Multiple IV's for one student, none for the rest... Is this usual during clinical?

broughden · Apr 7, 2018

Too bad you can't practice on each other.

In the army we do. I dont start nursing school till this Fall, right now Im just taking pre-reqs.

Do civilian students not use each other for IV practice?

artifex · Apr 7, 2018

Will you have an ED/ER rotation? I'm an LVN in a BSN transition program, and my experience with both LVN and current clinicals is that getting a chance to do an IV on the med/surg floors is a matter of getting lucky. Most of the skills practice I've had - IVs but also NGTs/OGTs, Foleys, etc., have been in my ER rotation.

Also, when I get to wherever I'll be that day, I am assertive about introducing myself and asking the staff to grab me for procedures or anything interesting. (This is based on my experience with precepting people in my LVN jobs; I'm not going to drag people off their butts and convince them to care about learning the job.) Also, I see you said you spend time helping CNAs and such - while it's awesome to show that you're willing to help out, you're in clinical to learn to be an RN, not to be a CNA. If you're in a room helping with a bed bath, you may not be visible, or you may look too busy, when a floor nurse has an IV that needs to be started now. And you may not see that something is happening down the hall that you can nose your way into. I'm not saying, sit behind the desk and ignore call bells, I'm just saying, there are advantages and disadvantages.

And you also get a certain amount of luck of the draw, not just with what's happening on the floor, but who is on the floor. Nurses are people, and people are weird, are introverted, didn't get enough sleep, have a sick kid, whatever. Some nurses love to teach and precept, and some don't. (I got lucky last week and had two ED nurses pulling me every which way...I started 7 IVs before lunch!)

turtlesRcool · Apr 7, 2018

In the army we do. I dont start nursing school till this Fall, right now Im just taking pre-reqs.
Do civilian students not use each other for IV practice?

Not in my experience. My program did not teach/allow IV starts. Once I was hired, I volunteered my arm to be used with another new nurse, but the nurse educator declined.

As a new nurse, my orientation included teaching on fake veins, but I had like 2 chances to do IVs in the whole time I was in preceptorship. It was a telemetry floor, and most people came up from the ED with IVs already placed.

We do have an IV team that will come for difficult cases, but they usually like us to try first. Also, putting in a peripheral IV for my patient's fluids or antibiotic isn't a priority when they have a trauma come in, a PICC to place, etc. Therefore, I usually break out a tourniquet and at least look and see if there is promising site. Although I've had some luck on people with good veins, I'm really not very good at IV insertion. People with crap veins, roll-y veins, etc. seem to be the majority.

broughden · Apr 8, 2018

Not in my experience. My program did not teach/allow IV starts. Once I was hired, I volunteered my arm to be used with another new nurse, but the nurse educator declined.
As a new nurse, my orientation included teaching on fake veins, but I had like 2 chances to do IVs in the whole time I was in preceptorship. It was a telemetry floor, and most people came up from the ED with IVs already placed.
We do have an IV team that will come for difficult cases, but they usually like us to try first. Also, putting in a peripheral IV for my patient's fluids or antibiotic isn't a priority when they have a trauma come in, a PICC to place, etc. Therefore, I usually break out a tourniquet and at least look and see if there is promising site. Although I've had some luck on people with good veins, I'm really not very good at IV insertion. People with crap veins, roll-y veins, etc. seem to be the majority.

Wow. Definitely not what I expected. We even put infantry guys through combat medic courses and teach them how to start IVs. The actual medics are expected to know how to hit veins in the feet or even neck....and have to practice to do it.

jess.mont, ADN, RN · Apr 8, 2018

I needed a blood draw at my doctor's office recently, and the nurse was a former medic. He said, "Doesn't matter to me how your veins look - I can get you anywhere. Even your neck!" I happily gave him my arm!

midwifemae · Apr 8, 2018

I haven't read all the comments, but I did see a few people suggest that you need to seek out the skills you are wanting to perform. I was assertive with the nurses who precepted me and I was able to get several opportunities to do those skills while other students did not. Sometimes it was the luck of the draw: IV infiltrated, IV in the AC that needed replaced, and patients who were willing to allow a student to start an IV on them. Also, you or the clinical faculty who is overseeing all of you can mention to the charge nurse that she or he has students who would like opportunities to do certain skills and they can keep an eye out for it. This has helped me get practice several times.

bgxyrnf, MSN, RN · Apr 8, 2018

.....

bgxyrnf, MSN, RN · Apr 8, 2018

Now I am very strong and confident in doing (IVs).

If you are a student, then you are *not* very strong; you are *overconfident.*

akulahawkRN, ADN, RN, EMT-P · Apr 8, 2018

I needed a blood draw at my doctor's office recently, and the nurse was a former medic. He said, "Doesn't matter to me how your veins look - I can get you anywhere. Even your neck!" I happily gave him my arm!

I know that kind of nurse. I'm one of them. I'm able to get a line started in nearly every patient that needs one. If I can't do it (and it does happen) then you're likely to need either someone very skilled with starting lines via ultrasound or you're going to need a central line. If I really need access, I'll use the IO... I work in the ED so I do get a lot of sticks. I used to get many more per day when I was actively working as a medic. If I see (or feel) a peripheral vein (including an EJ) I can usually put an IV into it. Sometimes I get completely humbled by an extremely tough stick... but that's how you learn and become better.

Seriously though, I do approach the task of doing IV starts with a measure of supreme confidence. It's not that I think that I'm that good, it's that I really am that good. However, getting that good takes a lot of practice and lots of doing your first attempt on the tougher sticks. When you're a student, it's tough because few people want to be the IV mannequin for a student. Honestly though, most people are able to get their required sticks done and move on. When you are a student, if you need a particular skill, let people know you're in need of them and let support staff know because that way you can just let them know that if you're helping them and an opportunity come along, that you can bounce out of what you're doing to get that opportunity and that you'll return at the earliest time. Depending upon the task, you might also want to let the patient know so they're not surprised if you bounce out when an opportunity knocks.

FSZ Student Nurse, RN · Apr 8, 2018

Hey guys,
I'm just wondering about your clinical experience in terms of gaining real-world experience with skills such as IV insertion, foley's, etc... The trend seems to be that certain people get multiple IV's (4 in two days for two students as an example) but none for any of the other students (there are 12 of us on this rotation). We kind of hoped this was a first-semester thing but now we are midway through the second semester and here we go again. Anyone else experience this and if so, how did you handle it?
Thanks in advance!

Wow, that is frustrating!

I have experienced this in clinicals, but I don't think it's calculated. In my experience, the students who tend to get more IVs, Foleys, etc. are the ones who volunteer for it. When the instructor asks a bunch of us, "Who would like to perform _______ today?", it's pretty predictable who will eagerly volunteer and who will look away.

I've handled it by becoming more assertive and also more open to opportunities as they present themselves. If there is a skill I've never done, I mention it to my clinical instructor and ask for an opportunity. Whenever the clinical instructor "offers" a skill, I volunteer for it; clinicals are not the time to be shy! Even when I'm not in the mood, I push myself to volunteer for the experience because I don't know if it will be presented to me again.

Good luck! :snurse:

JKL33 · Apr 8, 2018

Thank you for your reply. Everything you shared really hit home because my clinical instructor asked me if I am in the hallway and available in case there is an IV or a procedure and I told her no, I am not standing in the hallway. If my patient is stable and taken care of for the moment, I'm helping the CNA's. I'm giving bathes, refilling water, answering call-lights and offering to help other nurses'... I was slightly confused by her question to be honest. Like you, i don't feel like it's the right to do in any situation, to be standing around in the hallway while patient's go uncared for, call-lights go unanswered and hospital staff are understaffed.
Again, thank you.

Hi, Sherijo -

I wanted to drop back in after reading this ^.

It occurs to me that "back then" (when I was in school) nurses were more often directly involved in doing (or helping with) the activities I described in my first post - therefore, when I described helping with those things (personal care, toileting, etc), at that time doing so meant sticking pretty close to a nurse. I realize now that in many places staffing algorhythms are such that helping patients with personal care might mean that you are spending way more time helping techs than being visible to nurses.

So I would like to amend my answer. :)

When you're not working directly with your assigned patient, stick with a nurse. Maybe the nurse who is assigned to your patient, or another nurse who could use help or looks like s/he has a welcoming attitude.

I guess I'd have to say that neither simply being in the hallway nor being sequestered in rooms helping techs is the answer. Building relationships with nurses is likely part of the answer. Sharing your list of desired skills as Jen mentioned is also a great idea. As a nurse, I've also spent time with students just taking out the supplies, showing them how everything fits together, how they are held in the hand, etc., etc., and talking through the procedure so that when an opportunity arises they feel some sense of familiarity with those things. If there is a nurse that you click with a little, don't be afraid to ask if there might be 5-10 minutes that could be spent on activities like that, if s/he has time. Hearing how experienced people do things is very helpful.

**

Lastly, although I didn't drop in on this thread to argue about the importance of skills vs. knowledge---

I will heartily disagree that becoming adept at most of these skills we are talking about is something that can be learned in an afternoon (a claim I saw a few posts back). I've never once seen that be the case. And it is important. For a nurse, knowledge and skills go together. In my specialty (ED) if you aren't adept at both you are completely hobbled and won't survive. This doesn't mean one should panic if there are few opportunities to practice while in clinical; it's just that at the same time their importance shouldn't be minimized.

Anyway - best wishes to all who are making your way through your programs!

Sherijo71 · Apr 8, 2018

Hi, Sherijo -
I wanted to drop back in after reading this ^.
It occurs to me that "back then" (when I was in school) nurses were more often directly involved in doing (or helping with) the activities I described in my first post - therefore, when I described helping with those things (personal care, toileting, etc), at that time doing so meant sticking pretty close to a nurse. I realize now that in many places staffing algorhythms are such that helping patients with personal care might mean that you are spending way more time helping techs than being visible to nurses.
So I would like to amend my answer. :)
When you're not working directly with your assigned patient, stick with a nurse. Maybe the nurse who is assigned to your patient, or another nurse who could use help or looks like s/he has a welcoming attitude.
I guess I'd have to say that neither simply being in the hallway nor being sequestered in rooms helping techs is the answer. Building relationships with nurses is likely part of the answer. Sharing your list of desired skills as Jen mentioned is also a great idea. As a nurse, I've also spent time with students just taking out the supplies, showing them how everything fits together, how they are held in the hand, etc., etc., and talking through the procedure so that when an opportunity arises they feel some sense of familiarity with those things. If there is a nurse that you click with a little, don't be afraid to ask if there might be 5-10 minutes that could be spent on activities like that, if s/he has time. Hearing how experienced people do things is very helpful.
**
Lastly, although I didn't drop in on this thread to argue about the importance of skills vs. knowledge---
I will heartily disagree that becoming adept at most of these skills we are talking about is something that can be learned in an afternoon (a claim I saw a few posts back). I've never once seen that be the case. And it is important. For a nurse, knowledge and skills go together. In my specialty (ED) if you aren't adept at both you are completely hobbled and won't survive. This doesn't mean one should panic if there are few opportunities to practice while in clinical; it's just that at the same time their importance shouldn't be minimized.
Anyway - best wishes to all who are making your way through your programs!

Thank you for coming back and okay, that makes sense. I could have easily spent my free time with the nurse assigned to my patient; he was great and told me at the end of my two days with his patient that he was really happy to have had me assigned to said patient. He said that he felt confident that I knew what I was doing and that he didn't feel a need to check in with the patient or me for anything besides IV meds (none of us are there yet but will be this week) so yeah, I know he would have been good with letting me follow him. I just didn't think of it, I guess because we weren't 'assigned' to the nurse per se. However, after reading your comment, I now will think of if every single clinical day.

To everyone who has commented, thank you. Every single comment has been helpful because you have all shared a different perspective that I wouldn't have had otherwise. I've thought about this from each and every one of your points of view and now I can tackle the situation from something other than frustration and be productive about it :)