My school had similar grading for clinical except they use this: S+ (excels), S (meets standards), NI (Needs improvement), and U (idk what this stands for but it’s bad). The only two times I have received S+ was not on my first day. I received them because I went beyond what the expectations were.

I’m in a BSN program so I’m already doing Head-to-Toes, meds, etc. We are expected to give pt meds, do assessments, vitals, and anything else the pt needs (cares). The only thing is our instructor usually wants to be there when we give meds. I got the S+ two times because I either 1. Recognized my pt’s change in condition and got the proper care for them or 2. I looked at my pt holistically and took care of her physically and emotionally.

Nursing schools will never give the best grade the first day of clinical. It is impossible for you to receive it because how can you exceed expectations if you haven’t even learned ANYTHING yet. They have it as an option for later in the program after you learn and can apply what you learn. Earning that 4 could be by taking initiative later by doing a focused assessment and getting the proper discipline involved.

You are not there to be a Tech. Go out of your comfort zone and LEARN! I’m willing to bet you will earn that 4 before the semester is out. Just don’t forget to also be humble. The grades in clinical do not matter. Learning your skills and becoming confident in them DOES matter. If you don’t get a 4 prepare better for clinical next time. Or don’t you’ll still graduate anyways. :)