Procedure hoarding classmates

Daytonite, BSN, RN · Apr 6, 2009

i know you all must have or are experienceing the debacale that took place this morning during my iv therapy clinical.

actually, no, i wasn't there. i have no idea what school you are in. an instructor is the same as a supervisor. you will need a written recommendation from them in order to get your first job as a licensed nurse. they are the only ones who are able to attest to your ability to perform the duties and behavior of an rn. on your written write up, which you will probably need to sign, you may disagree with it but make sure you give your own written account of the situation but make sure you keep it very factual.

pinkiepie_RN · Apr 6, 2009

You have an IV therapy clinical? How cool! Sorry you weren't able to do IVs today; at my school they just teach in a lab and we're told we'll learn OTJ after graduation.

newtress, LPN · Apr 7, 2009

I've been actually looking forward to the IV therapy clinical. I think we're lucky to be able to do this. I should have said you all may have had an experience like this instead of you all must have had an experience like this. I was directing this incident and sharing it with current students. I'm an older student (49 yo) and have stayed low keyed and respectful toward others and my instructors. This is why I was so taken aback by what felt like being shot at against a wall by three people, and six eyes burning holes in my face. The imitation of me and the dramatic animation by my instructor complete with dialog that didn't come out of my mouth was so classic of a grade school bully. Again, I have not ever seen this in the two years at this school. I also have seen people do this to others that were guilty of their own lack of professionalisim. Literally being made fun of with the other 2 students joining right in with the instructor. This is wrong. If there had been say the usual 10 students post conference, I don't think this would of happened. This instructor and these students have gone to lunch in her car with her and returned for the last hour of the class day recently. How could she not be partial to them now. What's with making a student feel like an outsider when she IS a student. Read the scenario again.

Daytonite, BSN, RN · Apr 7, 2009

let me tell you about my experiences learning iv therapy and i am not conceited when i say i am a master at it. i was nationally certified in it with the ins but i had to take the national exam twice because i failed it the first time. it is a difficult exam and i failed the electrolyte portion of it. i worked hard to become very good at iv insertion, but i wasn't always that way. i worked on iv teams for 7 years. iv insertion is not an easy skill. after 6 months on the job as a new nurse, i knew i was having difficulty with this skill because i was constantly missing the veins. my first stick (which i missed) was on a celebrity. i was so embarrassed. i was advised to take the 30-hour course given to lvns who wanted to be certified in this. at first i was insulted. i was an rn, for pity sake. but i finally decided to do it because post-graduation there was no other way to learn the skill. i went. this was in 1980. i drove to long beach every week for about 6 weeks to attend this class and was i glad i did. the instructor turned out to be an rn who was a former navy corpsman. he knew his stuff. although i was surrounded by lvns i brought my months of experience as an rn already doing ivs with me and i think that made a big difference. i picked this guy's brain about some things each week and then i went back and i put into practice what i was learning on patients. this instructor was also a member of nita (the previous name of ins) and talked to us about the nita guidelines. i started looking for ivs to start and began following nita guidelines. within 6 months i was so improved that my supervisors would occasionally start to ask me to go to other units to try starting a difficult iv. at the time, i was flattered. every difficult stick became a challenge i was determined to know why i could or could not be successful at. 10 years later i finally had the opportunity to become part of an iv team and i jumped at the chance. i was starting 20 to 30 ivs a day, 5 days a week on the iv team. i honed my skill at recognizing phlebitis and infiltrations. sadly, however, i could see that many of the staff nurses were not very skilled in this. worse, many of them didn't seem to care. i saw some terrible phlebitis and infiltrations at that job. it was better at the next iv therapy job where our team had responsibility for all ivs in the house and made rounds to check all iv sites twice a day and change iv sites as we deemed necessary.

iv therapy is a difficult technical skill. believe me, you will have hundreds of opportunities to start ivs in the future. when you are new at it you will miss more veins than you will be successful. when we took learners around with us we always tried to find patients with garden hoses for them to stick. however, in reality, as a practicing nurse, that will not always be the case. the patients may be elderly, frail, dehydrated or the good veins already used up, they have edematous arms or their arms are phlebotic from previous ivs. it takes a lot of experience to work around these conditions successfully. i told our medical students that inserting an iv is like putting a steel pipe inside another steel pipe. you have to be dead on accurate. and, you can't see the pipe you are trying to get into or the direction it is going all the time. the nurses over on the er forum started a wonderful thread asking for tips on how to insert ivs. while you are waiting for your chance to finally get your first sticks done you might want to read through that thread which has gotten quite long. there is a lot of good stuff on there that you won't find anywhere else--loads of experience. https://allnurses.com/emergency-nursing/iv-tips-tricks-3793.html - iv tips and tricks

i know you are upset at the immature behavior of these people. i was a supervisor and manager myself and, believe me, i've seen managers who engaged in some childish behavior as well. being in a leadership position doesn't make someone a saint. you wouldn't believe some of the things i saw managers do to each other--and i thought staff nurses could be nasty. this is life. they may have acted like vultures, but you need to keep secure in yourself that you have a different purpose in mind. you want to be (1) a better person and (2) a better practitioner. you will sleep better a night. i promise. and, i also promise that you are going to have the opportunity to start all kinds of ivs. i estimate that over my 30-year career (and i started no ivs in nursing school) i started over 40,000 ivs and placed over 100 picc lines. those are just the successful ones. it will happen for you as well.

i've put together all kinds of information about ivs and iv therapy. it is on post #5 of this sticky thread: https://allnurses.com/nursing-student-assistance/any-good-iv-127657.html - any good iv therapy or nursing procedure web sites. your day to shine will come.

newtress, LPN · Apr 7, 2009

Oh how I appreciate you, and love seeing you here Daytonite. I read your reply X thrice. You are not only seasoned, you are saged. You were completely right in saying it is like trying to put a steel pipe inside another steel pipe and having to be dead on accurate. I aim to look at your sticky thread #5 after this. That would have been so darn dandy if you could have been on the day surgery and endoscopy floors today!

Update: I reported to the day surgery floor with the co-classmates this morning and yeah, they still continued (pardon the pun) needleling me relentlessly. Back in the day my saying was BFD, and that's how I went on pursuing what I needed to get done regardless. I did not mention anything further to my instructor regarding the total meltdown that took place yesterday. I was there to get IV insertions done timely to get these patients off the floor and into the OR. It seems to be a running theme with patients and facilities that you get ones that come in batches. All of them were male, big big burley guys with thick rhino skin and I wasn't allowed to insert AC, and had to use only 20G and no exceptions. I had attempted all 7 of them dorsal hand and it was a no go... AND a no go for my instructor also. She was thoroughly challenged and at least I didn't feel like it was bad technique on my part. I went to the endoscopy lab and was finally allowed to do one AC with a 22G and it went in like silk. My first one at another facility was absolutely flawless also. The difference in using what I had to use there today and the other facility were totally different catheters in their mechanisim and I felt it made a very big difference. I'd like to see the information regarding this as to there being a difference in what you are using. I'm sure Daytonite you are so well versed on this subject. As soon as I was allowed to change guage it was like... man what a relief, this works. So my question is why must a patient(s) have to endure bunged up hands or arms and be stuck and infiltrated numerous times when there is "the right tool for the job." I believe such expertise as yourself and the right IV cath is a great combonation. I have one more to do and I'll be signed off. Thank you again. I value your insight and advice, and all the extensive sharing you do for us students!

cursedandblessed · Apr 8, 2009

luckily my experience yesterday was not so dramatic, but i was still ticked about it. it was one of my days to have two patients, and it was 1:30, we go off the floor for post conference at 2 pm. as well i had a patient who needed to go for a procedure at that time. well i was doing my final cleaning of my first patients room and hadn't cleaned the dynamap yet, when one of the other's asked to use it. i said sure, i'm still cleaning and when she was done, i'd need it back for patient # 2. the third student came down the hall after i'd finished with this patient, and asked if i knew where a dynamap was, i said well so and so has the one for this hall, and i'm waiting for it so i can complete my 2nd patient's vitals. the little you-know-what went down stood outside the room and took it (without cleaning it) to her patient's room and left me out in the cold.

so i went and walked down to the other hall and got one (like she couldn't do that herself) took my vitals, cleaned the patients room, cleaned the machine, gave report, and kept my mouth shut.

1. she came down to a hall that was closer to her patients room instead of using the equipment for her own hall.

2. she knew she had to wrap things up by 2 why did she wait until 1:40 to look for the machine.

3. i specifically told her i was waiting on the machine, but she took it anyway.

4. i thought i was being nice by not hogging the machine, since i had to finish some things up before i went on to my next patient.

Daytonite, BSN, RN · Apr 8, 2009

IV therapy and insertion of IVs is a skill. People get stoked at the success of inserting their first or second IV and I know (because of years at doing this) that there is so much more involved to hitting these targets successfully. If it were such an easy skill they would let anyone do it. At the moment, not all states even allow LPNs to do IVs. California has been permitting it for some time, but LVNs here must take a 30-hour course and get certified. Most states that let LPNs do IVs have the same restrictions. When you must put an IV into the arm of an edematous or obese lady or someone with an already bruised up arm that no veins pop up when you put a tourniquet on is when you realize that there is more to this skill than just looking and sticking.

newtress, LPN · Apr 8, 2009

Yes, and better left for the pros to do. A lot of folks get certified in phlebotomy and I remember some that have drawn blood on me that were swift and precise like a hawk. Others.. OMG. I see the difference between drawing blood and starting an IV. But both procedures you need to be really really skilled at. Veins seem so decieving.

To the above poster, This sneaky pete behavior genuinely ****** me off to no end. I think what bothers me the most about it is that I can't say anything about it as it is happening or after they do their deed. Any upheaval during the clinical rotation always gets nailed on the person who did not do the deed if you make mention of it and I don't get that. I just don't have the cahones to bum off with a classmates wheelie knowing if I did they would be bumped out of getting their VS done. I'd at least ask, or time a trade off or something. No manners or maturity, and I expect to hear "well geez you get that anywhere in the workplace." Yes ain't it the truth. I've worked along side some nurses who had some manners and mutual respect and actually said "thank you" or at least asked me if my kits and set ups were mine instead of bumming off with them. That's what I meant by "hoarding." Kids and adults do it. I get why kids do it, but when grown folks do this I don't seem to have a good inner mechanisim to let it roll off my back. I don't say anything to the person and end up stewing and brewing about it. Like taking charts and patients right out from under my nose and worse yet your instructor knew you were prepared for that patient, and now you have to start all over with a new patient which takes time. I can't wait until I can count the hours down to graduation May 1st. :coollook: