There is an old adage about nurses eating their young. Is it true? Unfortunately, yes. I am not trying to make excuses for this, but as a nursing preceptor, there is nothing more soul-crushing than a student who thinks they know everything making stupid mistakes, and putting your patients at risk.
I love working with students. They frequently bring fresh eyes and new knowledge to the game. In my state precepting can get your CE credit exactly because of this. Honestly, in many cases, a student is more up-to-date on many things. Where they may falter is that they frequently do not see the big picture. Let me give you an example.
If a patient has limited resources (homeless, poor, no insurance) the brand new diabetes medications on the market, even if all your clinical recommendations push for it, may not be a great choice. If a patient cannot afford the treatment or the treatment is not obtainable then you need to find something that does regardless of the clinical recommendations.
This is where clinical experience becomes so valuable for new nurses and nurse practitioners. We have to see the patient in the bigger picture. Frequently this means finding a less optimal solution, but one that provides benefit to a patient that may not have any benefit otherwise. Flexibility is key.
So how can you avoid being the meal of an experienced nurse?
Don't assume anything. If you don't know the answer, say so. You can say "I think blah, but I want to look it up first." Most nurses don't remember everything, but we have looked things up so many times that we have a pretty good idea of what we are doing. Never be ashamed of having to look something up. On the other hand, there are things you need to KNOW. Basic nursing skills are basic because you need to know them. Any excuses will just be viewed as laziness.
Not understanding the rationals for basic care and medication administration is unforgivable. You might get one chance at missing or messing up something, but more than once will not gain you anything.
Being late to clinical. Most likely you will be sent back to school to review the material. In my school, two missed clinical days was considered a fail. In some schools, it takes only one.
If you did it, chart it. If it's not charted, it did not happen. This may sound unimportant, however, may a nurse has been confronted by a family that reports their nana did not get the care that they did. But if the chart does not reflect it, you have no way to prove otherwise.
Every test you take in nursing school is deadly important. It only takes one missed question to force a repeat of a semester. There are no easy classes or classes that can be flown through. You will need every bit of this information to pass your tests. An instructor that does not think you have the ability or knowledge can fail you. In my school, an instructor could hold you back even if you passed the tests, for any reason.
On your clinical, you have to understand that many hospitals are evaluating you as a future nurse. Don't be cocky. This is your job interview. You might even be looking to these nurses for letters of recommendation. Understand that many nurses are looking for reasons to blacklist you because they care that much for their patients. Pretend that every day of clinical is a job interview.
Every patient is our patient. Never, ever, use the excuse that "that's not my patient" to refuse to care for a patient. That is an instant fail in everyone's mind.
Every opportunity you have to learn a new skill, TAKE IT. Never pass up an opportunity to learn something new. If someone asks who wants to clean up the patient in room 203. You better be the first person to say "I'll do it!" And do it happily.
We do this because our community needs us, our heart tells us this is the right thing to do, and because we love what we do. Anyone who makes us think that our patients will be at risk will be viewed as a danger to be dealt with.
Be earnest, thoughtful, and strive to be the best nurse you can be and you will have little to nothing to worry about. Cheers! -Daniel
