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.
That is what I was thinking and why would you do that if there is a port? The fact that they have a port means their veins are probably a mess already. I think she was testing the student. Not fair to the patient. Sometimes floor nurses play head games with students and it is kind of creepy. A type of bullying.
I was not sure at that moment. I felt grateful when she gave me a chance to do it. I did the vitals fine. LOL. The good thing was the patient just got one stick. The IV was successful at first try. Good for that poor lady. She is a fighter.
Yes, the whole post is about my failure. You are so right that I failed to build a therapeutic relationship with the patient. I did stayed to see if they need anything else that I could help, and that is why when the preceptor needed another needle I could get it to her right away. But, I did not know how to support the patient who became more and more agitated because of my presence. Holding her hands? Could it be a physical assaults to her without her permission? She was already so mad at me despite of my non-stop apology. Yes, I failed to achieve any relationship with that preceptor. Yes, I did not know what a port in the superior vena cava is. Shame on me! Nursing student should know everything about nursing. But, I know what it is a port now when Google and other helpful people who patiently taught me now.
I agree that letting a nursing student or new nurse to start an IV is not to the patients' best interest. Why not a more experienced nurse? It is an ethical dilemma. I know that the patient whom I started an IV on has a higher chance to get a second poke compared to an experienced nurse. I never feel proud of that. I always feel sorry for that, and I always feel gratitude if the patient agreed to let me do it.
I had no problem with any another patients or receptor during my whole ten-day clinical rotation. But this situation, I did not know how to deal with. The red flag is that I sense the patient may not want me to be there at first. She thought I was not nice to her, so she said " be nice". I greeted her and introduced myself the way I did to any other patients. Seriously, I had no problem at all with any other patients. I asked her permission before everything I did. I asked her "Ma'am, I am going to put the blood pressure cuff on you, is it OK?". She said "be nice". When I sensed that she did not trust me at all, I should not even be there, I was so confused, let alone starting an IV on her. It is my mistake! I admitted it, and I learned from it.
And, please do not project my experience to any other nursing students or new graduates, especially the one you have to precept. The post is just about my failure, not others.
Nursing students or new graduates will ask dumb questions, and seem have no skills at all. They can get scared. They do not know everything about nursing. They may make stupid mistakes. If you are not comfortable to be with them, please please refuse the assignment.
Don't keep apologizing. You came here for support and do not deserve to be raked over the coals. This patient was a piece of work. Some nurses would be nasty to her in return. I have seen it. You apologized for the vein, that was a kind thing to do. Most nurses would not do even that. They would be matter-of-fact about it. The vein blew, I have to try in another spot. I think this patient picked up on your insecurity and it increased hers. You will get more secure in time. But do not fall all over yourself apologizing to nurses or patients. When you need to, do it. But not excessively. That only makes you look weak and patients need you to be strong and capable even if you are terrified inside. I never told a patient that they were my first IV, injection, trach, foley, nothing. I always acted like I had done it many times before. Act confident, but not cocky. Explain with kindness what you must do. You can agree with them if they say it hurts- "I know it does, we are almost done, not much longer, you are doing great", but do not crumble at their fear or their pain. I think walking away for a moment to compose yourself was OK to do. You will be great. I can tell you really care and want to do a good job. Hang in there.
Please advocate for better kits. Even if you don't access a lot, you and the patient deserve the best materials to work with.
Are you a community hospital or a critical access hospital? Yes that is difficult; some rural hospital nurses do not know to ask for port papers to look up the protocol for it on the internet. It is easier on Hickmans/Broviac as the manufacturers name is one the line. Manufacturers have pretty good sites.
I have been advocating for better kits, unfortunately this falls on generally deaf ears. Therefore I must do the best I can with what I have. We're neither a community nor a critical access hospital. We just don't have certain services in-house, oncology being one of them.
But do not fall all over yourself apologizing to nurses or patients. When you need to, do it. But not excessively. That only makes you look weak and patients need you to be strong and capable even if you are terrified inside.
Yes," being strong and capable even if you are terrified" is something I have to practice. Sometimes, being humble or modest is not a good strategy to deal with difficult situation. Saying sorry makes people more angry. Being mean and difficult will earn more respect, at least, people will not pick you up because you are not the soft peach. LOL. That is a hard truth. Thanks for the tips.
But, I did not know how to support the patient who became more and more agitated because of my presence. Holding her hands? Could it be a physical assaults to her without her permission? S
I was reading something today from my local school of medicine "that kindness needs to be taught to medical students". This is much the same in nursing. Holding hands is not the same as a physical assault.
On 4/22/2021 at 3:07 PM, j0622 said:
Letting a nursing student or new graduate practice IV is definitely not the best interest to the patient. Why not a experience one with 20 years of experience?
Selection of patient experiences with a student nurse is the answer to this. When I got off the elevator on the floor that I taught, atleast one nurse would tell me they had a "good patient for a student's experience." I am sure all instructors will relate to this. It was usually a patient that had a lot of CNA skills, not RN skills.
And when a student came up to me with the excitement "My patient needs a new IV" all I saw were roly-poly veins, misses and paper thin skin. (No thanks) . Sometimes I would start the IV but the student would morosely tell the clinical group "I could of started an IV).
I am wondering if you did not have an instructor with you? I just cannot work for a school that farms out students to a 'preceptor' to avoid paying faculty or because clinical associated hospitals do not have enough space to provide 10 students with individual preceptors with a professor-back up.
Selecting student-patient experiences depends on if the preceptor knows what skills were achieved in the nursing skills lab. I was a FT instructor but we always included are 'adjunct' in skills testing with a DVD of the skill-required performance. Would I send a student into a situation where they have 0% chance of achieving IV placement? That is a punishment to the patient and student and may ruin the only good vein the patient has left.
Yes," being strong and capable even if you are terrified" is something I have to practice. Sometimes, being humble or modest is not a good strategy to deal with difficult situation. Saying sorry makes people more angry. Being mean and difficult will earn more respect, at least, people will not pick you up because you are not the soft peach. LOL. That is a hard truth. Thanks for the tips.
No...you have some misunderstandings here. ?
Being humble and modest is a fine mindset from which to handle a difficult situation! I wonder if you are confusing humble and modest with lack of confidence and timidity. These are not the same things at all!
Being mean and difficult -- has that ever earned actual respect? I don't think so. It breeds all sorts of negative things, fear and hatred among them. Not genuine respect.
You are writing that coming from a place of humility isn't good if something is a little difficult and that being mean is the better way to go.
Please rethink. I mean that kindly. You have reported a situation where there was fear and timidity on your part. Unfortunately you were not supported through that--which was not right at all. But you can't mislabel this situation the way you are. That would be a much bigger mistake.
Humility goes along with a lot of other positive things. Personally I would say it is a huge part of being able to love, and in the context of this profession I would say it a big part of being able to care for others.
Being humble and modest is a fine mindset from which to handle a difficult situation! I wonder if you are confusing humble and modest with lack of confidence and timidity. These are not the same things at all!
Being mean and difficult -- has that ever earned actual respect? I don't think so. It breeds all sorts of negative things, fear and hatred among them. Not genuine respect.
You are writing that coming from a place of humility isn't good if something is a little difficult and that being mean is the better way to go.
Please rethink. I mean that kindly. You have reported a situation where there was fear and timidity on your part. Unfortunately you were not supported through that--which was not right at all. But you can't mislabel this situation the way you are. That would be a much bigger mistake.
Humility goes along with a lot of other positive things. Personally I would say it is a huge part of being able to love, and in the context of this profession I would say it a big part of being able to care for others.
Yes, you are right. I agree with you. It is not right to treat bad with bad. Bing kind and generous is the way. I need edit the wrong thought. I should not let fear and timidity get in the way. Thanks for being patient.
I was reading something today from my local school of medicine "that kindness needs to be taught to medical students". This is much the same in nursing. Holding hands is not the same as a physical assault.
Selection of patient experiences with a student nurse is the answer to this. When I got off the elevator on the floor that I taught, atleast one nurse would tell me they had a "good patient for a student's experience." I am sure all instructors will relate to this. It was usually a patient that had a lot of CNA skills, not RN skills.
And when a student came up to me with the excitement "My patient needs a new IV" all I saw were roly-poly veins, misses and paper thin skin. (No thanks) . Sometimes I would start the IV but the student would morosely tell the clinical group "I could of started an IV).
I am wondering if you did not have an instructor with you? I just cannot work for a school that farms out students to a 'preceptor' to avoid paying faculty or because clinical associated hospitals do not have enough space to provide 10 students with individual preceptors with a professor-back up.
Selecting student-patient experiences depends on if the preceptor knows what skills were achieved in the nursing skills lab. I was a FT instructor but we always included are 'adjunct' in skills testing with a DVD of the skill-required performance. Would I send a student into a situation where they have 0% chance of achieving IV placement? That is a punishment to the patient and student and may ruin the only good vein the patient has left.
Ma'am you are perfectly right! There is a long way to go for nursing students!
Yes," being strong and capable even if you are terrified" is something I have to practice. Sometimes, being humble or modest is not a good strategy to deal with difficult situation. Saying sorry makes people more angry. Being mean and difficult will earn more respect, at least, people will not pick you up because you are not the soft peach. LOL. That is a hard truth. Thanks for the tips.
No. Not mean and difficult. Strong. Confident. I have a feeling that your native language is other than American English. We have some concepts that may not be the same in other languages. You can be humble. You can be modest. But to the point where you seem insecure can frighten a patient. Your confidence will improve in time. I promise it will. Just avoid excessive apologizing, and I know that is hard. Women in particular tend to apologize a lot, and I think that is because we do not want to hurt anyone. But in your career it can hurt you to apologize too much, especially if it is nothing you can control. Better to acknowledge the patient's feelings in another way- "I know this is hard. I hear you". And if you do make a mistake then apologize. But not excessively.
I don't mean to pick apart what you have said. But I sense that you are still insecure and that is normal. It will get better. Even apologizing to us, here on this board is unnecessary. Just try to think hard before you say you are sorry, and think whether it is necessary or not. Was it something you could control? Is it going to make the person feel better if you say it? If the answer is no, don't apologize. Explain instead. "The vein blew. The trays are late because there was an emergency. We had to order your medicine from the pharmacy. It won't be much longer. This must be frustrating for you. I understand your frustration", like that.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 4/22/2021 at 12:54 PM, j0622 said:
Yes, the whole post is about my failure. You are so right that I failed to build a therapeutic relationship with the patient. I did stayed to see if they need anything else that I could help, and that is why when the preceptor needed another needle I could get it to her right away. But, I did not know how to support the patient who became more and more agitated because of my presence. Holding her hands? Could it be a physical assaults to her without her permission? She was already so mad at me despite of my non-stop apology. Yes, I failed to achieve any relationship with that preceptor. Yes, I did not know what a port in the superior vena cava is. Shame on me! Nursing student should know everything about nursing. But, I know what it is a port now when Google and other helpful people who patiently taught me now.
I agree that letting a nursing student or new nurse to start an IV is not to the patients' best interest. Why not a more experienced nurse? It is an ethical dilemma. I know that the patient whom I started an IV on has a higher chance to get a second poke compared to an experienced nurse. I never feel proud of that. I always feel sorry for that, and I always feel gratitude if the patient agreed to let me do it.
I had no problem with any another patients or receptor during my whole ten-day clinical rotation. But this situation, I did not know how to deal with. The red flag is that I sense the patient may not want me to be there at first. She thought I was not nice to her, so she said " be nice". I greeted her and introduced myself the way I did to any other patients. Seriously, I had no problem at all with any other patients. I asked her permission before everything I did. I asked her "Ma'am, I am going to put the blood pressure cuff on you, is it OK?". She said "be nice". When I sensed that she did not trust me at all, I should not even be there, I was so confused, let alone starting an IV on her. It is my mistake! I admitted it, and I learned from it.
And, please do not project my experience to any other nursing students or new graduates, especially the one you have to precept. The post is just about my failure, not others.
Nursing students or new graduates will ask dumb questions, and seem have no skills at all. They can get scared. They do not know everything about nursing. They may make stupid mistakes. If you are not comfortable to be with them, please please refuse the assignment.
You got some pretty blunt feedback from londonflo which of course isn't pleasant to hear. Then you responded with anger and defensiveness. I really don't think londonflo is trying to slam you as a person or a student. Just giving you another perspective that you can choose to make use of.
Physical skills (like IV inserts) are important. But a huge unseen (and often unaddressed) part of nursing is providing the emotional support. It's not something you can cross off a skills checklist because it's not something any of us ever get done learning.
I don't think londonflo is second-guessing how you were with that patient. I think she is giving you something to think about for the next one. When you approach the next patient for an IV stick or anything else, always be thinking "What kind of day is this person having? How are they going to experience what I'm about to do?" Just bearing those thoughts in mind will have an unconscious effect on what you project and the patient will usually pick up on that empathy.
Here's one concrete suggestion: when someone is having a terrible hospital experience and you feel helpless to change it, ask them "Is there anything I can do right this minute to make your day a little less crummy?" You'll get some surprising (and often helpful) answers.
Learning to be a nurse is where it stops being about you. A bit of a hurdle for all of us.
Better to acknowledge the patient's feelings in another way- "I know this is hard. I hear you". And if you do make a mistake then apologize. But not excessively.
7 minutes ago, nursemarion said:
Just try to think hard before you say you are sorry, and think whether it is necessary or not. Was it something you could control? Is it going to make the person feel better if you say it? If the answer is no, don't apologize. Explain instead.
Thanks for your advice. Very straight and clear. You are a very insightful person. I need to work on my communication skills. My confidence will improve overtime. I promise. I will keep you advice in mind.
j0622
29 Posts
I was not sure at that moment. I felt grateful when she gave me a chance to do it. I did the vitals fine. LOL. The good thing was the patient just got one stick. The IV was successful at first try. Good for that poor lady. She is a fighter.