I need some tips on starting Iv's. I have been praticing In a level 1 trauma hospital (ER) for all of about 3 weeks. I am having so much trouble with them. Sometimes, it just so hard to feel the vein. I dont know if my hands are not sensitive to them or what. At first i would get a few and then miss a few but lately, I've been missing all the time and it's really starting to make me feel inadequate so i wanted to know if you guys can tell me something I don't know already. I would greatly appreciated and I sure my patients would too!
Okay, now let the venting began...I am so slow and I think my preceptor is trying to make me pick up the speed. For example, she hounds me about acknowledging orders (in a nice way) right away. But sometimes, I get stuck working up a patient and trying to make sure I'm doing the right thing, taking my time because I dont want to lose my license you guys. I'm paranoid about that, as we all are because we've worked so hard for that piece of paper. Okay back to the story, I wonder why she doesnt just acknowledge them for me if she sees i'm busy...I mean she is over me! Today, she ask "Have you seen your orders on 216?" I said no because I've been with this patient trying to get the labs drawn and sent off but i will look at them as soon as I finish this. She said, "Okay, we'll they've been on there since 6:30pm (it was about 7:15) and I get off at 7:30pm. I honestly did not want to leave all that work for the next person to do so I thought I was prioritizing but I guess not.
Also, I do ask simple questions but it only because I want to make sure i'm doing something right before I do it. So I may ask her about tasks related to protocol or doing something on the computer and lately I've notice a somewhat condenscending tone to her answers(it's minimal but I'm picking up on it).
I really dont want to form a negative opinion about her because I need her help. I am trying to keep and open mind and put my best foot forward each day I work with her. She's been nursing for 2 years so I would think she understands where I'm coming from but maybe she thinks I'm leaning on her too much, I don't know. Its just a little frustating somedays. And sometimes I feel like she doesnt have my back bc if she saw those orders today at 6:30pm she should have just acknowledged them. Heck, I was trying to do stuff for 3 patients and it was my first time having that load.
Anybody that has precepted, please respond. I so badly want to be a competent nurse and i want to crawl before i walk because I dont want to hurt a patient bc I was moving to fast. But I dont want to be a burden and a liability either nor do I want somebody looking at me like im freaking stupid and I'm trying to learn...Okay, thanks for your ears..Please give me tips on the IV starts.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
good evening,
i need some tips on starting iv's. i have been praticing in a level 1 trauma hospital (er) for all of about 3 weeks. i am having so much trouble with them. sometimes, it just so hard to feel the vein. i dont know if my hands are not sensitive to them or what. at first i would get a few and then miss a few but lately, i've been missing all the time and it's really starting to make me feel inadequate so i wanted to know if you guys can tell me something i don't know already. i would greatly appreciated and i sure my patients would too!
ivs aren't my thing anymore -- i used to be able to get blood out of a turnip but that was before the days of iv teams. what i would say to you, though, is it sounds as if your anxiety about missing veins is causing you to miss veins which causes you to be more anxious about missing veins which causes you to miss . . . .
every er nurse i've ever known has been great at iv starts, but every nurse i've ever known who was great at iv starts practiced a lot. so practice, practice, practice! it's a skill that can be learned.
okay, now let the venting began...i am so slow and i think my preceptor is trying to make me pick up the speed. for example, she hounds me about acknowledging orders (in a nice way) right away. but sometimes, i get stuck working up a patient and trying to make sure i'm doing the right thing, taking my time because i dont want to lose my license you guys. i'm paranoid about that, as we all are because we've worked so hard for that piece of paper. okay back to the story, i wonder why she doesnt just acknowledge them for me if she sees i'm busy...i mean she is over me! today, she ask "have you seen your orders on 216?" i said no because i've been with this patient trying to get the labs drawn and sent off but i will look at them as soon as i finish this. she said, "okay, we'll they've been on there since 6:30pm (it was about 7:15) and i get off at 7:30pm. i honestly did not want to leave all that work for the next person to do so i thought i was prioritizing but i guess not.
of course you're slow -- you're brand new. but your preceptor is right to try to make you pick up the pace. as a nurse, you don't always -- or even usually -- have the luxury of taking your time with anything!
and again, your preceptor is right to make you acknowledge your own orders. the goal is to take care of the patients, yes, but it is also to help you to become an independent and fully functioning nurse. if your preceptor does your work for you, you'll never fly on your own. yes, it would be easy for her to just acknowledge the orders. in fact, you have no idea how difficult it is to let them sit until you get around to dealing with them. sitting on my hands is one of the most difficult things i do as a preceptor -- but the orientee won't learn how to manage a full assignment if i keep helping them.
prioritizing, like critical thinking and picking up the pace will come. it won't come all at once, and it won't come until after you've spent a good long time feeling like a dunce and a failure (or at least, it didn't for me). but keep working on it, and it will come. from what you're saying, it sounds like you have a good preceptor who is determined to help you succeed.
also, i do ask simple questions but it only because i want to make sure i'm doing something right before i do it. so i may ask her about tasks related to protocol or doing something on the computer and lately i've notice a somewhat condenscending tone to her answers(it's minimal but i'm picking up on it).
asking questions about something you're unsure of is a good thing. the orientee i trust is the orientee i know will ask me before they go off and do something stupid. most preceptors feel that way. ask yourself, though, if you're asking the same questions over and over or if you're learning from the answers you get and taking it a step further each time. if you're not learning and just asking the same questions over and over, resolve to do better. keep a notebook with you and write down the things you're having the most trouble with. refer to your notes as needed.
for the life of me, i cannot remember the number to the pharmacy even though i call it several times a day. i usually remember numbers, but i think i have a mental block about that one because the last four digits are the same as an old boyfriend's phone number. (see what i mean about remembering numbers?) i finally put that one on my badge . . . do whatever it takes to help you. you'll use a lot of crutches now, but gradually you'll be able to do without them.
i really dont want to form a negative opinion about her because i need her help. i am trying to keep and open mind and put my best foot forward each day i work with her. she's been nursing for 2 years so i would think she understands where i'm coming from but maybe she thinks i'm leaning on her too much, i don't know. its just a little frustating somedays. and sometimes i feel like she doesnt have my back bc if she saw those orders today at 6:30pm she should have just acknowledged them. heck, i was trying to do stuff for 3 patients and it was my first time having that load.
anybody that has precepted, please respond. i so badly want to be a competent nurse and i want to crawl before i walk because i dont want to hurt a patient bc i was moving to fast. but i dont want to be a burden and a liability either nor do i want somebody looking at me like im freaking stupid and i'm trying to learn...okay, thanks for your ears..please give me tips on the iv starts.
two year nurses are probably the least likely to remember what it feels like to be a brand new nurse. they're still new enough not to know much, but experienced enough to think they know more than they do. and they don't want to remember being a brand new nurse . . . . that was a painful time for most of us. after 34 years, i remember acutely what it felt like and still cringe when i think of some of the things i said, did and thought.
your preceptor noticed your orders and pointed them out to you. she has your back. she's just not interfering, but letting you manage the assignment on your own. that's good news -- she must think you're capable of doing so! the best preceptors are aware of what's going on with the assignment and can gently ask questions to help you figure out your priorities without stepping in and taking over. congratulations -- it sounds like you have one of those.
you don't need tips on iv starts from us -- you need more practice and specific input from your preceptor who has probably already noted what you're doing wrong. i'm betting you are doing a good job . . . just keep up the learning and study at home.
You have gotten some great advice on how to deal with your preceptor. The feelings you are having right now are absolutely normal!!!
Transitioning from student to practicing RN is very very challenging emotionally, mentally, and physically! Be kind to yourself and realize you will feel like a complete idiot for a while. You are obviously not an idiot, because you are asking questions and making great effort to do things well, keep this up because that is what makes a good nurse. The scariest new nurses are the ones who do not ask questions and think they know everything.
As far as your preceptor hounding you to note orders, she is trying to guide you into priorities. Orders guide what we can do so the sooner we note them the sooner we can intervene, pts can get diagnosed, relief etc. so it is extremely important to try to stay on top of them.
IV's: I have been nursing for two years and I was horrible at IV's and I mean seriously embarrassingly horrible to the point where it became a unit joke. I could not ever feel a vein and thought I might have neuropathy in my hands or something! I just kept poking, and poking, and poking and all of a sudden in just the last couple months I have gotten every IV I have tried and now other nurses are starting to ask me to get IV's for them. The only way to get good is to keep trying.
Ruby, thank you so much for dissecting my post and giving me such good advice, encouragement and thank you for analyzing my preceptor for me from another preceptor's point of view. As far as asking the same questions over and over,yesterday I started writing down the stuff that i had questions/answers about so that I wont forget and so that I dont have to ask her over and over again because that's annoying and I know it!
I have started feeling the pressure that she's transitioning me and letting the leash out so I can work more indepently and I know in the end, it will be very beneficial to me. I've listened to everyone's advice and Im so happy I can come to this website and talk to people that understand where I'm coming from so thanks again for your time and expert advice.
P.S. I'm going to keep at those IV's...and you are so right about being nervous and having anxiety. Today I was shaking and trying to get my hand to stop and when I didnt get it the IV, I felt so bad when I had to tell my preceptor that I couldnt get it bc at this point I'm sounding like a broken record . And you are so right about the only way to get rid of that anxiety is by continued practice so I must continue on and I will
Specializes in Emergency Dept. Trauma. Pediatrics.
I was worried about doing IV's. I did get one on my teenager (they will do anything for money). I have had 1 successful on a patient but I had help and although he said I did it I think it was more him on the catheter part, and I have missed like 4 times between my instructor and step mom. I can get the flashback each time, putting in the catheter is where I blow the vein.
Now for my first nursing job I will have to do them on kiddos. Now I wish I had adults to do.
mividalocarn- we'll just keep trying..look at sugarcoma story.
sugarcoma-oh wow, everything said on here has made me feel a trillion times better but it seems as if your IV story is so similar to mine. I'll keep poking, i'm sure I'll get it.
and youre so right about the orders. I do see the urgency in them but sometimes I get stuck on other patients and just get so wrapped up in what I'm doing that I try to finish it bc again i'm slow and I get fixiated on getting done what i'm working on bc It's probaly already late anyway!
I think I'll set my watch to check my charts every 15 minutes no matter what I'm doing..unless it has something to do with airway, breathing or circulation. I got too bc I dont want my preceptor to feel like she talking to a brick wall! tHANKS AGAIN
I'm a new grad in the ER too. Recently done with orientation!
The only thing I'll add on IVs is that even when you get good at them, everyone has off days. I feel generally comfortable with them but can still go in to do an IV on someone with pipes you could hit with a dart across the room and still blow the line. Even the go-to experts we grab for tough sticks after we've missed have bad IV days.
My preceptor also pushed me to speed up a lot, especially at first. You have to work at a quick pace in the ER and you can't get stuck in one room for a long time with one patient because you have other patients and empty rooms that can become patients. If you need more time to get the basics down, ask for an extra week with only 2 patients. But you also need to push yourself while you have the luxury of a preceptor to watch your back: for most of my orientation I functioned just outside my comfort level.
With the questions you ask: learn where to go to look things up. I still ask questions but I also look up policies, look up the drugs, etc quickly first.
Specializes in General adult inpatient psychiatry.
I'm 2 years out of school and while I do think I am experienced enough to precept, I find myself impatient when someone doesn't get something (and it's something that clicked easily with me), so it's important to have that communication with your preceptor. I think that talking about mutual expectations, of yourself and of her are crucial for this to be a good learning experience for you and for her to be able to evaluate your progress and feel comfortable in getting her work done too.
3 weeks into orientation, I felt like I had so much information swarming around - orders, computer charting, pyxis...it was like I felt more helpless than I did when I started!
I understand where your preceptor is coming from because she is trying to give you a little dose of reality. When you take your own patients, she is not going to be there to acnknowledge your other patients orders.
When i was getting precepted, i felt really overwhelmed with everything i had to do. SBAR from 6:30-7:00. Medications/Assessments from 7:00-8:00. Rounds with Docs at 8:00-8:30. Report rounding info to Charge RN. in between all that, getting patients to dialysis, surgery, cath lab the list goes on and on. So there was alot to prioritize and working on timing was the most difficult thing.
I asked my preceptor to slow it down a little bit, and maybe start with 1 patient i'm responsible for. Then work my way up to 2 patients, then work my way up to 3 patients, then 4...and so on. It worked for me.
When i got off precepting, i was only allowed to take 2 patients at most for the first month or so (cant remember). Our hospital is great with the new grads and really tries to transition them slowly and does everything they can to help. Slowly transitioned into taking 4 patients. Sometimes i still get a little flustered with 4 and i prefer to take 3.
On nights we take about 5-6 patients, but there is less you have to do during the night that interferes with timing of things (less patients going to appointments, Docs not doing rounding etc. )
Starting a peripheral line is DIFFICULT and FRUSTRATING at first, and even discouraging if you missed on your first shots! When i was new @ a secondary hospital, i told my preceptor right away, "i just want you to know that i SUCK at starting peripheral lines, and i really need training on this". Few months have passed, and I transformed into a COMPETENT iv starter (except for babies--not really my thing lol). And about your preceptor: he/she is the one who lets you know that you will develop your skills over time, but at the same time thinks of you as a default (or new) trainee, and she looks after you all the time. Just "feel" your preceptor and over time you will consider yourselves as a floor tag team!
Its just a little frustating somedays. And sometimes I feel like she doesnt have my back bc if she saw those orders today at 6:30pm she should have just acknowledged them. Heck, I was trying to do stuff for 3 patients and it was my first time having that load.
. And you are so right about the only way to get rid of that anxiety is by continued practice so I must continue on and I will.thumb.jpg.5aa4d55557c0228e31b94de19666bbbb.jpg){kind=small}
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