From The Nursing Professor The Clinical Edition

Clinical has a way of making everything feel like a much bigger deal than it actually is.

You answered a question wrong in front of your instructor. You couldn't remember why your patient was taking a medication. You stumbled through report. You walked out of a patient's room and immediately realized you forgot to ask something.

And now you're driving home replaying the entire day.

Meanwhile, your clinical instructor has more than likely already moved on. And I don't mean that in an I don't care way.

I mean that after more than ten years of teaching nursing students, I know what learning in clinical looks like. And it is not perfect.

There are things I've watched students worry about for days (or even weeks) that I haven't thought about again since the day it happened.

So, from the other side of clinical, here are a few things I wish nursing students knew.

I Am Not Keeping a Running List of Everything You've Done Wrong

Students sometimes seem surprised when they bring up something that happened weeks ago and I don't immediately remember it.

They've been thinking about it ever since. I haven't.

Again, that's not because I don't care. It's because I don't go home and mentally file away every mistake a student made that day.

If you didn’t know the answer to a question I asked you, we talked about it, you learned something, and we moved on.

If you forgot something during your assessment, I had you go back and do it. And then we moved on.

If you had an awkward conversation with a patient? It happens. We moved on.

There are absolutely things I need to remember and follow up on as an instructor. If I see a pattern, a safety concern, a professionalism issue, or something else that needs continued attention, I'm going to address it.

But every imperfect moment isn't becoming part of some permanent record I keep about you.

Sometimes a mistake is just a mistake. And we moved on.

Every Clinical Day Is a New Day

This is probably one of the biggest things I wish students understood about me as an instructor. I take every clinical day as a new day.

If you struggled last week, I'm not walking onto the unit this week thinking: Let's see what they mess up today.

What I’m thinking about is: Okay. Who are our patients? What's happening today? What can we learn from this?

Last week already happened. If we identified something you needed to work on, then yes, I may be watching for improvement. That's part of teaching. But I'm not bringing every awkward moment, wrong answer, or mistake from last week into today.

I've had students come back to clinical still carrying something that happened during a previous clinical day. Sometimes they apologize for it again. Sometimes I can tell they're nervous around me because of it.

And sometimes I genuinely have to think for a minute before I even remember what they're talking about.

They've spent a week thinking about it. I haven't. You are allowed to have a bad clinical day and come back next week.

I Promise You Are Not the First Student Who Has Done That

The thing you did that you're currently horrified about? There is about a 99% chance I've seen another nursing student do it before. I've been teaching nursing students for more than ten years.

I've seen students completely blank when I ask them a question they absolutely know. I've seen students forget what they walked into a patient's room to do. I've seen students confidently start explaining something and then realize halfway through that they're completely wrong. I've watched students look up a medication and then immediately forget what they just read because they're nervous. I've seen students walk out of a patient's room and suddenly remember the one assessment question they meant to ask.

I've heard some very awkward attempts at patient education. I've watched students struggle through report. I've seen students get so nervous when I walk up that they temporarily appear to forget everything they've learned in nursing school.

You are almost never as uniquely terrible as you think you are in that moment. You're a nursing student. I've taught nursing students before. I promise I've seen some things.

I Don't Expect You to Know Every Medication I Ask You About

This is a big one in clinical. I ask: “Why is your patient taking this?” And I can see the panic start immediately because you aren’t sure.

Now you’re thinking that I know that you don't know.

Well...yes. That's why I asked. But that doesn't automatically mean I'm concerned about you. Sometimes I ask questions because I want to know what you know. Sometimes I ask because I want you to connect the medication to this particular patient. Sometimes I ask because it's something worth looking up.

And sometimes you just don't know the answer. And that's okay.

What I care much more about is what happens next. Can you recognize that you don't know? Can you find reliable information? Can you come back and explain it to me?

I'd much rather hear: “I'm not sure. Let me look that up.” than watch you try to invent an answer because you're afraid to admit you don't know.

Sometimes I Don't Know the Answer Either

Every once in a while, a student asks me a really specific question. And I don't know the answer. That's it.

I've been a nurse for a long time. I've taught nursing for a long time. I still don't know everything about nursing.

Sometimes we're dealing with a medication I haven't encountered in years. Sometimes it's a very specific disease process. Sometimes there's a piece of equipment or a procedure that's unfamiliar. Sometimes the question is so specific that I genuinely don't know the answer off the top of my head.

I have absolutely no problem saying: “I don't know. Let's look it up.” We can both learn something. That's nursing.

You are never going to reach a point where you have every medication, disease, procedure, policy, lab value, and piece of equipment memorized.

Part of becoming a safe nurse is becoming comfortable saying: I don't know this yet. And then knowing what to do about it.

Needing Help Does Not Make Me Think You Can't Do It

Sometimes students are incredibly reluctant to ask for help in clinical. They don't want me to think they aren't prepared. They don't want the nurse to think they don't know what they're doing. They think they should be more independent by now.

But you are still a student. There are things I expect you to do independently at different points in your education, but there are also times when asking for help is exactly what I want you to do.

I'd much rather you stop and say: “I'm not comfortable doing this without you.” than continue because you don't want anyone to know you're unsure. Knowing when you need help is part of safe practice.

You Are Probably More Aware of Me Watching You Than I Am of Watching You

There is a very specific phenomenon that happens in clinical. A student is doing perfectly fine. Then the instructor walks into the room. Suddenly nobody knows how to use a blood pressure cuff.

I get it. Being observed changes things. But I am not standing there waiting for you to mess up. Most of the time, I'm just checking on you. It’s my job to be involved and make know: Do you understand what you're doing? Are you safe? Do you know when you need help? Can you connect what you learned in class to the patient standing in front of you?

I'm looking at the whole picture. You're thinking about the fact that you dropped the alcohol pad.

An Awkward Patient Interaction Is Usually Just an Awkward Patient Interaction

Talking to actual patients can feel surprisingly uncomfortable when you're new at it. You may not know how to introduce yourself. You may ask a question in a weird way. You may have no idea what to say when the patient tells you something personal. You may try to leave the room three separate times and somehow still be standing there.

That's okay. Talking to patients is a skill too.

It gets easier because you keep doing it, not because someone teaches you the perfect sentence to say in every situation.

If I'm Actually Concerned, I Will Tell You

This might be the most important thing in this entire article.

Nursing students spend a surprising amount of time trying to interpret their clinical instructor's facial expressions.

She looked concerned.

He asked me another question.

She corrected me twice today.

She asked me to stay for a minute after clinical.

And suddenly you're wondering whether you're failing.

If there is a genuine concern about your clinical performance, you should not have to figure it out from clues. I will tell you.

If there's a safety concern, we're going to talk about it. If I'm seeing a pattern, we're going to talk about it. If there's something you need to improve, we're going to talk about it. If there is a formal concern that needs to be addressed, you will know.

That doesn't mean every conversation will be comfortable. Feedback is part of clinical education, and sometimes the feedback is going to be that something needs to change.

But you don't need to spend the drive home analyzing whether the way I said “Have a good weekend” sounded slightly different than usual.

Come Back Next Week

You're going to have clinical days that feel great. You're also going to have clinical days when you leave wondering whether you learned anything in nursing school.

I've seen both.

I've watched students who were terrified to walk into a patient's room eventually become comfortable talking to patients and families. I've watched students who couldn't figure out what information mattered learn to recognize changes in their patients.

I've watched students who needed me beside them constantly become increasingly independent. And I've watched plenty of students have a rough clinical day and come back the next week and do just fine.

That's what I want you to do. Learn from what happened. Take the feedback. Figure out what you need to work on. Then come back. Because while you may still be thinking about that thing that happened three clinical days ago...

There's a pretty good chance your professor isn't.