As a nursing student going to graduate in May, I know I should not get obsessed with my bad feelings about my last day clinical rotation in the hospital. I have a bright career and future in front of me. However, I need to get it off chest.
I never expected and understand why some nurses want to see the new nurse or a student fail. I started an IV on a old lady. When I put a blood pressure cuff on her , she said “be nice”. I did not pay attention to the red flag. Then when I was trying to locate a good vein, she said “be nice” again. I was a little confused, but I still did not get the dangerous signal.
I did three IV successfully before that. Stupid confidence. Shame on me. When I started to get needle in, she started screaming, “What are you doing? It hurts.” and starts cursing like “shi*” . I got nervous.
The vein is fragile, and she kept moving, then I blew the vein. I felt bad, and I kept apologizing. She was so mad, and turned to the nurse, “Why you do not do it?” And the cursing is really bad. The nurse said nothing to calm down the patient. She took it over and chose another hand. She showed off her skill and told me, ”See, you should choose this vein.”
I can tell from her voice she felt very proud that my failure would show how capable she is. I felt guilty, so I still stayed around to see if she needed anything. With all the confidence, she failed that vein too because the patient kept moving. She had to do on another location. She asked to get another needle very impatiently. I got it for her ... and the patient is still cursing. This time, I walked away. I could not bear those words.
About an hour later, I walked toward the nurse. She rolled her eyes on me. I do not think I deserve that, so I approached her and apologized that I did not get it. She avoided eye contact and said nothing. I asked her if the patient got her any trouble because of me. She said no. I could feel she didn’t want to talk to me, so I said thank you and left.
I felt really bad, but I got a lesson - if you do not feel right, walk away.
When I was about to leave, another nurse asked me if I could take vital signs and start IV for her new patient. I never talked with that nurse before. She never asked me to help or so. I said OK. I was there to learn and practice. The patient was 80 years old. She has chemo therapy a year ago. She was on wheelchair with oxygen.
She had really difficult vein. They put a portal under her clavicle. With all that info, the nurse still told the patient that I was going to start an IV on her. I didn't feel right. I know my limit. This IV needed a very experienced nurse. Why would this nurse do that?
I told the nurse directly I didn’t feel comfortable to start IV. She asked another nurse to start it. The nurse ended up spending a lot of time on it. And, she was in ICU for more than 20 years.
I was glad that I dodged a bullet.
Did she do it on purpose? I don’t know. But, I had enough. I turned in my badge on the educator’s desk and left.
Mild assertiveness is a contradiction in terms. When confronted with an expectation to do something you are not allowed to do, you must say so clearly. "I'm not comfortable c that" doesn't tell the nurse that you're not allowed to touch a port.
What I got from the scenario she described was that the nurse wanted her to start an IV on the patient with the port, not access the port itself. I've seen this practice where they avoid accessing the port in order to protect it from the risk of infection. The problem is that the patient has a port for a reason and they generally suffer multiple needlesticks in the attempt to find a good vein.
I do agree with the student's assessment that, if the patient needs a port, to begin with, she is not a patient that is a good candidate for beginners to practice their IV skills on. I ran into this problem when I did my internship on an oncology floor, but it's better to protect the patients and get your IV experience at another time. Also, even the most skilled at IVs have days when we just can't hit the broad side of a barn for some reason.
There is never a reason to put someone down about their skills. We should really put more time and effort into building each other up. Especially when teaching those new to the profession, specialty, or just new to a skill. Discussing what to look for in the optimal vein, selecting the right gauge for the patient and situation, and even including the patient in on teaching if they're able (such as asking where others have usually had success with them) is helpful. Using someone else missing a vein, especially with a patient that is not tolerating the procedure, as an opportunity to boost your own ego is always inappropriate. It's not some sort of twisted competition. In this case, finishing the task and discussing the case with the student outside the room regarding the particular difficulties would be more than appropriate, as well as tips for handling patients that twist and move during venipuncture.
I have no idea what is wrong with these kind of people. I encountered one too when I was a student— she hated her job, hated nursing, and was going to make students miserable. Just file it away and determine to never be like that.
I have been a nurse for two years, and this weekend I had students for the first time! It was super fun (to be fair, it was a slow day so I didn’t mind them taking forever to do tasks) and I showed them that I love my career. You will have students someday too and you will be a great preceptor because you know how NOT to act.
Unfortunately, being a good person is no guarantee that others will treat you well; it only increases the likelihood that most of them will.
I definitely agree with your saying. I tend to think "treat people the way you want to be treated", so people treat you well when you treat them well. But it is not a universal law.
On 4/20/2021 at 11:48 AM, TriciaJ said:
The bright career and future you have ahead of you will be a lot brighter when you can emotionally separate yourself from the people around you
I tried to improve my emotional intelligence. I know I should not be emotional about it, but the anger or shame or frustration just got me. I felt so bad for myself that day and the day after. Today, I feel much much better. I really need to work on the "emotionally separate yourself" part.
On 4/20/2021 at 11:48 AM, TriciaJ said:
Try to be as pleasant to everyone as you can muster under the circumstances. Sometimes the most stellar people will have a bad day and behave badly toward you. Maintain your compassion and professionalism simply because you are compassionate and professional.
I have no idea what is wrong with these kind of people. I encountered one too when I was a student— she hated her job, hated nursing, and was going to make students miserable. Just file it away and determine to never be like that.
I have been a nurse for two years, and this weekend I had students for the first time! It was super fun (to be fair, it was a slow day so I didn’t mind them taking forever to do tasks) and I showed them that I love my career. You will have students someday too and you will be a great preceptor because you know how NOT to act.
Thanks for being a good preceptor. I like teaching. Someday, if I have a student, I will treat him or her like I wanted to be treated when I was a student.
There is never a reason to put someone down about their skills. We should really put more time and effort into building each other up. Especially when teaching those new to the profession, specialty, or just new to a skill.
Most people will think this way, I believe. Most nurses I met are good and respectful. Unfortunately, not everyone wants to see others become more capable. It is fine when that person is not a preceptor. When I have to deal a preceptor who does not want to teach me or let me do anything, it is so frustrating, and I started doubting about myself. Will it be my problem that my preceptor does not want to teach me? What do I do wrong? Am I good enough? ....... Those are pretty bad feelings. Anyway, I was through those feelings now. I will not allow this to crash my little fragile confidence I made a great effort to build up. LOL. I need those tiny confidence or assertiveness.
Over the coming years, you will meet many people like those you met during your last day on that floor. There will be some great people to work with, both as co-workers and as patients and there will be some really horrible people too. The thing to remember is that you need to know what you're comfortable with, what you're willing to tolerate, and what you're not going to tolerate at all. When you have good, firm boundaries, you'll be amazed how quickly the toxic people stop trying to bother you because they realize that they can't bother you.
As to the IV starts, there will also be people that just don't tolerate pain at all and will scream, wiggle, shout, and the like from something that is usually a relatively minimal painful thing. It's a natural reaction to withdraw from pain. It's a self-preservation thing. However we can learn to tolerate certain amounts of it or tolerate pain when we know it is for a short period of time or for a specific purpose.
Don't get too enamored of the idea that ICU nurses are fantastic at doing things like IV starts. I'm an ED RN. I do IV starts (usually) several times a day on multiple patients and I used to be an active Paramedic. I've done this particular task for years. I really am that good. There are times that even I can't get a line. At my facility, I'm also ultrasound PIV trained and I usually can get those in one stick. It's very much true that even the most experienced of us can have trouble getting a line. I had a patient the other night that despite every trick in the book (and some that probably aren't), I just couldn't get IV access.
You were, however, given a great piece of education on your last day. You were presented a challenge that you felt you couldn't meet. You successfully said that you aren't comfortable with doing that particular task. It's often a difficult thing to say "no" (and even do it gracefully) when you're in a student/orientee/junior role. That's a huge thing to learn that you can do it.
Now I will say that when you have a chemo patient that has an implanted port, it is a clue that they're a difficult stick but they're not always a difficult stick. With port patients, I prefer NOT to access the port unless I absolutely MUST. There's just much that can go wrong and infection is just for starters. I've placed many a peripheral line in these patients. The key thing is to look and look, and look, and look, and look before you commit to doing the puncture. When I'm doing USGPIV's, I tell my patients that I will look and look and will NOT poke them unless I see something that I feel confident about. Same goes for regular IV lines. I had a difficult stick patient a couple nights ago and looked around a LOT until I found a vein that would likely work the first time. It was small but viable. I got it in one stick. I'm also not "married" to a given IV catheter size. I'll reach for an 18g or a 24g or anything in-between if it suits the need. These days I most commonly place 20g and 22g lines but I also happily place 18g as the need arises. Don't worry: you'll find your stride in this in due time.
Seriously, the biggest lesson often ends up learning to say "no."
You had no business accessing a port (not portal) anyway as a student and the nurse probably knew that. Good thing you didn’t try.
As an aside, being 20 years in ICU Is zero guarantee of venipuncture expertise. I was nearly 24 years and couldn’t hit a vein if my life depended on it, because all my patients had central lines or arterial lines with stopcocks on ‘em, LOL.
This is so true. Try having a nurse that works with IV drug users on a daily basis. They can get the hard sticks because they’re used to having crappy veins that the doc would never allow a central line for fear they’d leave to go get a fix
Specializes in ICU, Cardiac, ACLS, ED, School Nurse.
I also had many confrontations in nursing school. I feel it's a part of the process. Out in the "real world" you will confront more nurses just like this, and you will know who they are. I've learned to kill them with kindness, because it's not about you, it's about them. Keep on keepin on. I never learned IV skills in nursing school, so you're already steps ahead. Keep going!
You had no business accessing a port (not portal) anyway as a student
The port was surgically placed, needs a special needle and requires an insertion procedure that checks placement. But I do have to ask why a peripheral IV would be required (but I have found many nurses are unsure of the port procedure)
On 4/16/2021 at 5:00 PM, j0622 said:
I did not pay attention to the red flag.
What is the red flag...
On 4/16/2021 at 5:00 PM, j0622 said:
She asked to get another needle very impatiently. I got it to her, and the patient is still cursing. This time, I walked away
Do you consider supporting the patient? Walk away my a**. Maybe iif you stayed and helped hold the patient's hand and talked to her the RN would have an easier time....atleast you would know you contributed to the comfort of the patient. You are not there for an expertise in starting IVs (with 3 starts to your record)
On 4/16/2021 at 5:00 PM, j0622 said:
Then when I was trying to locate a good vein, she said “be nice” again. I was a little confused, but I till did not get the dangerous signal.
What is the "dangerous signal"? You have codes I do not understand -- red flag, dangerous signal
On 4/16/2021 at 5:00 PM, j0622 said:
I have a bright career and future in front of me.
Well pride always goes before the fall. Learn from this. 1) you did not support the patient at all. 2) you failed to achieve any relationship with your preceptor and think there is animosity there 3) You have started 3 IVs before. 4) you don't know what a port in the superior vena cavae is.
20 hours ago, HarleyvQuinn said:
I've seen this practice where they avoid accessing the port in order to protect it from the risk of infection. The problem is that the patient has a port for a reason and they generally suffer multiple needlesticks in the attempt to find a good vein.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
46 minutes ago, NurseSpeedy said:
Try having a nurse that works with IV drug users on a daily basis. They can get the hard sticks because they’re used to having crappy veins that the doc would never allow a central line for fear they’d leave to go get a fix
Oh yeah. We had a guy once at the city hospital with endocarditis (from IV drugs, natch) who they put a central line in. He would have breakfast, get his 0800 dose, and go outside to resume his usual occupations, to wit., dealing and running a string of ladies. He would come back for his 2000 dose, have a nice hot shower, and sleep well. This went on for six or eight weeks. Then, as they say, “lost to follow up.” Prolly in the river with a block tied to his ankles.
And when you pull those lines they are "crunchy" with a lot of sediment. Sometimes in home care you figure it out when the patient asks for more 'flushes'
HarleyvQuinn, MSN, RN, NP
222 Posts
What I got from the scenario she described was that the nurse wanted her to start an IV on the patient with the port, not access the port itself. I've seen this practice where they avoid accessing the port in order to protect it from the risk of infection. The problem is that the patient has a port for a reason and they generally suffer multiple needlesticks in the attempt to find a good vein.
I do agree with the student's assessment that, if the patient needs a port, to begin with, she is not a patient that is a good candidate for beginners to practice their IV skills on. I ran into this problem when I did my internship on an oncology floor, but it's better to protect the patients and get your IV experience at another time. Also, even the most skilled at IVs have days when we just can't hit the broad side of a barn for some reason.
There is never a reason to put someone down about their skills. We should really put more time and effort into building each other up. Especially when teaching those new to the profession, specialty, or just new to a skill. Discussing what to look for in the optimal vein, selecting the right gauge for the patient and situation, and even including the patient in on teaching if they're able (such as asking where others have usually had success with them) is helpful. Using someone else missing a vein, especially with a patient that is not tolerating the procedure, as an opportunity to boost your own ego is always inappropriate. It's not some sort of twisted competition. In this case, finishing the task and discussing the case with the student outside the room regarding the particular difficulties would be more than appropriate, as well as tips for handling patients that twist and move during venipuncture.