Clinic staff ask pt how to find injection site?

[MinneNurse]

My apologies ahead of time if this is posted in the wrong section.

I need some advice as to if I should report a situation I experienced and who to report it to.

I'm going to try to make this quick and simple, but if more details are wanted I can elaborate.

Today I went to my clinic to get my depo-provera injection and the CMA asked me,

"So how do they give this in your hip? How do they find the right spot?"

I explained how to find the site, and she then asked me after finding the spot, "Does this look right? Is this where they usually do it?"

After having to tell her not to pinch the skin during an IM injection, she told me "you don't look like you have enough meat though."

This is the third time at this clinic I have encountered a situation where the person giving the injection was unaware how to locate the appropriate site and/or the correct technique to administer the injection.

I feel this is not necessarily the staffs fault for not being aware of the location and techniques of giving these injections if this information came into practice after they have graduated and their facility has not trained them on it.

But I am very uncomfortable with the fact that this last time I was asked by the person responsible for administering my injection how to do it and where to give it. I'm a nursing student and I have learned about the appropriate injection sites and techniques, but she was not aware of that..

[MinneNurse, BSN, RN]

I wonder if maybe they're asking you specifically because you are so skinny. I know I'll ask hard sticks where nurses normally land IVs successfully on them. Really skinny people are a little daunting to find good IM or SQ sites on.

That definitely makes sense, and although I appreciated her comment about not having much meat, I'm not sure where that came from since I certainly have enough

[MinneNurse, BSN, RN]

What I find frustrating is that so many nurses and MAs continue to give IMs in the dorso-gluteal site, rather than the preferred ventrogluteal.

I agree with this, unfortunately it seems like quite a few of the staff members I've encountered there aren't familiar with the site at all. I'm not sure if this was never taught during their MA programs or what, but I will definitely be contacting the clinic manager on Monday.

[LTCNS, LPN]

I would understand that an MA doesn't know how to give an IM injection but an LVN, that's scary.

I have to agree with this.

[TMColeman, CMA, LPN]

I'm sorry you had that experience. I've been a Certified Medical Assistant now turned nursing student for 11 years. We had to learn the appropriate way to draw up and give ALL injections. I've worked and given injections in Allergy and Asthma, Internal and Family Medicine, Dermatology, and Community Health. I've lived in Georgia and currently in Iowa, and we are allowed to do it. Now with phone triage we are allowed to take messages off the phone, put them in the computer but we are limited to which messages we are allowed to call back and answer. We are also allowed to assist in Surgery and everything. We do preop and postop calls as well. So I think it truly depends on where you are. Its truly unfortunate that you had that experience though. Please don't think that ALL MAs are unknowledgeable about how to do things.

[TriciaJ, RN]

The nurse who works at my doctor's office did the same thing, but I think it was actually a courtesy of sorts. She knows I'm a nurse and knows that I've taken quite a few IM injections at home for a short, but intense, treatment.

When she gave me an IM injection at the office, she asked me where to give it and also asked, "How does your husband give it at home?" I told her, "No particular place and no particular way...". She gave the injection flawlessly.

I've also heard, from other staff there, that some nurses (as patients) can be very particular about injections, lab draws, etc. I wonder if this "fact" could be influencing the MAs and the way they interact with you at your doctor's office.

The nurse who gave my injection was an RN, by the way.

It's one thing to ask a patient if she has a site preference. I always ask a patient if she prefers her depo provera in arm or hip. It's a different story to ask the patient how to correctly landmark the site and administer the injection. Once they tell me their site preference, the correct technique is my responsibility.

[stephatron289]

Another CMA here: In agreement with Coleman, we are all trained in how to give injections for many medications. In internal medicine, if a patient is coming in for a shot that is routine, like a Depo, I will confirm the site that I'm going to give it in (deltoid or ventrogluteal)with the patient for which preference. We are also allowed to triage phones in our state, as we don't have RNs in our office and the front desk staff doesn't have any training regarding medical knowlege. I don't know why your particular MA didn't ask someone for clarification before she went into the room. It makes the MA look so bad when it comes off to the patient that she doesn't know what she's doing. Not really instilling a lot of confidence!

It's so frustrating when I come on here and I hear stories of MAs that lack knowlege of normal vital signs and administering injections incorrectly. I'm not saying we're all perfect (there are a few right now at work that I would like to slap silly for their nonsense!), but I promise we aren't all incompetent.

"Whatever you are, be a good one"

[nurseactivist]

Ick and ouch!

[Big Blondie, ASN, BSN, MSN, APRN]

This sounds bogus.

[imintrouble, BSN, RN]

This sounds bogus.

Bogus, or a student who misconstrues what and why an experienced nurse/MA says what they say.

When I was a student I critiqued every single thing I saw taking place in my clinical site. Every time I visited a hospital I critiqued the nurses.

I outgrew that nasty habit within 6 weeks of my first job.

[Farawyn]

I think it sounds sadly non bogus.

[lindarn]

If doctors thought that they could get away with it, they would have MAs doing brain surgery.

I read last year, that a physician actually trained an MA to cauterized rectal polyps. I don't know how he got caught. But that it the extent that physicians have taken this issue of MAs to.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW