The first day of clinical is a bag full of mixed emotions. The nerves, the excitement, the anticipation, the yearning- all are an accumulation of many years worth of hard work, sacrifices, time and money. As my faculty told me, each day you step into the operating room from day one until the last day you are interviewing for your next job. Setting yourself up for success the night before each clinical day is like a mental reset. If you have a bad day, stick to your nightly routine, and let it serve as a reminder to keep pushing through the tough days. For those of you starting your first day of clinical, here are some helpful tips that I have implemented in order for me to stay organized, prevent burn out and get ready to go on those early mornings. 

The Night Before: Preparation is Key

1. Confirm Communication: If your program requires you to notify your clinical coordinators, verify that the email or text message has been sent and have a reply of some sort! If you do not have a reply from them, reach out again and let them know that you are coming. Sounds silly, but I’ve heard of students showing up to clinical sites and the coordinator has no idea that they are coming.
2. Prioritize Sleep: Get a good night's sleep. That is hard to do- you are excited and nervous to start something you’ve never done before. You are a novice again after being at the top of your game as a bedside nurse. The great part of the nerves is that your preceptors know that you are super nervous too. So, calm the type-A-personality-perfectionist person in you and make sure you are adequately rested. This may mean you have to take a melatonin, turn your screens off early, or drink that sleepy time tea. Find what makes you most relaxed and stick to it. 
3. Pack Light: Gather your supplies, but pack light! You are not going on a 24-hour call shift on your first day, so you don’t need to bring multiple tote bags. Understand that some clinical locations do not have enough lockers or storage spaces for students. I recommend that you reach out to the individuals in the class above you who have rotated through various sites. However, I also recommend that regardless of what they say you only bring a cross body and a lunch box- that’s it! After the first day, you can better gauge whether or not you will have a locker, cubby or nothing at all. Also, to save time in the morning, I lay out all the things that I am taking to clinical the night before; keys, wallets, bag, lunch, water bottle, and my scrubs/scrub hat. That way I can get up, get dressed and get out of the house with ample time to beat any traffic and take my time setting up my room for the day. 
4. Be Proactive: Usually for your first day you will start off with a tour of the facility and then they will help you pick out a room to get started in. If your clinical sites tell you what cases you will be participating in the night before, be proactive!! Review your class notes, look through Nagelhout or the Jaffe text in order to get an idea of what you will be doing. I’m a sucker for a good YouTube video, just to get an idea of the approach to the procedure and anticipate possible anesthetic needs throughout the case. The more prepared you are, the higher the chance you will get into tougher, more complex cases sooner.

The Day Of: Making a Great Impression

1. Arrive Early: Get there early. This is a no brainer but there is also no excuse for showing up late on your first day. Impressions matter, so don’t start off on a bad one. 
2. Ask Questions: Be a Sponge. Ask ALLLLL the questions. One of my preceptors told me during my first week that the most dangerous practitioners are the ones that don’t ask questions. Besides a short orientation when you start your job, this will be the only time you will ever be under the wing of other CRNA’s, so take advantage of their knowledge! They may have little pearls to make your flow more efficient or help you better understand the utilization of the anesthetic gasses. All that to say, there will also be days where the only thing you learn that day is what you are NOT going to do. As you go through clinical, you will start to develop your way of doing things. 
3. Introduce Yourself: Introduce yourself to everyone! Anesthesiologists, anesthesia techs, circulators, scrub techs and first assists can all have an impact on your overall clinical experience. Take the initiative and introduce yourself to the surgical team. This is where confidence is key and how you can make a positive impression early. Later down the road when you need something or are in a stressful situation, you already have some rapport with the team,
4. Verbalize Your Actions: Verbalize everything. If you did not have a shadow day before starting clinical then this is your first experience intubating a real human. You are nervous- everyone knows that. The best way to ease everyone’s anxiety is to verbalize everything you are doing even if it sounds silly. What do you see? Can you see the epiglottis? Can you see cords? Is it just a bunch of pink tissue? If you are having difficulty, it’s okay to step aside and let your preceptor show in the tube and you get the next one. Give yourself grace, take in the feedback from your preceptor and step up to and get the next one. An MDA once told me that in your training you will go two weeks getting every single airway and feel on top of the world then the following two weeks you’ll miss every single one of them. You are learning- that’s the beautiful thing about growth!

I don’t know about you, but being a student is hard and starting from the beginning is even harder. However, know that each and every CRNA started out exactly where you are. Take each day as it comes and remember that growth is not linear! If you have any other tips, share them in the comments below, so that new students starting clinical know how to be successful from the jump.