Tired Of Being The Bad Guy

[PMFB-RN]

The hospital where I work part time has a children's hospital incorporated into it. I occasionally work in the PICU and other units there.

The children's hospital has a standard practice of not doing painful or scary procedures in the kids room, and not having the child's nurse preform scary or painful procedures. Instead he kids are taken to a procedure room, accompanied by a child life specialists and an outside staff member is brought in to do the scary and painful procedures. That outside staff member is nearly ALWAYS me when I am working. I get a call from the nursing supervisor to please go to peds and start an IV, get and ABG, drop an NG, start a central or art line or some other procedure.

I get that they want to keep the child's nurse and room as a safe and caring place for the kids. I get that they do not want the kids to fear their primary nurse. I get that sick kids need procedures preformed on them. I get the whole thing.

I just HATE always being the one who has to play the bad guy. Despite taking as many precautions as possible to prevent pain in children during procedures, occasionally what they need done hurts them, and even when it doesn't it's usually scary for them. The child life specialists do a great job with the kids during procedures, but still crying kids is very common.

I am a father, I love children, I love caring for pediatric patients when I get the be the primary RN. I hate when cute little kids start crying just at the sight of me. Makes me feel like I must be a truly evil person.

Last night I worked transport on that hospital. When some of the other transport nurses and I went down to the cafeteria to grab some dinner there were a bunch of kids from the pediatric floor accompanied by a child life specialists there getting ice-cream sundaes. As soon as I walked in two or three of the little kids started crying as the sight of me.

Starts to get to you after a while.

[sharpeimom]

I have a foot in both camps. I was the baby, toddler, little kid who spent quite a bit of time in children's hospitals or a world famous clinic due to having been born with a very very rare neurological condition. So rare that I have been the subject of textbooks or chapters in texts.

I was the only surviving triplet. The genetic anomaly that killed them very shortly after birth was also expected to kill me too. The doctors and nurses I did best with fully expected the same good behavior from me that they did from the other kids. My dad was a marshmallow, but my mom had just one rule I HAD to follow during a procedure. I could make as much noise as I wanted during the

procedure but I had to hold absolutely still. If I did that, I was given a small reward afterward. Back during the years when I was little, there was a short-lived theory that babies and small children didn't feel pain in the same way that older kids and adults did. What that meant was that I wasn't sedated as I would have been if I had been older.

I feel that almost all procedures cold be done by most peds nurses. If you get a kid with miserable-to-stick veins like mine, then bring in an IV team member. But routine things can and should be carried out by a child's assigned nurse. I always preferred the security of having someone I knew carry out what I used to call the "bad stuff." Having my teddy bear have the same procedure done, then getting his sticker helped me to be brave too.

I agree. You should not b the only bad guy. I like your suggestion. I wish you luck.

[PMFB-RN, RN]

I agree this policy is extremely excessive. ALL kids have to go to the treatment room for invasive procedures and have a "safe" person come do the procedure?

That isn't the policy and I didn't say it was.

What about a 12 yr old who's been on chemotherapy for 2 years and needs his port accessed? I GUARANTEE he'd roll his eyes at you if you said to him, "Ok, Johnny, we need to keep your room a safe place so we're going to bring you to the treatment room to put your tubies in." I mean, I have three year old patients who can sit still for that.

Well I have never been called to access a port there so I would assume that would not fit the scary and dangerous criteria. hardly ever see anyone as old as 12 either.

And we definitely did not have the luxury of calling in someone else to do the procedures- we had an IV team but they always had a list a mile long and if you could do it, 9 times out of 10 you were better of just doing it yourself.

The vast majority of IVs are placed by the peds nurses. I only get called for the really hard sticks.

What about things like shots, finger sticks and straight cathing?

Never been called to do any of that either so I assume the staff RNs do them. I don't know exactly what the criteria for taking kids to the procedure room is but it's not for little stuff and I know it depends on the kids abiliety to handel it. All I ever see are the more difficult procedures and the most upset kids.

Well, in my current job I do procedures that a child would view as invasive all the time in their homes (PICC line and CVL dressing changes, port accessing, shots), sometimes in their own room and they all seem to get along just fine.

I have never been called for anything so simple as dressing changes, accessing ports, or giving shots.

The bigs ones I get called for are NG tubes, and usually after other nurses have failed, difficult IV starts, arterial lines, PICCs, IJ central lines, chest tube placement ( I assist the resident), IOs and other stuff like that.

Also occasionaly get called to do sedation for burn debriedment but then I am just another nurse in the room. Also just come down to "stand by" for procedures preformed by physicians like EGD's.

[gonzo1, ASN, RN]

Sounds like you def need a little break from this. The way I learned to cope with doing what you do is to remind myself that the kiddo needs something that I can do better and faster than most others. Just keep telling yourself you are not the one that caused the kiddo to be sick, but you can help in this "little" way to get them better faster.

You have a special skill, so be joyful you can use it to help. I can tell you that you are looked up to and appreciated by many, or you wouldn't be in the spot you are in. You sound like an extremely skilled and experienced guy. We need more like you

Hugs and good luck to you.

[Esme12, ASN, BSN, RN]

Kids are tough, they pull at your heart strings...I try to remember that a screaming kid is one that is going to be OK...its the silent ones that scare me. I remember that it really is for thier own good and they just can't understand. Do I think that these nurses might be abusing the system a little? Probably.

[ThePrincessBride, MSN, RN, NP]

They need to rotate that mess. It shouldn't be the same few people being selected.

You sound like a really nice, caring guy. Could you refuse to do it the next time or tell them that you need a break? I wonder if being male has anything to do with the selection process.

[PMFB-RN, RN]

They need to rotate that mess. It shouldn't be the same few people being selected.

You sound like a really nice, caring guy. Could you refuse to do it the next time or tell them that you need a break? I wonder if being male has anything to do with the selection process.

They actually have a couple of highly skilled nurses who normaly do these things. In fact one of them must be scheduled at all times EXCEPT when I am also scheduled. When they see me on the schedule for transport or unassinged they will usually request that night off. Other times when the designated day person wasn't able to come to work there may be several things lined up for me to do when I arrive. In this particular hospital they have a system called "expanded roll RN" (ERRN) I am one of them and the only part timer. Expanded roll RNs have policies and competencies specificaly related to us.

It often isn't the nurses who request assistance. The residents and staff physicians will often call the supervisor and request an expanded roll RN to preform a procedure, or assist with one and the supervisor calls me. It just usually happens that I am the only one on when I work, usually a night shift on the weekend and often after a day shift when no ERRN was available on days so there can be a list of things to get done as soon as I arrive. In fave I am often asked to come in at 1530 instead of 1930 just to do procedures in pediatrics before I start my shift.

I honestly don't think that being a male has anything to do with it.

[babysteps25]

Sorry you are in an unhappy situation and I hope you can find a resolution. I know this is off topic... But if you don't mind my asking, what kind of training/education/experience did you get in order to be able to start art lines/draw abg's, and insert IO caths?

[PMFB-RN, RN]

Sorry you are in an unhappy situation and I hope you can find a resolution. I know this is off topic... But if you don't mind my asking, what kind of training/education/experience did you get in order to be able to start art lines/draw abg's, and insert IO caths?

I have been placing IOs since I was trained to do so many years ago as an army medic. Drawing ABG from arterial sticks is a common, every day, ordinary task for all ICU nurses in the last few hospitals I have worked in. I know that in others it is not but it's pretty easy 90% of the time. I often use a doppler on the hard sticks, and an ultrasound on the really hard ones (usually extremely obese patients). The real difference is that I can draw from a variety of sites besides the standard radial & brachial site the ICU nurses and RT's draw from.

Arterial lines I learned from a class taught by CRNAs in a different hospital where I am full time RRT. All of our RRT RNs are trained to place arterial lines, PICCs and IJ central catheters using ultrasound. We train the medical residents to place them. I am the only RN who is privileged to place arterial lines in the hospital I wrote about in the OP and that privilege is based on my training and competency from my full time job and that happened because of a physician I worked with at my full time job who came to work at my part time hospital and he sort of made it happen for me. He did that because he was tired of having to drive in from home to place lines when his residents couldn't get them.

I have always volunteered for any training offered by my employer and sought opportunities to learn and be trained in things.

I expect you will be seeing more and more RNs trained to do things that physicians used to do as their reimbursement for doing them declines to the point that they won't do them anymore.