Most nursing schools blend a combination of theory lecture and clinical experience to provide students with the necessary skills to cope and thrive in a clinical setting. One of the ways that they may verify their students are ready to enter a clinical setting is through the utilization of skill check offs.
Check offs are done on fundamental nursing skills that every registered nurse should be able to perform as part of their daily duties. While the list of skills being checked off may vary per school, some of the most common ones you will see are: vital signs, head to toe assessments, wound dressings, NG tube, catheters, IVs and medicine administration.
The student is expected to demonstrate the skill being tested to a level that is safe and acceptable in a patient care setting, and a clinical instructor grades the student according to a rubric. They may also be expected to know what event or patient history may contraindicate the process or what the purpose of the skill being tested is.
Check offs can be intimidating. Many schools only give two or three attempts to pass the skill check off before the student is giving an unsatisfactory or failing grade. And, students may not be able to pass a nursing class with one or more unsatisfactory or failing grades on clinical skill check offs even if they’re passing the lecture portion. Thus, it’s vital that the student not just attempt to learn the basics behind the skill but really try to practice and simulate the skill being tested as if they were in a real clinical setting.
Since nursing school is already hard enough as it is, here’s my 5 tips to help you pass clinical skill check offs.
1. Review the grading rubric
My school provides a copy of the grading rubric to students before the actual check off so that we can know what is an absolutely required step of the skill being checked off and what is an extraneous but good to practice step. I know, it sounds weird. But, for an example, if you’re doing a sterile dressing change, you would have to know the proper steps to follow to don sterile gloves without breaking sterility or the sterile field. This would be required step of the skill check off. In that same check off, you may not be required to get your own supplies, but you should know what supplies are required of you anyways and should be able to list them anyways, this is an extraneous but suggested step.
With the way my school’s grading rubric is set up, you need to pass all the required skills to pass, and pass at least 3 additional extraneous steps as well. Your school may be different, but it’s good to know what you’re being graded on beforehand.
2. Practice like you’re being tested for your skill check off, actually practice
Whether you’re practicing the skills at home or at school after class in the lab, practice like you’re being graded during the actual check off. Introduce yourself, verify your patient’s identity and explain like you would during your check off, and in a real life situation. Go through all the steps and motions, don’t skip or shorten a step for convenience. When you practice the skill as you would use it in a real life situation, makes it harder to forget a step or mess up the process because you move more conscientiously and methodically.
To add, do actually practice these skills. While they look very simple on the skill demonstration videos and in person skill demonstrations, actually practicing these skills at home or in lab will give you confidence to recover from an issue or error if they occur. It will also help you develop a workflow that works for you and sets you up for success in your check offs.
3. Set up your check off environment the way you need it to be to ensure you don’t get nervous or flustered
Even before you begin your check off, make sure your environment and work area is suitable to you. You may not be able to change the bed or mannequin you’re working with, however you can still make sure the bedside table is on the side you want it to be on. You can make sure all your supplies are laid out in a manner that’s comfortable and familiar for you. It’s possible you’re left handed and the person before you was right handed, and everything has been set up to benefit them and not you.
If you need to, grab the trash can in advance so that you don’t have to go searching for it. You can and should reduce the number of factors that can raise your stress level by making the room and area work for you.
4. Explain or narrate everything you’re doing to the clinical instructor (as if they’re the patient)
Clinical skill check offs are a way for the clinical instructor to determine if you’re competent at the skill being tested. This can be done in number of ways such as physically verifying if you have mastery over the skill being tested, asking if you understand the purpose of the medical device being used and if you can accurate describe the procedure in a manner a patient would be able to understand.
When you explain and narrate your actions, it does two things. One, it lets the instructor know it took place even if it happened in the span of time they looked away from you, and two, in a real patient setting, it lets the patient know what’s happening. When patients can understand and follow the process of the procedure, it takes off some of the anxiety they may have. In turn, this can result in the procedure becoming easier for you because you have the patient’s cooperation.
Patient awareness of the procedure reduces chances of an accident, misunderstanding, and liability towards you be it as a student or later on as a practicing nurse.
5. Slow down to speed up
This is actually one of my favorite phrases from work, and it’s silly but it makes sense.
When you slow down and take your time to make sure each step is done correctly, you reduce the chances of making mistakes. Not making mistakes means that you can be finished on the first attempt. If you rush, you may make mistakes or forget steps entirely. It could be the difference between having to go back and do the step you forgot or failing your clinical skill check off completely.
Take your time, and trust yourself.
Well, that’s it.
I hope these tips help get you through your skill check offs. The biggest thing to remember is that all these skills are possible. They may be difficult but it’s only because you haven’t had much time to practice them. Practice, repetition and familiarity are the only things that will help you develop the confidence to perform these skills later on in an actual patient setting.
And, the biggest thing to remember is that your instructors don’t expect you to do the skill perfectly. They know the process. They really only expect you to watch the videos and practice on your own time so that you can perform it at an acceptable level.