Graduate nurse never inserted foley :/

TheCommuter, BSN, RN · Jan 10, 2006

It was the same situation in my class. I have never inserted a foley cath, only removed one.

If you don't know something, I personally wouldn't be shy about telling my preceptor that "I don't know how to do this."

Noryn · Jan 10, 2006

There are always procedures you arent going to get to do in nursing school. During my last year in an associate degree program they made us precept with our instructors for one shift in different specialities. Our local BSN students had to do this for well over 100 hours in their picked speciality such as the ER.

Anyway had it not been for 1 shift in CCU I would have never inserted a NG tube before graduating. I never took one out during college though. I am pretty sure I didnt insert a Foley in a woman during school either.

You know the procedure--you just need experience. Don't worry, you will get plenty of practice doing it every day once you start your clinicals. It may even work to your advantage that you tell your preceptor you have never did some of these procedures as they will probably give you tips on techniques they have learned along the way.

NG tubes arent that bad for us--they really suck for the patients getting one. Anyway of course make sure they have had no facial trauma or surgery--ask them even after checking the chart. If they havent then check your order for size which in my experience it is usually up to the nurse. After you measure the tube, I will curl up the beginning around my hand. Use plenty of lubricant and once it gets to the back of their throat have them swallow water through a straw. Swallow Swallow Swallow!

Then of course check placement according to facility protocol. Discontinuing a NG really isnt that bad. Give them some Kleenex. I take a towel, grasp the ng tube, tell the patient to take a deep breath then blow out while I use constant pressure to pull it out. You dont remove it as fast as you can but you do use a relatively fast motion. Then they will want to blow their nose and WHATEVER YOU DO, DO NOT STAND DIRECTLY IN FRONT OF THEM doing this--stand off to the side.

Foleys are really simple for the most part unless you get an obese woman or a geriatric patient who has contractures of their legs. The important thing is to follow your sterile technique, check order--you want to use the right catheter, and make sure you visualize the meatus. Sometimes there are people that are hard to catheterize. You may have to get a more experienced person--dont worry about it. Sometimes it helps for women if you put a pillow under their bottom. Men are so easy if they dont have an enlarged prostate. With a man just insert the catheter, if you feel resistance dont force--I pull back a bit, advance slowly and keep a constant pressure on the resistance and it usually goes through in a few seconds.

Nursing school just teaches us the basics--practice makes perfect. The one rule of thumb for everything not only in nursing but in everyday life is to NEVER FORCE THINGS. If you feel resistance inserting a catheter, ng, or even iv medication never use brute force. Of course you never say never and there are always exceptions to the rule.

GooeyRN, ADN, BSN, CNA, LPN, RN · Jan 10, 2006

I didn't have a lot of skills experience until I started working. Employers expect that. You will be ok.

doddlebuggin · Jan 10, 2006

was taught that when you use the betadine swabs to clean further away then near toyou ,with the third one clean down the center do a little twist (not the chubby checker kind) and the betadine will slightly pool at the urethra( did I spell that right) I worked part time at hosp but full time at ltc and they would come get me for difficult caths cause I did it so much.

grannynurse FNP student · Jan 10, 2006

I realize that I did my clinical experience, back in the dark ages, however everyone inserted atleast one foley, ng tube, d/c both and did much of the other basic nursing procedures. Sorry but I cannot understand why some students graduate without performing basic clinical nursing skills. We had a list, which had to be signed off by either our clinical instructor or an RN, and it had to be completed. And I graduated from a two year program.

Grannynurse:balloons:

jimthorp · Jan 11, 2006

I think it's pretty common. There were several in my class that I know did not insert a Foley or NG tube. I got do do several Foley Catheters, a suprapubic catheter, an NG tube, an OG tube, and start an IV. IV therapy and venipuncture was part of my curriculum.

We had one clinical instructor that would search out skills for us to do on non-student assigned patients. I was one of the lucky students. This same clinical instructor thought highly enough of me that she sent me to work in ICU for two days with those nurses. I got to perform some skills that nobody else in my class did.

jimthorp · Jan 11, 2006

I realize that I did my clinical experience, back in the dark ages, however everyone inserted atleast one foley, ng tube, d/c both and did much of the other basic nursing procedures. Sorry but I cannot understand why some students graduate without performing basic clinical nursing skills. We had a list, which had to be signed off by either our clinical instructor or an RN, and it had to be completed. And I graduated from a two year program.
Grannynurse:balloons:

Could it be that indwelling catheters and NG tubes are not as common as they used to be?

grannynurse FNP student · Jan 11, 2006

Could it be that indwelling catheters and NG tubes are not as common as they used to be?

Could be but down here, where I live, most patients are over 60, on strict I & O, some incontinent, so I would hazard a guess and say foleys are the rule rather then the exception. Same goes for NG tubes. And most same day surgery require foleys and NGs during surgery. That presents opportunity.

Grannynurse

jimthorp · Jan 11, 2006

Could be but down here, where I live, most patients are over 60, on strict I & O, some incontinent, so I would hazard a guess and say foleys are the rule rather then the exception. Same goes for NG tubes. And most same day surgery require foleys and NGs during surgery. That presents opportunity.
Grannynurse

Sounds like the new federal guidelines for indwelling catheters have not hit you yet. Incontinance is not justification enough to keep a Foley in.

Jasano · Jan 11, 2006

I think its sad that today's nursing schools frown to broadly upon skills and medical knowledge in general. I for one was very dissappointed in the training that I received in university and agree with many diploma nurses, that their hands-on, skills and medical knowledge focus, certainly serve them better in the hospital environment. I think that nursing is doing itself a disservice in pursuing this course.

Everything in my course was about caring and reflection. Students were terrified when they got out into the real world. (If only their patients knew how little practical training they had really had). Now, you have to be caring to be a nurse, but my god you also have to know how to provide the care! If find I'm really struggling to pick things up on the fly, and feel sorry for those who had become RNs directly, without spending time as RPNs first.

NikiChiki · Jan 11, 2006

Thank you everyone for all the replies! It means a lot. I am a GPN now and I take my NCLEX in Feb. but I have a job on MedSurg floor and I start nursing orientation tomorrow. I have the med test and all the other training first. Next week I am on the floor (with my preceptor). I'm very scared.

You are right when you say they teach all about how to be CARING and not exactly enough focus with the actual procedures. I had to get checked off on procedures but only on dummies. If they came up in clinical we did them but it just wasn't the way it should have been IMO.