How does your program teach/evaluate injections?

[amok]

I was perusing another nursing forum and stumbled on a discussion about how programs handle injections during skills labs and evaluations. My skills group has a practice lab where we practice drawing the "medication" (i.e., 0.9% NaCl) and injecting into mannequins/mimic pads (or hotdogs with "skins" during the intradermal, for bonus humor). On evaluation day our instructor watches the entire process from vial to injection individually. We perform the injections on a partner who then has their turn, all with supplies right out of the packages of course. We also swap the syringes we prepared with our partner, so we're always being injected with something we drew (with supervision) ourselves. Subcut was back of the arm, transdermal was the forearm, IM was ventrogluteal.

The discussion I saw was mostly about the IMs, but also about the whole general idea. People were outraged about the ventrogluteal IM! Like, suggestions for the student to get a lawyer and general freaking out. Is how my program does things atypical?

[night_owls]

I'd be upset if someone tried to give me a ventrogluteal IM injection too. All of my classmates practiced on mannequins before we went on to practice on patients. I know some of my classmates would be okay with getting practiced on (I've put IV's in some of classmates since they were kind enough to let me practice) but making it mandatory seems unethical. Our program runs a flu vaccination distribution to all hospital employees and even then we're not required to give them to each other unless we want to. We have the choice to receive our vaccination elsewhere. I would speak to the director of the course and if they tell you it is what it is, go up the chain of command (ex: class advisor, program director). It would help if a lot of your classmates did the same thing or if you went as a group.

[verene, MSN]

In my program we preform injects first in lab on a manikin and are checked off in the lab. We must then preform the first injection (of each type) in the clinical setting under the supervision of our instructor.

They give us lots of opportunities to practice though. The nursing students run the flu clinic each year for our university (including university hospital) for all staff and students. We are under the supervision of our instructor and the hospital occupational health nurses. Students typically give the first flu shot to classmate (because we all need them) and then spend an 8 hour shift giving them to employees and students, by the end of the day no one will ever forget how to safely give an IM. (I will note these are all deltoid injections, our first ventrogleutal outside of lab are on patients).

[amok]

I would speak to the director of the course and if they tell you it is what it is, go up the chain of command (ex: class advisor, program director). It would help if a lot of your classmates did the same thing or if you went as a group.

I don't mind at all, really? I'd imagine they would be OK making alternative arrangements in my program if a student had an issue, I just didn't realize that it wasn't the usual practice. I understand if others feel differently, but I would be much more anxious doing my first injections on patients. That's just me, of course.

[BAY AREA RN, BSN]

In my program we preform injects first in lab on a manikin, injection pads and are checked off in the lab. We then preform the all our injection in the clinical setting under the supervision of our instructor.

[night_owls]

I don't mind at all, really? I'd imagine they would be OK making alternative arrangements in my program if a student had an issue, I just didn't realize that it wasn't the usual practice. I understand if others feel differently, but I would be much more anxious doing my first injections on patients. That's just me, of course.

Ah, I see. I misunderstood. There is an advantage to practicing on another student though. You can get feedback on how to make your sticks less painful.

[jhcz]

My school has us practice on mannequins and then we do one sub-q shot on each other as long as we sign a form. Also my school no longer teaches the ventrogluteal IM site, they teach the Vastus lateralis site instead.

[katyq82]

Injection pad in lab with skill checked by instructor and then on a patient, supervised/guided by instructor in the clinical setting. I have found that the patients were more than willing to allow a new student to give the injection when they saw that my very competent instructor was guiding each step. I wouldn't be too thrilled to have another student give me an injection in the lab for practice but I know that some programs do it that way.

[lehaley1989, ADN, RN]

We learned on different types of mannequins and models, and had to demonstrate the skill in front of our instructors. Unfortunately we are unable to practice things like injections and IV starts on each other in my program thanks to my school's legal department. We did get to practice giving IM injections during our school's free flu clinic, though. Our first clinical experience begins in about 3 weeks, so I'm hoping to get some additional practice on real humans there.

[KelRN215, BSN, RN]

We gave each other injections of a small amount of normal saline in skills lab but it was definitely deltoid only for IM. I would not have allowed another student to administer a ventrogluteal IM injection on me. And, to be perfectly honest, in 10 years of being an RN, I've never given an IM injection in the ventrogluteal muscle. It's not a muscle used in pediatric IM injections. I've given vastus lateralis IMs a bunch in babies and deltoid IMs in older kids.

In school, during our pediatric clinical, there also was an outbreak of pertussis so we gave each other the TDaP boosters we were required to get.

[NICU Guy, BSN, RN]

Learned and checked off on mannequins and pads. My school runs a low-income pediatric shot clinic during the summer and early fall. I gave more injections that day then the last three yrs. as a nurse.

[WanderingWilder, ASN]

We practice on pads and mannequins and get checked off by an instructor. We do injections with patients with the instructor. We do give each other our flu shots in class, we have already been doing injections in clinical so its not really for practice. I don't see how injections are different then other skills, we don't put in a Foley cath in a classmate to practice before doing them with patients. Why would we need to practice injections on classmates?