What to Expect in Nursing School Clinicals

There’s no doubt about it, clinicals can be scary. But, they are an essential part of nursing school. Some would argue that clinicals may be even more important than the classroom because that’s where you actually get hands-on experience. 
It’s important to know that being nervous before each clinical day is very, very normal. But this guide will help you know what to expect in clinicals and how to prepare yourself.

Nursing School Breakdown

Nursing school is typically divided into three major components: didactic, simulation lab, and clinicals.

• Didactic: In-classroom lectures that provide a fundamental layer of knowledge for students to apply in the clinical setting.
• Simulation lab: Students practice various skills and tasks they need, in a safe, non-risk environment before touching real patients.
• Clinicals:  Hands-on, hospital-site, “in-the-field” portion of nursing school.

What are Clinicals in Nursing School?

Clinicals are an essential part of the nursing school curriculum. They are also a requirement regardless if your nursing program offers an Associate’s Degree or Bachelor’s Degree.

Clinicals are designed to provide nursing students with hands-on experience in the healthcare setting. It allows students to work on practical skills that are needed to succeed at the bedside.

How Do Nursing School Clinicals Work?

When do they start?
Generally, clinicals start after general education courses. The first nursing clinical experience is general nursing, where students become acclimated to the healthcare setting and have their first encounter with patients and their families.

Who will be teaching you?
During clinicals, you will be assigned to a special clinical instructor and floor in a hospital or long-term care facility. The clinical instructor is the liaison between the hospital and the school. Sometimes clinical instructors will also teach in the classroom and other times they are solely focused on the clinical setting.

What will you be doing?
The clinical instructor will assign each student to a specific patient, group of patients, or nurse for the clinical day. It is then your responsibility as the nursing student, to determine the plan of care for the patient for the day as well as know their orders, medications, and health history.

Essentially, you should be prepared to care for the patient as if you were the assigned nurse.

What will your clinical instructor be doing?
Your clinical instructor is there to assist you with any questions you may have, but they are also there to grade you on your performance and effort. You are not shadowing your clinical instructor, as they are not directly caring for patients.

Will I Have My Own Patients in Nursing School Clinicals?

In the beginning, no. By the end of your nursing program, however, there is usually a final practicum or preceptorship. During this time, you may be given the responsibility of a small patient load by yourself (with the assistance of your preceptor, of course.)

It is important to mention that while you may not have your own patients that you are “in charge” of and the primary caregiver - you will be assigned patients to care for during the clinical rotations. 
Caring for these patients will entail following nursing orders, assisting with procedures, assisting in ADLs, and administering medications (if assigned by the clinical instructor). 
More or less, you are responsible for assisting the nurse in caring for specific patients.

How are Clinicals Graded?

Every school has its own system of grading the clinical portion of the program. Despite each clinical program having its own grading system, it must adhere to national guidelines set forth by accreditation bodies.  

Typically, clinicals are graded on four things:

1. Attendance
2. Participation
3. Preparedness
4. Homework

What is Nursing Clinical Homework Like?

Homework will generally consist of care plans. Care plans are a way for you to connect the patients you see with the nursing process. 
Writing a nursing care plan can be tricky but knowing the five parts of the care plan is the first step to being successful. They are,  

• Assessment
• Nursing Diagnosis
• Plan
• Intervention
• Evaluation

Depending on the nursing program you will be required to complete a specific number of care plans. This will also vary depending on the clinical rotation. 
Generally, you will have a few days to complete the care plan. Remember - don’t procrastinate! These often take hours to complete.

What Happens If I Fail a Clinical?

Clinicals are a subjective experience, and it’s not very common to fail clinicals because there is a lot of support and interaction with the instructors. If you put in the effort — you’re on time, you complete your care plans, you ask questions, and you’re engaged — you will not fail clinicals. 
While failing clinicals is difficult it is not impossible. There are some circumstances in which you will fail clinicals. This could be for a variety of reasons including,

• Causing harm to a patient
• Not adhering to clinical guidelines
• Administering medications without the presence of a clinical instructor or licensed registered nurse
• Potentially causing harm to a patient

Some of the aforementioned things MAY cause immediate dismissal from the clinical setting but other reasons, like tardiness, less engagement, or issues with written assignments most likely will result in a conversation with your clinical instructor.
It’s important to keep an open line of communication with your clinical instructor. Formulating a plan of action is the best way to achieve success.

What Do I Wear to Clinicals?

Your school will give you a list of guidelines on what to wear to clinicals. Each nursing program will have a mandated school uniform:

• A pair of special order scrubs in the school's color
• A badge from the nursing program
• You will also be given a badge from the healthcare system

Comfortable closed-toed shoes are required. Since you will be on your feet for extended periods of time, compression stockings are very helpful. Other items to have handy are:

• Pen
• Nursing report sheet
• Penlight
• Stethoscope

What Specialties Will I Observe During Clinicals?

Clinicals serve as a way for nursing students to get exposure to different specialties in healthcare. Clinical rotations will typically include:

• Medical-surgical
• Labor and delivery
• Pediatrics
• Geriatrics
• Perioperative
• Critical care
• Emergency
• Psychiatric
• Community Health

How to Use Clinicals as a Powerful Career Tool

During clinicals, you will get to experience many different specialities and areas of nursing. In fact, clinicals often are a time you may decide exactly which speciality you want to pursue after graduation or which you don’t!
If you really like a specific area or floor, introduce yourself to the staff. Get to know them. Ask to meet the manager or the nurse educator on the unit.

Leaving a good impression might just help you secure a job after graduation.

How to Handle Less-Than-Welcoming Hospital Settings

Going into a hospital as a nursing student, you would think that the nurses around you are excited and supportive of your new journey — and don’t get me wrong, a lot of them are.

However, hospital settings can have very tense and stressed energies, and this can be reflected in the attitude of the nurses that you are shadowing or interacting with at the hospital. 
Unfortunately, you will likely encounter nurses who are seemingly not pleased about having you around and may not readily include you in the day’s activities.

Every student in the medical field will feel this to a degree, and it doesn’t do much for fostering a positive environment or cultivating relationships between nurses and students. But there is always a way to handle this.

1. Remind yourself that you CANNOT control how other people feel or act
You can only handle yourself and your own emotions — and it is NOT worth it to have a negative clinical experience due to the attitude of others.

2. Take a Deep Breath
Begin by taking deep breaths when you find yourself becoming overwhelmed by all the unknown factors of a clinical experience.

3. Remind Yourself That It’s Okay to Be a Beginner
When things get hard, you need to remember that you are an intelligent person worthy of being in this clinical rotation. 
You are doing your very best, and just because you don’t know how to start an IV today, don’t know what labetalol does, or feel terribly awkward talking to patients, doesn’t mean it’s going to be this way forever.

You are at the beginning of your journey – a gorgeous and beautifully blooming one. One day you will look back at this time and say — wow! I’ve come such a long way!