"Just do it"-"But Ive never done it"

[nagmeriendaak]

I was supposed to flush a implanted port,a port-a-cath the other day,but thing of it is I had only observed the procedure but had never done it,so I refused to do it. I did say that I was willing to be inserved by someone competent,which hasnt happened yet. One of the supervisors got an attitude that if the nurses in the facility are all getting the same pay we all should do the same work. But I work in basically long term and Ive never had to flush a port a cath before. Is that my fault? The inservice person said "didnt you see nurse so and so flush the port a cath the other day? to which I replied yes. It seems she was implying that if I saw someone perform the procedure that I would be qualified to do it.

Would any one out there preform a procedure , especially this one, if you had only observed it and never done it?

[TXMomRN]

I did say that I was willing to be inserved by someone competent,which hasnt happened yet.

This person did offer exactly that.

[mattsmom81]

Accessing ports can be a huge deal with sterile setups, and protocols etc at some facilities. I would have wanted to watch one first too...(and I did). Accessing a port wrong can cause complications for patients...direct line to the heart and pulmonary system.

Setting up an aline is not a fair comparison IMO...we aren't performing the insertion #1.

Too many nurses today are so burned out on the job they forget what its like to be new or unsure. Sad they must resort to hostility, especially to our new nurses.

[SuperSGirl]

I was using the A-Line as an example. A-Line set up is important because the physician placing the A-Line trusts that you have flushed the lines properly and left no air.

My first port access was under the same situation. I had observed one and was called upon months later to access one. I recalled basic nursing skills (sterile technique, etc.) If you know what a port is used for, you should be able to think and process. If not, open a skills textbook. When she watched the first one, she should have asked questions and made notes.

I have not forgotten what it was like to be new. As I stated before, she should have been educating herself, not waiting for situations like this to occur. She obviously knew that port access was part of her job whether she had performed the skill or not. Had she read up on anything or reviewed a skills textbook? I am constantly reading or looking up information on skills I may be asked to do so that I am a better nurse. That is what is so frustrating, people do not want to assume any of the responsibility. She waited until faced with a situation and then was all of a sudden the victim. I am sure there was a skills textbook on her unit. Did she look it up before so hastily refusing?

As I stated before, her supervisor was out of line. I would have shown her and taught her well but I also would have been questioning her later, in private, what she had done to educate herself.

[jemb]

I don't even remember the first time I flushed a port, but I can't imagine that I wasn't supervised. Observing the procedure and doing it are not the same thing.

Some ports are not so easy to palpate, depending on their location and the person's size. I would never expect a colleague to access a port for the first time without supervision/moral support from a fellow nurse!

The only way that you might not need to be observed would be if the port were already accessed and you just needed to flush the line as you would flush a heplock. That would be no different from flushing a heplock --it would just be in a different location. Even so, if you were uncomfortable doing it without supervision, it is definitely appropriate to ask for somone to go with you.

[Tweety, BSN, RN]

cecumseeker, the problem being not that she wasn't willing to learn. She was in the process of learning, having observed. She just didn't feel comfortable doing it herself and no one stepped up to the plate to offer to teach her. She was told to just go ahead and do it. Are you saying if she had questions that she should have read up on it, educated herself and then went into the patients room and do it. Perhaps you have that kind of confidence in yourself, but I wouldn't advocate it.

But I also hear what your are saying that ahead of time perhaps we should educate ourselves as to what procedures we need to know on our units. There's only so much book learning and theory can do, one needs one-on-one instruction in the real world to learn. The op's peers and management are leaving out a vital step in the learning process, even if the op left out some self-learning ahead of time.