First shift of preceptorship: told that my IV priming is wrong

[seks]

The hospitals in this city use the Alaris pump and this kind of Alaris infusion set:

Prior to my preceptorship, I've always twist that end cap a little bit so that the IV solution can dribble out while priming.

However, during my first shift of my preceptorship, my preceptor didn't agree with my method. She said just to let the IV solution flow to just before the end of the line, put in a threaded cannula and then let the solution dribble out. She mentioned that my method would cause the end to be non-sterile?????

Can someone shed some light on this as my previous clinical instructors have seen me prime IV lines and they never had a hissy fit about the way I do it.

[ProgressiveActivist, BSN, RN]

You know it reallly is not worth getting worked up about. The inside of the end cap is sterile and so is the fluid.

You need to accept that you have a preceptor who has her way of doing things and that neither of you are wrong.

Just say okay, thank you and drop it. If you argue with her she will put you in your place right quick. So not worth it.

[Altra, BSN, RN]

Agree with the previous poster ... if you are going to judge your preceptor based on the precious little clinical experience you gained in school, you will have a very hard road ahead of you.

[seks]

Actually I didnt' argue with her. I just said something like "oh..no..didn't know that would be non-sterile"

Well, if she happened to be my side when I prime another IV line, should I do it MY way and let her criticize me again?

[CASTLEGATES]

Potential is there for fluid, regardless how it "appears to be" flowing, to be nonsterile if it's touching an outside environment. If you were mixing and creating an IV bag or drug under a hood, those are the types of rules they follow. Microscopically, you could theoretically find swirling within the drops of solution from the outside exposed to bacteria cap and the unexposed sterile fluid inside, so allowing it to flow with minimal disturbance (optimally not allowing it to drip at all) seems to be the best practice. If you sit back and look at it as if under a microscope and recognize what happened to our petri dishes when we removed the cover for 15 seconds, recovered and incubated, your preceptor has a point. Even the most sterile environments get seeded with a single bacteria, mold or virus. One cannot be too careful when there's a life at stake and there's absolutely nothing to lose by adding that extra care taking step. Just my two cents, but I'd learn why (exactly why) and definitely follow the hand of experience (and always, evidence based practice). Fluid transfers impurities, wherever the fluid is touching at a single moment is considered to have transfer and the outside of a sterile cap is exposed and potentially colonized by air drift or a brush of a hand, finger or dust (I'm not there to see, but I assume this is your preceptor's point and to that I agree). If it were my body, I'd want someone THAT careful hooking up my IV. Placing dirty fingers on a priming cap will definitely result in wet, transferrable contact from where your fingers were to the inside of the tube if viewed under microscope all that water swirrling (water never takes a direct route under magnification).

[ProgressiveActivist, BSN, RN]

seks said:

Actually I didn't' argue with her. I just said something like "oh..no..didn't know that would be non-sterile"

Well, if she happened to be my side when I prime another IV line, should I do it MY way and let her criticize me again?

Yes, you let her "criticize" you and have "hissy fits" until she feels that you are competent to function independently.

You are not equals. She is your teacher. She has years of skill and professional wisdom to share with you if you would get over yourself and cooperate with learning the policies and procedures of your institution.

I have yet to see a new grad who understands clean technique, aseptic technique and sterile technique.

[Altra, BSN, RN]

seks said:

Well, if she happened to be my side when I prime another IV line, should I do it MY way and let her criticize me again?

I'm curious about your thought process on this. You've already had one experience on this and received feedback that you found negative, and had your preceptor indicate to you that you should change your technique. But here you appear to be asking if you should repeat the process, and receive the same negative feedback again.

[seks]

So are you all saying my past clinical instructors are incompetent and don't know what they were thinking?

So who is right or wrong or too anal or giving unecessary steps in this situation? My current preceptor or my past clinical instructors/buddy nurses?

That is my MAIN question.

It really is frustrating when you get different opinions on a technique and I don't know who to believe or abide by. Guess that is part of the so-called "reality shock"

[Do-over, ASN, RN]

seks said:

So are you all saying my past clinical instructors are incompetent and don't know what they were thinking?

So who is right or wrong or too anal or giving unecessary steps in this situation? My current preceptor or my past clinical instructors/buddy nurses?

That is my MAIN question.

It really is frustrating when you get different opinions on a technique and I don't know who to believe or abide by. Guess that is part of the so-called "reality shock"

I think what people are saying is that, unless you really think your preceptor is advising you to do something unsafe, you should do it the way he or she instructs - especially after you have already been corrected. For now, they are in charge of your learning experience, not your former instructors.

Is it worth a battle, or the chance of a negative report about your progress?

You will be free to do things however you see fit soon enough.

[SRDAVIS]

\ said:

So are you all saying my past clinical instructors are incompetent and don't know what they were thinking?

So who is right or wrong or too anal or giving unecessary steps in this situation? My current preceptor or my past clinical instructors/buddy nurses?

That is my MAIN question.

It really is frustrating when you get different opinions on a technique and I don't know who to believe or abide by. Guess that is part of the so-called "reality shock"

If I was you just do it the way your preceptor wants it, definitely not a big deal just another way of doing it. You are going to find this situation so much in your career. We have about 4 generations of education on the floors. Maybe she just went to a class that was based off " new evidence based practice" and the others instructors haven't had that in-service. My friend be flexible and pick your battles. Ijs

[psu_213, BSN, RN]

Unless your preceptor is telling you to do something in a way that you KNOW is unsafe/incorrect, just do it her way. No one is calling your clinical instructors incompetent, no one is calling your preceptor incompetent. There is more than one way to do many things correctly (there are a few things where the only is one correct way). Unless this is one of the latter situations, just do it they way she wants and move on.

[cardiacrocks, BSN, RN]

seks said:

So are you all saying my past clinical instructors are incompetent and don't know what they were thinking?

So who is right or wrong or too anal or giving unecessary steps in this situation? My current preceptor or my past clinical instructors/buddy nurses?

That is my MAIN question.

It really is frustrating when you get different opinions on a technique and I don't know who to believe or abide by. Guess that is part of the so-called "reality shock"

First of all, you need to listen to your preceptor hands down! Second, are your clinical instructors still working as floor nurses? During orientation on my floor, we were instructed by nurses who now work for the education part of the hospital and haven't practiced floor nursing for quite sometime on how to insert and IV. Well, low and behold when I tried to insert it the way they instructed I was quickly re-instructed on how to do it PROPERLY. They told me these other RN's that taught you don't really know new techniques, I did what my preceptor instructed me from then on, no arguing. Please don't act like a know it all, you still have so much to learn, good luck!! Maybe eventually you will be a preceptor would you like someone to argue with you? Just think about it, and be respectful, this is just my 2 cents.