Nursing students and new nurses.....about injection sites - page 5

I heard something today that just flabbergasted me......when I was in school back in the days of the horse and buggy, we had to name all IM injection sites and be able to demonstrate how to... Read More

  1. by   mlcsage
    Wow.............didn't know that such a simple thing as injections could become such a hot topic. Does anybody teach "Z-track" anymore???? Of course, if you are old school you probably figured out that I am too!
  2. by   buddiage
    we don't practice on people, we demonstrate on arms, injection pads, and verbalize what we are looking for, draw up "fake" medications that are saline or regular powder (to mix). We get into the clinical setting and CANNOT give injections without our instructor being present. It's not rocket science.
    We also have to know which ones to aspirate (and not aspirate) on, note consequences of incorrect administration, and yes, do the z-track, even if we might be able to count on one hand all the times we will do them in our life.
    We do not practice on other students, including basics like bathing, at all, other than doing assessments.
  3. by   buddiage
    Quote from TazziRN
    I heard something today that just flabbergasted me......when I was in school back in the days of the horse and buggy, we had to name all IM injection sites and be able to demonstrate how to administer at each site. I can give VG and glute and VL meds blindfold and asleep. Today we had a medsurg nurse float to the ER. She's relatively new, graduated about a year and a half ago, I believe. She was asking us how to find the glute sites to give an IM to a pt, because in school she had only been taught deltoids. Huh???? Let me add that she went to a very reputable nursing school and she has proven to be an excellent nurse on the floor. All pts admitted to the floors who need anything more than PO meds get IVs and injectables are given IV. My tech said that she received Toradol and Compazine in the doctor's office the other day (same doc's MA who gave my baby the flu vax I talked about here) and the MA gave both to her in the deltoids. My eyes went wide....both meds can be caustic, as well as 2 mls each. Is this what's being taught now???
    Only taught deltoid? Maybe she didn't know and was covering up her lack of knowelege? Lack of practice maybe? I admit, if it's not vastus lateralis or deltoid, i do get a bit more uneasy. Of course, I'm still first semester student, counting off until next week's finals :-)
    As far as MA goes, I can't believe they would even be touching injections.
    I'm still a student, but we are hammered in our heads that we need to know the proper administration of any IM drug and what NOT to do and rationales.
  4. by   TruDivaRN
    I just had my medication check off on Thursday Nov. 30, and we had to know how to find all IM injestion site as well as what guage syringe to use, also to demostrate an injection into all of those sites.
  5. by   mary78910
    I just graduated, yes we had to be checked off on all sites, with a plastic man lol. I gave my first IM injection to an adult my last 2 weeks of nursing school. SO for 6th quarter i got to give one deltoid and one glute. I had to have help with the glute, or so i thought, i did it right, and got the right spot, but because i only had to pass one test on a plastic man and never in the clinical setting, i was a bit afraid. And yes we went over Ztrack and had to be tested on it, i think like 1st or 2nd quarter, but after that test i have not seen it or used it. But i felt i got ripped off in clinical settings, i've never done a NG, put one in, taken it out, or cared for a patient with one. I've got to take out one cath, and put one in 3rd quarter. Thats it. HMM there is so much i haven't gotten to do and it drives me nuts. I use to ask the nurses on the floor if they had anything i would do it. Heck we didn't get to start charting till about 5th quarter. We did very little charting 4th. And that was just writing a narrative. So yeah, don't be suprised at the new students, blame the instructors for the most part. During my 4th quarter my instructor was nowhere to be found half the time (pediatrics, oncolody) and one student was hanging a piggy backt hats wasn't compatible, thank god there was a fluke in the machine (i still say devine intervention) When i cought her hanging it i asked if it was compatable an dshe said "the instructor said it's ok" but i went and got her nurse because the machine wasn't working and the nurse almost had a heart attack. I've had instructors that would check off my meds withought paying attention, i would go get another student to do it, i was afraid to trust them, and several times i'm glad i got another student because they would catch something wrong etc. We have to depend on each other as students, instructors are just there for easy money. Sorry any instructors out there, but man i got ripped off, i tought myself. Now fifth quarter i did have one heck of a male instructor, and he was shocked that i didn't know how to do stuff . But he was great, so i did have one good one in 6 quarters, thank god for him or i would be a complete idiot lol
  6. by   meannana
    also old school,but we have some new LPNs and they have been taught all the sites and when they are in doubt they will ask and older nurse if they are right before they give the injection. I work LTC and there aren't too many deltoids in our facility that I would want to stick a needle into
  7. by   jpetrunis
    Recent grad of a school in PA... as someone mentioned, we did have to learn sites, landmarks, gauges, angles, max mL per site, etc... in first semester. As far as testing, we had to demonstrate once then and once right before graduation, but it was what we "would" do, not actually ever doing it. As far as real clinical experience with injections, it was really hit or miss depending on your clinical sites and your instructors. Lots of SubQ (heparin and insulin), but very few occasions for IM. Most people graduating from my program only got to give an IM during the OB rotation, since the instructors tried to make sure that the students got to give the neonatal Vitamin K shot. But there's a big difference between giving an IM to an hour-old infant vs an 87-year-old LTC patient or a 22-year-old combative psych patient.

    As far as IVs, forget about it! we went over hanging bags, piggybacks, pumps vs good ol' counting the drops method, blood administration etc DAILY, but it was never even discussed that, hey, one day you'll have to learn how to put one in! Different sites and their pros and cons, gauge, how to find the vein, etc, not even discussed in classroom much less clinical. I was horrified when I figured out that I wasn't going to be able to learn until I was already a "real nurse".
  8. by   mary78910
    yeah as far as the IV's go, we had one session, not even in class, we did it on the computer. And that was the last few weeks before graduating. They sure don't teach ya how to do iv's. As far as pumps we dind't learn that in school, we only learned drip rate, it was up to the hospital nurses and clinical instructors to teach us. So we basically had to figure it out on our own.
  9. by   pvjerrys
    my first semester clinical group has performed the following in the clinical setting: insert & discontinue ng; insert & disc foleys; administer po, im, sqs, opiates; perform wound care (w-d, remove staples, apply steri-strips); administer enemas, e.g. harris flush; iv therapy (disc iv caths, change iv large volume); nasotracheal suctioning; learn how to assertively report changes about their pts to rn and mds. (list not inclusive.)

    i have given a list of procedures within their scope of practice to the units. i "troll" the units for procedures. the rns comment that my clinic students are very motivated & willing to do the procedures. and btw, for their experience, i have students give all ims in z-track technique.

    there have been bsn preceptees that have worked along side my students. they are amazed at how much these first semester students can do. for me, i take great pride in their competent manner and accomplishments.
  10. by   EarthChild1130
    I graduated last July from a BSN program and we learned in our 2nd semester how to administer IM injections, and I used that information quite a bit as my first job was acute care inpatient psychiatric nursing, which I love and miss terribly, as I am now working medical/oncology since moving from home. I will say that I am a 'crack shot' with a syringe! I do shots very well! LOL
  11. by   rnin02
    Quote from pvjerrys
    my first semester clinical group has performed the following in the clinical setting: insert & discontinue ng; insert & disc foleys; administer po, im, sqs, opiates; perform wound care (w-d, remove staples, apply steri-strips); administer enemas, e.g. harris flush; iv therapy (disc iv caths, change iv large volume); nasotracheal suctioning; learn how to assertively report changes about their pts to rn and mds. (list not inclusive.)

    i have given a list of procedures within their scope of practice to the units. i "troll" the units for procedures. the rns comment that my clinic students are very motivated & willing to do the procedures. and btw, for their experience, i have students give all ims in z-track technique.

    there have been bsn preceptees that have worked along side my students. they are amazed at how much these first semester students can do. for me, i take great pride in their competent manner and accomplishments.
    what a great teacher you are! most of my clinicals were quite lacking in chances to actually "do" things besides baths, bed changes and basic assessments, and basic medication administration. 4.5 years into nursing and i still haven't gotten the chance to actually put in an ng by myself, or a foley either for that matter. any patients i've had that needed them, have been the kind of patients that take the most experienced nurse on the floor to be successful at insertion, just my luck i suppose.

    back to the actual topic of the post, i've rarely needed to give an im outside of the deltoid, most have been small enough volumes that it was far easier to give in the deltoid. i have recently started working with newborns, so of course now i give ims in the vl.
  12. by   CarrieH
    Quote from TazziRN
    I heard something today that just flabbergasted me......when I was in school back in the days of the horse and buggy, we had to name all IM injection sites and be able to demonstrate how to administer at each site. I can give VG and glute and VL meds blindfold and asleep. Today we had a medsurg nurse float to the ER. She's relatively new, graduated about a year and a half ago, I believe. She was asking us how to find the glute sites to give an IM to a pt, because in school she had only been taught deltoids. Huh???? Let me add that she went to a very reputable nursing school and she has proven to be an excellent nurse on the floor. All pts admitted to the floors who need anything more than PO meds get IVs and injectables are given IV. My tech said that she received Toradol and Compazine in the doctor's office the other day (same doc's MA who gave my baby the flu vax I talked about here) and the MA gave both to her in the deltoids. My eyes went wide....both meds can be caustic, as well as 2 mls each. Is this what's being taught now???
    All I can say is there are some injections (ie - Bicillin) that I'm glad I can give it where the patient can't see it. I was also taught that the max in the deltoid is 1ml. As long as you know where the sciatic nerve is located, a gm injection isn't any more dangerous than any other location. I'm surprised that they're not teaching it anymore.
  13. by   MT Student Nurse
    I am currently in the last semester of nursing school and we were checked off on injection sites during our 1st semester and never used this info. I was recently doing a ER rotation and was able to finally use the information which I reviewed the night before. Ventral Gluteal was the site used most during the rotation. I did administer rocephin Vastus Lateralis to a 2yr. I participated in a Flu-Shot clinic yesterday which the deltoid site was used. During this event my instructor and one of the nurses participating were in disagreement about deltoid sites so that only added to my education. I guess I will continue to learn as I go along. :spin:

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