Clinicals prepare students to take care of patients

Raeanna Small jokes around with Samantha Howorka, junior nursing major, during a daily check-up at Robinson Memorial Hospital Tuesday afternoon. Howorka believes Small has cellulitis, a skin infection caused by bacteria. ALLIEY BENDER | DAILY KENT STATER

Credit: Carl Schierhorn

It’s the night before her first day of clinicals, and junior nursing major Samantha Howorka is stressing about the beginning of a new chapter in her life.

“I have my first patient tomorrow,” Howorka said. “I’m so nervous I don’t know that I’m going to be able to sleep.”

But sleep is important for getting up at 5:30 a.m. and being at the hospital on time. Howorka and a group of nine others meet at Robinson Memorial Hospital at 7 a.m. to work with patients for the first time in their college career. They’re chatting about how that first day was impossible to prepare for.

Nursing students must take a series of clinicals — a set of time when they work with actual patients in a local hospital under the supervision of instructors and hospital nurses. The sequence begins with an introductory clinical where students learn basic nursing assessment skills.

“They prepare you for what you do at clinicals, but they don’t prepare you for that first moment you walk into the room,” Howorka said before beginning her first day.

Clinicals instructor Cindy Majercik has been instructing clinicals for five years while maintaining her position as a nurse, which she has held for 25 years. She said moving from the classroom to the hospital can be difficult for students.

“It’s really about overcoming the fear factor that your role is as a nurse,” Majercik said.

The first day

But on day one for Howorka, she still has to have that moment of walking into the room of her very first patient. At the beginning of each day, the instructor meets with students to assign a patient to each one and discuss the patient’s history.

Students are equipped with Palm Pilots loaded with software that tell them what they need to know about their patient’s drugs and ailments.

Howorka asks her instructor questions about what her patient can eat and whether she needs to wear gloves in the room, which is necessary for some patients with compromised immune systems. Her patient is allowed to have ice chips and sips of water only and no precautions need to be taken with gloves or gowns to enter the room.

Finally the moment arrives to go in and see their patients.

Howorka walks into a room where a woman is in bed a few days after abdominal surgery.

“Hi, I’m Samantha, and I’m going to be your student nurse today,” she tells her patient. She might be nervous, but she sounds confident and prepared. “How are you feeling today?”

“Terrible,” her patient replies. The patient is still in a lot of pain from the surgery and asks Howorka for another morphine drip that she gets a nurse to administer.

From that moment on, the morning is a flurry of activity. Howorka keeps herself busy caring for her patient and asking her questions.

“Can you rate your pain on a scale of one to 10?” Howorka asks. For most of the morning, the patient holds steady at an eight, but the morphine drip helps to soothe her.

Howorka asks her what she needs and gets anything that comes up. Throughout the day, Howorka bathes her patient, washes her hair, changes her sheets and gets fresh water and ice chips.

“Once I got into that room and got over that initial fear, then I jumped into my nursing mode and made sure that my patient got all the care she needed,” Howorka said.

Majercik said the questions Howorka asked of the patient are the most important part of the learning process in the introductory clinical. The best way to get comfortable with being a nurse is learning the communication skills that are necessary, which includes asking questions about pain levels and what the patient needs.

As the day wore on, Howorka is noticeably more confident in her work. She is no longer tentative going into the room, and she knows exactly how to answer each question the patient asks. Howorka washes her patient’s hair when she asks and finds some lotion for her dry skin.

Howorka eventually becomes comfortable enough to ask some questions of her own. She talks to the patient about her children and grandchildren and what they’re all like.

“I felt like I was running around constantly for the entire time that I was on the floor,” Howorka said. “Overall, I feel much more confident in myself and believe that I actually have learned and retained the information taught to me.”

Moving on

Howorka said she was well prepared in her classes for the first day of clinicals.

“The staff does a great job at preparing you for all the skills and techniques that you need to know,” she said. “I am lucky to have great instructors now that will stay after class just to help us work on anything that we may be struggling on.”

On Thursdays, the students work in a lab preparing new skills that may be put to use in the following week’s clinical, such as sterile glove procedure and how to bathe a patient while he or she is in bed.

Howorka said the instructors allow students to use the opportunities that come up as a chance to learn. Because each patient is unique in personality and ailment, each week Howorka learns a new skill that will be used the following week in the hospital, such as changing a wound dressing, checking on the healing process of a scar after surgery, or handling a patient with a serious infection.

“The clinical instructors are good at not interfering with you learning what you need to know,” she said. “They make sure you know exactly what you are doing and then are there to answer questions and make sure everything goes right.”

Majercik assures her students she would never throw something at them that they aren’t prepared for. If something unusual comes up, she tells them she will help the students use the experience as an opportunity to learn something new.

“They need to not be afraid to learn from all the different experiences,” she said. “They’ll come across things they haven’t learned so far in their textbooks.”

Contact features correspondent Kelly Mills at [email protected].