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.
I started working October 2010 as a new grad and I can honestly tell you I have my good days with IV's and days where I can't get any in for a little while! Everyone will go through that, it does take practice but also depends on the veins! (and if they would prefer to cooperate!)
Don't be so hard on yourself, you've only been at this for about 3 weeks. There is a lot of time to learn and don't stop asking questions despite the tone of her voice. But please do talk to her and let her know your progress and what she can do to support you. She is probably just hormonal from the pregnancy or new to the process of being a preceptor and herself is getting used to the idea of having to preceptor someone completely fresh out of school.
I know when I am partnered with a final year student (if their preceptor is off duty), it does throw off my routine but I always try to be patient and understanding. I know that it will take longer because the student is still new (and so am I!) but I have to try and help them to the best of my ability.
I still ask questions and get the "how come you don't know that!" but asking is the only way for me to know. Last week I asked someone to help me put in an NG because it was my first time! So the learning never really stops.
I have been working for a 1.5 years now. During my residency, I remember going home and calling my sister and telling her "this woman hates me"! No matter how hard I tried or how well I did something, she never game me an praise. I give her a hard time about it now! She always says that she didn't want me to get "comfortable". It's good to get pushed a bit.
Remember, it's all about prioritizing-- time management develops over time. What is the most important thing to do now & when do I ask for help? If a doctor writes new orders, always try to just quickly scan over them. Forty-five minutes is a long time for an order to sit before a nurse looks at it. There are a number of things that could be written that are time-sensitive ( ie NPO for procedure, stat CT for r/o bleeding).
I remember when I was first on my own, other nurses would see me sinking and ask how they could help. I Try to identify tasks that can be delegate to other nurses/PCA's? Maybe get you caught up on vitals? Place IV for you? Obtain pt's history? And when you aren't busy, walk around and ask other nurses if they need any help, even if it's slow. They will remember it!
Re IV starts...... What worked for me was SITTING DOWN while I start the IV. Get all your supplies, grab a chair and Magic! Of course it could work because your angle changed or that sitting slows you down or forces you to relax.
inshallamiami- i'll thought about doing that but bc i'm in the er i've been a little skeptical about doing that. It possible to do it inside a room but my hospital uses hall spots too and there is alot of traffic from other hospital personnel but i'll try it in the rooms.
I also want to thank everyone for taking interest in my post and commenting..It has made me feel alot better about my situation
inshallamiami- i'll thought about doing that but bc i'm in the er i've been a little skeptical about doing that. It possible to do it inside a room but my hospital uses hall spots too and there is alot of traffic from other hospital personnel but i'll try it in the rooms.
I also want to thank everyone for taking interest in my post and commenting..It has made me feel alot better about my situation
I sit right on the stretcher if I need the stability and there's no chair handy.
RE: IV"S - warm towels, hang the arm over the stretcher. Feel gently & don't always go for the antecub. Put a little traction on the skin to stabilize the vein. Don't go in on top of the vein- try to go in the side of it-sneak it in. Watch out for valves- sometimes you can feel or even see them-try to go above a valve. Until you've more practice don't try to force a valve- yo may have to float it in. GET the labs first if you can!. Hep locks are great!
check out the infusion nurse specialty page. I read some great IV tips, esp the angle of entry. Don't give up!
Specializes in med/surg, cardiology, advanced care.
Dear Deetermined,
haven't read the whole thread so i don't know if these are repeats but make sure the tourniquet isn't too tight and i always had better luck using angiocaths instead of butterflys (intimas?), they are much sharper i think so you don't have to stick as hard. on people with fragile veins i would usually not thread the catheter all the way in, less chance of going through/blowing the vein. make sure you have good bright light, i have used a gooseneck type floor lamp and positioned it over the pt's arm many times. use your thumb to stretch the skin and stabilize the vein. elevate the bed so the pt's arm hangs down. if your hospital has an iv therapy team maybe you could shadow one of the nurses and pick up some tips. don't get discouraged, you can do it!
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.
Miller86
151 Posts
Hey!
I started working October 2010 as a new grad and I can honestly tell you I have my good days with IV's and days where I can't get any in for a little while! Everyone will go through that, it does take practice but also depends on the veins! (and if they would prefer to cooperate!)
Don't be so hard on yourself, you've only been at this for about 3 weeks. There is a lot of time to learn and don't stop asking questions despite the tone of her voice. But please do talk to her and let her know your progress and what she can do to support you. She is probably just hormonal from the pregnancy or new to the process of being a preceptor and herself is getting used to the idea of having to preceptor someone completely fresh out of school.
I know when I am partnered with a final year student (if their preceptor is off duty), it does throw off my routine but I always try to be patient and understanding. I know that it will take longer because the student is still new (and so am I!) but I have to try and help them to the best of my ability.
I still ask questions and get the "how come you don't know that!" but asking is the only way for me to know. Last week I asked someone to help me put in an NG because it was my first time! So the learning never really stops.
Best of luck:D