Dressing a mannequin was also no problemo (oddly). Dressing agitated residents is not that way; they will fight you or start to cry. Practicing catching a falling student was way easy...she slid gracefully to the floor. Walking next to a frail elder who started to sway caused my bowel contents to liquefy (what if she falls, breaks a hip, and dies all because I couldn't ease her to the floor correctly?). I mean, it's not rocket science, but there are just a lot of new things at once!

I'm sure I left a bunch of stuff out. Readers: please add comments with more tips!