Broken arm and the emergency room

[AprilRosedw]

My mother broke her arm because she slipped on ice and snow.

We went to the emergency room.

It took about 2 hours for her to see a doctor.

My mom is a nurse.

My mother was trying to explain to a nurse that finding a vein on her was going to be hard, she suggested where to try but the nurse ignored her.

After a few failed attempts she quit and another nurse came in.

What do you do in that situation, if a nurse is not listening to you?

[sbyramRN]

I don't like people telling me how to do my job. I don't tell others how to do theirs.

[mjjlRN]

Often, as a nurse, i have patients tell me that they are "terrible sticks" and that they "always" require a picc line. some have told me that the ONLY place I will ever find an iv is on their left wrist, and don't even think about looking at their right hand, etc, etc.

I always smile, nod my head, and say "well, let me just look all over before I stick you, OK." Some times, they are right, and their only vein is on their left wrist. . .usually, they are wrong, and they have several possiblities to choose from. I always try to start an IV were it will bother the patient less (not in AC if I can avoid it, and not on their dominant arm if possible.) However, usually in the ER, they are attempting to draw labs and start a largeer IV at the same time, and they probably attempted the IV in the best place to suit their needs, even if it wasn't your mom's suggested place.

[8jimi8ICURN]

If i had someone who told me... hey i am hard to stick, please use (this) vein, then I would listen to them.

And if my nurse insisted on not listening to me, i would get a new nurse.

It doesn't matter if you don't like people telling you how to do your job. It is THEIR body. The patient is the one paying the bill, they are the one purchasing your services. If they are not happy with your job, you need to find out how to fix it. Now then, its different if someone is trying to tell you " i need exactly 32 cubes of ice in my water and you need to come in a fluff my pillow every 15 minutes." But when it comes to things like people not liking to have multiple attempts at IVs after they specifically warned you not to use a certain site, you deserve the bad patient satisfaction scores they give you.

If its a matter of life and death, i can see some leeway in something such as an iv site, but when its not life and death... why wouldn't you listen to your patients preference?

[sbyramRN]

If i had someone who told me... hey i am hard to stick, please use (this) vein, then I would listen to them.

And if my nurse insisted on not listening to me, i would get a new nurse.

It doesn't matter if you don't like people telling you how to do your job. It is THEIR body. The patient is the one paying the bill, they are the one purchasing your services. If they are not happy with your job, you need to find out how to fix it. Now then, its different if someone is trying to tell you " i need exactly 32 cubes of ice in my water and you need to come in a fluff my pillow every 15 minutes." But when it comes to things like people not liking to have multiple attempts at IVs after they specifically warned you not to use a certain site, you deserve the bad patient satisfaction scores they give you.

If its a matter of life and death, i can see some leeway in something such as an iv site, but when its not life and death... why wouldn't you listen to your patients preference?

So what happens when you stick them where they say, and it is not a good vein and you have to stick them again? I work in a pediatric ER and have parents telling me all day long how to do my job. When it comes down to it, I do what I know I can do. If I see a big vein in the R hand, that is where I am going for, even if the parent tells me to start it in the L foot. I go where it is easiest to get it the first time.

[Batman24]

I look at area that patient points out and most times I will go with that area. If however it is the dominant hand and I can do it elsewhere I do and explain why.

[nicolegrow]

So how many sticks is OK? If you can't get it by the second try, something different needs to be done. The nurse may not have listened to her patient, but she should recoginize when help is needed. I have seen in the ER a physician use portable ultrasound to ensure finding a good vein to spare the patient any more unnecessary sticks.

[8jimi8ICURN]

So what happens when you stick them where they say, and it is not a good vein and you have to stick them again? I work in a pediatric ER and have parents telling me all day long how to do my job. When it comes down to it, I do what I know I can do. If I see a big vein in the R hand, that is where I am going for, even if the parent tells me to start it in the L foot. I go where it is easiest to get it the first time.

I am not doubting your skills or your judgment. I understand that people micromanaging you is frustrating, but your situation is way different than the one the OP is describing. She's not talking about a parent who thinks they know what they are talking about. She is talking about a person who is a nurse who knows that she is a hard stick, and who was ignored. If someone tells you oh you have to do the left foot blah blah blah do you just ignore them, or do you explain what you are doing?

[rnto?]

If the patient knows they are a hard stick and is suggesting, hey, they usually have good luck here, it's just stupid, imho, to ignore it. Maybe they're not a hard stick and maybe you don't see anything there, but patients know their bodies. if they suggest something, a conscientious nurse will at least assess what they are saying. My husband is a very hard stick and I will always demand IV team-i try to stay out of the nurses' way for the most part when I'm playing patient, but just because you're a patient doesn't mean you don't know what you're talking about.

Nurses need to value what thier pateints are saying, end of story.

[Altra, BSN, RN]

My thoughts:

Half of the potential peripheral IV sites were excluded on your mother's broken arm. (my current facility frowns on using feet in adults & EJs)

If your mother continues to direct phlebotomists and nurses to one particular site, guess what? That site will soon be sclerotic & unsuitable. That may very well have been the case that day.

A couple other random thoughts not directed at the OP:

If after I set up all the supplies, fluid, pump and the meds I'm about to give you one one side ... and I'm looking at a nice juicy vein in your forearm ... and your 5+ family members have camped out on your other side ... then, you suddenly tell me you want it on the other arm ... I'm probably going to suggest we proceed where we are.

In my personal experience there is a high correlation between patients who insist on one specific IV site and patients whose next move is to tell me exactly what dose of meds they're going to need, in what port they want it administered, and how fast.

[AprilRosedw]

I understand that someone telling you how to do your job can be stressful.

My mother and I were the only people in the room including the nurse.

If I was having trouble finding a vein I would ask for help from another nurse or ask the patient.

I thought it was unprofessional. The situation is stressful enough for both the patient and nurse.

My mother informed the nurse that it would be hard to find a vein. Then, when the nurse was having trouble, my mother suggested another place. The nurse just kept trying and didn't listen.

I don't know how that nurses night was or how stressful but the next nurse listened and everything worked out.

She wasn't telling the nurses how to do their jobs. A suggestion is different than ordering her too.

My family has respect for all nurses. My mother brothers and grandmothers are nurses.

[CheyRN]

I work in corrections, and if one of the inmates tells me where I should try first I listen to them as most have had some up close and personal experiance with their venous system.