Is this how my preceptor should be? Or is something wrong?

neneRN, BSN, RN · Aug 26, 2007

Nurses all have their own way of doing things and usually feel "their" way is best....some are more OCD than others...I'm kind of like this, but I can usually back off when I'm teaching/precepting someone else...okay maybe not usually, but at least sometimes, LOL!

annaRNC · Aug 26, 2007

Having been precepted by one nurse on days and several on nights I can say it sounds like my experience. Every nurse had a different way of doing things and while I was with them I tried my best to do it their way. Now that it's been a year I find I've taken pieces of what they all do and have my own way of doing things. The more experienced nurses are very good about teaching me things or showing me different ways. I think that's in part due to asking how they do things. Hang in there and remember orientation isn't forever! You'll have a chance to determine your own way soon.

Anna

Daytonite, BSN, RN · Aug 26, 2007

she's passing on to you little things like this that have proven to be time savers in the long run. not every person you work with is going to have the greatest personality to get along with what they are teaching to you. you're not seeing it now and she's probably not able to fully articulate the reasons why she does things this way, but i recognize what you are saying she is telling you to do as some things i do myself. her time management skills are probably why she was made a preceptor. you didn't mention that she was mean spirited so it sounds like you and her personalities just don't gel too well together. now, i, personally, probably wouldn't be that anal with you. i am articulate and might mention why i would tape an iv a certain way and why i would hang an iv bag here--once and maybe twice. after that, i'd let you sink or swim all on your own because i know that you will learn far more by having to spend the time cleaning up a big mess you made and figuring out how you could have avoided it. your preceptor is trying to save you some of that heartache because at one time she went through it herself and is trying to save you from having to experience it. however, she won't be your preceptor forever and soon you will be free to do things the way you want. i'm thinking that a few years from now you'll be taping and hanging ivs much the same as she is now telling you, much as you'll hate to admit it to yourself.

i just posted to a thread on iv starting on one of the student forums. i was an iv therapist and crni for many years. so many new nurses think that iv therapy is a skill that is as easily learned as any other and you are all wrong. it takes years and years to become proficient in the management and maintenance of ivs. it is such an important skill that there is a whole professional organization devoted to it. many of your hospital policies are based upon the standards written by this organization (the intravenous nurses society).

Zookeeper3 · Aug 29, 2007

Unless I'm reading this wrong, instead of having major issues to focus on, you're now fine tuning your skills.... WHILE in orientation. It seems to me you have it together. I spend months after orientation helping newbies prioritize, chart and manage time.

Ask your preceptor what they feel your major issues are for you to focus on, I set goals each day, and one for the week for my newbies...

Chloe'sinNYNow · Aug 30, 2007

i just posted to a thread on iv starting on one of the student forums. i was an iv therapist and crni for many years. so many new nurses think that iv therapy is a skill that is as easily learned as any other and you are all wrong. it takes years and years to become proficient in the management and maintenance of ivs. it is such an important skill that there is a whole professional organization devoted to it. many of your hospital policies are based upon the standards written by this organization (the intravenous nurses society).

d2nite,

i would like to read this thread of yours on iv's but cannot locate it. can you please send the link?

thanks!

november17, ASN, RN · Aug 30, 2007

I can see where she's coming from. I'm kind of fussy about where I hang my bags and where I put the tape too. I like to have the bags hanging so I can see the label easily when I go into a patient's room, and so that the tubing will not get easily tangled up. I also pull the pumps higher up on the pole if they are low so they are closer to eye level; so I'm not constantly bending over if I have to adjust/program them. I also make sure the front of the pump is easily visualized from the foot of the bed.

the taping can be important to prevent kinking of the tube if the patient is moving around a lot. It also drives me nuts when people put tape over the clear plastic IV dressing, obscuring the view of the actual insertion spot. Not only that, but if you ever have to remove the tape it pulls the clear dressing off too! Plus depending on what way the tubing is coming off the patient, it can make it uncomfortable or awkward for them if they are eating, reading a book, or whatever.

It might make more sense once you've worked a couple of shifts dealing with positional IVs and the darn pump keeps beeping because of an occlusion. Or trying to get around a cramped patient's room just to double check what is hanging and what the rate is! Sometimes it's like trying to solve a rubik's cube. Move table back, push chair to side, pull IV pole into view. Then move everything back.

Daytonite, BSN, RN · Aug 31, 2007

D2Nite,
I would like to read this thread of yours on IV's but cannot locate it. Can you please send the link?
Thanks!

I think this is the thread I was talking about. I made two posts to it:

https://allnurses.com/forums/f50/iv-therapy-245146.html

Chloe'sinNYNow · Aug 31, 2007

I think this is the thread I was talking about. I made two posts to it:
https://allnurses.com/forums/f50/iv-therapy-245146.html

I liked the articles as well as the links within the articles. Fabulous array of info in there. But GAWD the bickering about what gauges to use is giving me a HA and baffling me further. What's the bottom line there? If I do dare ask on another open forum?

Thanks again D2nite!

Daytonite, BSN, RN · Sep 2, 2007

i liked the articles as well as the links within the articles. fabulous array of info in there. but gawd the bickering about what gauges to use is giving me a ha and baffling me further. what's the bottom line there? if i do dare ask on another open forum?

oh, dare! makes life more fun!

there is always theory and logic behind the choice of the size and length of the iv device you use. the more assessment information you have about the patient, the more you know about the theory behind iv therapy, the better choice you are going to make. (there's that dog gone nursing process again!)

basically, you use the smallest gauge and shortest length of cannula that is going to give you the result you want. the reason for this is to

minimize trauma to the vessel (a fat catheter that is bigger than the slim vein you shove it into = physical trauma)
permit blood in the vessel to flow around the sides of the iv catheter, (see next line)
which allows for hemodilution of the solution being infused into the vein (iv fluid mixes with blood) which decreases chemical irritation of the internal vein wall and minimizes development of phlebitis

here is what my resource book has to say about the sizes of iv needles to use (page 383, intravenous therapy: clinical principles and practice, by judy terry, leslie baranowski, rose anne lonsway and carolyn hedrick, published by the intravenous nurses society, 1995)

14 to 18 gauge (largest sizes) - use for trauma, surgery, blood transfusion
20 gauge - continuous or intermittent iv infusions, blood transfusion
22 gauge - continuous or intermittent iv infusions, children and elderly patients
24 gauge (smallest size) - fragile veins for intermittent or continuous infusions, (we used 24g in newborns)

nurses who work in the er and critical care areas will tell you, quite rightly, that you cannot rapidly bolus (push) life saving iv medications very effectively through small bore (gauge) needles, so they like to have at least a 20-gauge or larger catheter in their patients. emts and paramedics usually insert 14 or 16 gauge catheters in the field if they can. whole blood will literally pour into a vein through one of these 14g catheters. our anesthesiologists were always happiest if we put 18 or 16 gauge catheters in their or patients, but they do look like nails and can hurt when being inserted. however, for patients getting iv fluids with piggybacks of antibiotics a 22 gauge catheter will work just fine in most cases.

in general, i mostly see nurses taking a 22g or a 20g catheters into a patient to start an iv. a 22g is easier to manipulate because it is smaller (small needle + large vein = less margin for error and better success). one nurse on an iv team i worked on put 24g catheters in everyone, no matter what. then, we would need to go back and put an 18g or 20g in them if they needed to get a blood transfusion or go to surgery and she hadn't checked their labwork or admission diagnosis before inserting the iv. :smackingf i know she was thinking of the patient's comfort in inserting the smaller catheter, but how considerate was it to subject the patient to a second stick when a few minutes taken to check their chart could have avoided extra anxiety and trauma?

Chloe'sinNYNow · Sep 2, 2007

Incredibly helpful Day2nite. Thank you soooooooo much. :flowersfo