ICU approach vs Floor nurse

murseman24, MSN, CRNA · Mar 4, 2019

She just sounds like a biotch ICU/ED nurses tend to not stress the "small stuff", as they tend to have a better grasp on pharm/physiology, and take care of much sicker patients, so I would expect them to be very nonchalant on a med/surg floor. But no, this is a personality thing. She is just mean

**NICU Guy, BSN, RN** · Mar 4, 2019

On 3/1/2019 at 8:24 PM, Flylik3abr1 said:
I have been told by her to stick sleeping patients with their shots so I don't have to deal with a conversation

This is dangerous both to the patient and you. The patient will have a tendency to pull away when they are stuck with a needle while they are asleep potentially causing injury. You may also be slapped or punched by a not quite awake patient.

On 3/1/2019 at 8:24 PM, Flylik3abr1 said:
I have seen her reattempt an IV insertion wayyy more than the standard "two tries" before you get a PICC team

The two tries is not absolute. If the "floor expert" is attempting to start an IV on a difficult patient, they may try a few extra times before calling the IV team or PICC nurse.

Here.I.Stand, BSN, RN · Mar 26, 2019

Dang... like NICU Guy said that is dangerous! Plus I personally would NOT want to have the inevitable “conversation” as to why I woke somebody up by jamming a needle into them.

I am an ICU nurse and while I can be very matter of fact (gang members who get shot are the BIGGEST man-children I have met in my life!) I probably say “I’m so sorry” more here than anywhere. I work with trauma patients and I HATE causing pain... and some things I need to do such as repositioning are going to be painful even with a bolus of fentanyl prior.

Personally if I know a pt is a very difficult IV stick I may try once or not at all before calling the PICC team... again I hate torturing people. But the two sticks isn’t really a rule or even an industry standard.

Here.I.Stand, BSN, RN · Mar 26, 2019

Just now, Here.I.Stand said:
Dang... like NICU Guy said that is dangerous! Plus I personally would NOT want to have the inevitable “conversation” as to why I woke somebody up by jamming a needle into them.
I am an ICU nurse and while I can be very matter of fact (gang members who get shot are the BIGGEST man-children I have met in my life, and I will not reward their bad choices with coddling!) I probably say “I’m so sorry” more here than anywhere. I work with trauma patients and I HATE causing pain... and some things I need to do such as repositioning are going to be painful even with a bolus of fentanyl prior.
Personally if I know a pt is a very difficult IV stick I may try once or not at all before calling the PICC team... again I hate torturing people. But the two sticks isn’t really a rule or even an industry standard.

Here.I.Stand, BSN, RN · Mar 26, 2019

And just to be clear — I don’t deny a man-child pain control or try to “punish” him. However I have said “You didn’t get shot in your ARM” if one whines “I need someone to feed me”

smuin538, ADN, RN · Apr 2, 2019

Unused blood products should be returned to the blood bank. Sometimes it's difficult to maintain sterility, particularly during emergent/uncontrollable situations. Sticking patients while they are sleeping is dangerous and incredibly rude, and I can't imagine that any facility (or patient) would be okay with it. As far as the number of attempts to start an IV, that may be facility specific, but is she employed by the facility where she teaches your clinicals? It sounds strange to me that a clinical instructor would be inserting an IV--but to be fair, in PA, nursing students cannot start IVs and therefore our instructors would have zero reason to even attempt it.

As long as you don't see a patient being put at serious risk for harm, I would just use this as an experience to learn what NOT to do and how NOT to treat patients/approach your job. You can't make anyone follow protocol or develop respect for their career path, but you can make these choices for yourself. During nursing school, I've used experiences like these to really reflect on the risk to patients/staff/families/etc. and decide on the kind of nurse that I would like to be.

Flylik3abr1 · Apr 6, 2019

On 4/2/2019 at 10:38 AM, smuin538 said:
Unused blood products should be returned to the blood bank. Sometimes it's difficult to maintain sterility, particularly during emergent/uncontrollable situations. Sticking patients while they are sleeping is dangerous and incredibly rude, and I can't imagine that any facility (or patient) would be okay with it. As far as the number of attempts to start an IV, that may be facility specific, but is she employed by the facility where she teaches your clinicals? It sounds strange to me that a clinical instructor would be inserting an IV--but to be fair, in PA, nursing students cannot start IVs and therefore our instructors would have zero reason to even attempt it.
As long as you don't see a patient being put at serious risk for harm, I would just use this as an experience to learn what NOT to do and how NOT to treat patients/approach your job. You can't make anyone follow protocol or develop respect for their career path, but you can make these choices for yourself. During nursing school, I've used experiences like these to really reflect on the risk to patients/staff/families/etc. and decide on the kind of nurse that I would like to be.

Well, I am in a training program in Alabama and as far as I can see we as students can essentially perform any skill that an RN is capable of doing so long as there is supervision and someone to claim responsibility for the students aka the Clinical Instructor. Yes, she does work at the facility we were learning at. Our instructor does things in a very specific way. Rather than being a point of reference for the educational aspect of the clinical experience she essentially comes to the floor as a floater nurse and each of her patients are assigned a student. This way we are "supposed" to get more information from our patients due to the one on one approach but realistically we tend to get bored since not every patient is near death. So whenever a patient needs an IV or any other types of procedural order done a student is allowed to volunteer to attempt the skill but inevitably she is the one who has to do things. And I need to rephrase the IV complaint from earlier because yes I can see how two sticks can be different from another facility but she will essentially fish for the vein before even locating a good spot to start from like how we are taught to in school. The way I see it yes you have to do what you have to do but prodding an arm repeatedly with the same needle and creating several tiny wounds near a vein seems like a quick way to get sepsis which is why I have a huge problem with that. Also, the complaint with the blood products was: as I entered the CVICU to tour the facility I witnessed a nurse take all of the leftover blood products from the transfusion (bag with a small amount of blood in it, tubing, towels, etc.) and threw them straight in the trash. No thought about it she just chucked it straight in the garbage like that's where it goes.