Not sure where to post this but I saw something today in clinical that was just eating me up. My school has an agreement with a few clinical sites to allow students to return to clinical early, and I saw something today that made me very uncomfortable. A nurse allowed myself and another student to go into her (sedated) patient's room, and offered to let us start an IV. IV insertion is strictly prohibited and the clinical coordinator specifically told us not to even attempt it, as it can result in "major consequences". I told this to the nurse, but my classmate decided to try to insert the IV anyway. The classmate poked the patient 1, then 2, then 3.... until the nurse finally stopped her, at 7 attempts. 7 insertions, including one on a different site which was not cleaned.
The school's clinical coordinator showed up on site about 30 minutes after the event, and she asked me if we had gotten to do any IVs. I had the feeling that she knew about it, and I told her about my classmates IV attempts. It turns out that she had no idea about the event, she just happened to show up and ask. She was angry at me for reporting it and told me not to tell anyone about it, or there would be consequences. The student and I are paired to go into the ED this week, and she was going on about how she hopes that we'll have more tries at starting IVs and that she'll make sure I can do it next.
I have no idea what to do. I feel that if I report it further, the clinical coordinator will do something to take it out on me. I can't stop thinking about how that patient was sedated and didn't have any idea a student was involved in their care, the potential pain, or the risk of infection from all of those repeated insertions, including a site that wasn't cleaned at all.
As I recall, I remember hearing old-time stories of medical residents & other HC students practicing suturings & intubations on cadavers in the autopsy lab. I doubt there was ever any consent given.
Wuzzie, I agree with your position. But a sedated pt may still TRULY need an IV line. But NOT for 7 tries by an uninitiated, inexperienced student! For heaven's sake, it was a HOSPITAL! Dang! Couldn't they get some type of interventional service for its insertion?!?
I still think FOR ME, I would have breathed easier and felt more comfortable knowing that the pt would not feel my feeble venipuncture attempts. (I believe that 'sedated' means aff cognitive status.) Perhaps that relief would allow me to do my sticks more 'confidently' and successfully. Just hypothesizing here.
But NOT to do venipuncture for the sake of practice!! For that I apologize that I was not clear enough.
I would appear to be in the minority as I don't see any glaring problem with students attempting IV insertion on a 'sedated' patient, so long as the patient needed an IV and so long as there was proper oversight.
Current sedation practices in a Critical Care setting is to use primarily analgesia, and while we can't say for sure that best practices were in place for this patient, the safest assumption would be that this patient had far more analgesia on board that most patients who are getting an IV.
7 attempts is of course too many to allow a student to make back-to-back, although what constitutes an "attempt" could be it's own thread. I would say in my experience most nurses refer to two attempts as trying at two different sites. Personally I'm not a fan of rooting around with the needle looking for the vein, but I've found that particularly inexperienced nurses will call each of those jabs to be different attempts.
Ang again in the minority based on various threads on the subject, but the fact that as nurses we'll be expected to teach student nurses was never offered as a gray area in nursing school, I'm not sure how many nurses got the impression it's not just part of the deal.
Wuzzie, I agree with your position. But a sedated pt may still TRULY need an IV line.
4 minutes ago, MunoRN said:
I would appear to be in the minority as I don't see any glaring problem with students attempting IV insertion on a 'sedated' patient, so long as the patient needed an IV and so long as there was proper oversight.
Apparently I did not make myself as clear as I thought I did. I have zero issue with allowing a student or inexperienced nurse to attempt a needed IV on a sedated patient and have, indeed, done this myself when precepting such folk. My issue is when I asked for clarification regarding the patient in the OP and a subsequent post by another member as to the necessity of the IV I was met with crickets. This opened up the horrifying thought that some people are actually allowing others to practice IV starts on defenseless patients just for the sake of practice. I don’t care how sedated the patient is this is entirely, morally and ethically wrong and must not be allowed to continue.
Apparently I did not make myself as clear as I thought I did. I have zero issue with allowing a student or inexperienced nurse to attempt a needed IV on a sedated patient and have, indeed, done this myself when precepting such folk. My issue is when I asked for clarification regarding the patient in the OP and a subsequent post by another member as to the necessity of the IV I was met with crickets. This opened up the horrifying thought that some people are actually allowing others to practice IV starts on defenseless patients just for the sake of practice. I don’t care how sedated the patient is this is entirely, morally and ethically wrong and must not be allowed to continue.
I agree that you were pretty clear that the issue is whether there was actually a need for a new IV so I apologize if that seemed directed at you. I had gotten the impression that it was said by someone other than you that there should have been specific permission from the patient to allow a student to attempt the IV even if the IV was needed, although looking back I'm not exactly sure where I got that from.
I can't believe what I'm reading here. Seriously, I just can't. All I can say is if this scenario ever "played out" at any school or facility that I've ever heard of, both the OP and the other student would be out of their program and the school asked not to return. (And trust me, one way or another this episode WOULD come to light eventually.)The lack of judgment of all involved including the patient's assigned nurse has me dumbfounded. This is patient abuse plain and simple. I can only hope that this story was just that: a complete fabrication posted to get a reaction.
I too am confused. You're not to start IVs because the coordinator says it's policy not to, and the the coordinator encourages you to start one.
If the patient was sedated and needing an IV, I see nothing wrong with a student trying. The policy where I work is that one nurse only sticks a patient twice, if three nurses are unsuccessful after two sticks apiece you stop and call the MD.
The nurse should never have let the student stick the patient that many times, and the instructor should not have dismissed it.
What you can do to learn from this is just do what you know is right for yourself, and that's to never stick more than two (maybe three if that's hospital policy) times. You might have to let this incident go as you've used the chain of command.
Apparently I did not make myself as clear as I thought I did. I have zero issue with allowing a student or inexperienced nurse to attempt a needed IV on a sedated patient and have, indeed, done this myself when precepting such folk. My issue is when I asked for clarification regarding the patient in the OP and a subsequent post by another member as to the necessity of the IV I was met with crickets. This opened up the horrifying thought that some people are actually allowing others to practice IV starts on defenseless patients just for the sake of practice. I don’t care how sedated the patient is this is entirely, morally and ethically wrong and must not be allowed to continue.
eh in the ICU, there is no such thing as having too much IVs especially when we have like 3-4 different IV antibiotics ordered with other stuff as well. A sedated patient maxed out on profofol probably won't even feel a pinch but 7 tries cmon thats still too much and overboard.
This opened up the horrifying thought that some people are actually allowing others to practice IV starts on defenseless patients just for the sake of practice. I don’t care how sedated the patient is this is entirely, morally and ethically wrong and must not be allowed to continue.
Absolutely correct. If a patient has to have an IV or procedure or care done of course it has to be done, but to allow an inexperienced student to attempt more than twice was wrong....
If this is a true story and not a fabrication to get reactions, perhaps that is why the coordinator became angry...not because of not following orders, but because they got caught disrespecting patients and allowing student nurses to practice on someone who did not need an IV inserted. Which leads to the question of what else are they allowing them to practice that is not medically necessary on vulnerable, defenseless patients when no one is there to say "Stop!" Or ask why....
Case in point many, many years ago, I know of a patient who was in the hospital, when the bill was received charges for pap smears, gyno exams, and other tests that were made that the patient was not even aware had happened and she was not hospitalized for anything concerning gynecological issues. At the time she was being given medicine to help her relax and stay calm and a family member was not able to be with her. If it was in this day and age, I would be suggesting to that patient that they needed to contact a lawyer...
If that were me or my family member that was being "practiced" on, you can bet your behind that heads would roll once I found out. When I was teaching, for any procedure we had to get patient permission- dressing change, IV start, medication administration, foley catheters, etc. Some people don't mind letting a student learn how to do skills with them, other people do mind very much, then you have those who allow some things but not others. I hope this thread is just a "figmentation of someone's imagination", because the actions of the 2 students, the nurse they were with, and the clinical coordinator are beyond words.
By the way, just because someone is sedated doesn't mean that they have no awareness of what's going on around them. They might not be in as deep as sleep as you think they are.
eh in the ICU, there is no such thing as having too much IVs especially when we have like 3-4 different IV antibiotics ordered with other stuff as well. A sedated patient maxed out on profofol probably won't even feel a pinch but 7 tries cmon thats still too much and overboard.
We often need multiple IV's in the ICU but there certainly is a thing as too many IVs, I find it's not unheard of for nurses to place new IVs because they didn't bother to look up compatibility or for some reason just insist on believing that infusions aren't compatible when they are.
Propofol is a sedative and an amnesic but is not an analgesic, it shouldn't be assumed that a patient can't feel pain just because we've made it appear like they don't.
I'm still not clear if the definition we're using of different attempts is the same as the OP's.
54 minutes ago, Hoosier_RN said:
If that were me or my family member that was being "practiced" on, you can bet your behind that heads would roll once I found out. When I was teaching, for any procedure we had to get patient permission- dressing change, IV start, medication administration, foley catheters, etc. Some people don't mind letting a student learn how to do skills with them, other people do mind very much, then you have those who allow some things but not others. I hope this thread is just a "figmentation of someone's imagination", because the actions of the 2 students, the nurse they were with, and the clinical coordinator are beyond words.
We need consent for everything we do, although things like IV medications often fall under the broader consent to treat, if consent has already been obtained to treat an infection using IV antibiotics, then that would include the IV.
In terms of consenting specifically for a student to perform a procedure I've worked in one place where that was the rule, but other than that patients haven't been able to decline who is doing the procedure, if they decline to allow a student to place an IV then they've declined the IV.
Ang again in the minority based on various threads on the subject, but the fact that as nurses we'll be expected to teach student nurses was never offered as a gray area in nursing school, I'm not sure how many nurses got the impression it's not just part of the deal.
Hi, Muno: I will expand upon my thought.
1. "Lean" business doctrine and staff nurses being the primary clinical-site teachers of students do not go together. When "standard work" (ultra-efficient workflows) for staff nurses are being established there is no allowance made for the primary teaching of any students who might happen to show up; there arguably isn't even an allowance that readily accommodates a licensed nurse needing a significant orientation (such as a new grad).
2. With regard to duty (the duty of a professional nurse), my first duty is to my patient(s). If there is a conflict and I must prioritize between my patients getting the care they need vs. the needs or activities of a student, I struggle to think of a scenario where I would choose the student's interests. Not trying to be sarcastic in any way or minimize the importance of training new nurses or deny that helping to educate them is a responsibility of a professional nurse. It's just that no other nurse has the primary duty to provide bedside nursing care to my patients, yet someone else (the nurse who accepted the role of clinical instructor) could be said to have main role (duty) of helping that clientele, the group of students.
3. Agree that it is part of the deal to help student nurses. I feel the caveats are what I have written above. I would not feel it appropriate to avoid giving other students the same educational benefits that others gave me, if/when I have the the free and clear choice to do so without a significant patient-related conflict of interest.
Overall: I understand and agree that "nurses" have the duty to educate nursing students, new nurses, etc. But saying that *this* [particular] nurse has this duty at this time/moment is a different deal categorically. It isn't any different than saying *this* staff RN must develop the unit's budget now/today while caring for a patient load because because our profession advocates that nurses fill administrative roles.
amoLucia
7,736 Posts
As I recall, I remember hearing old-time stories of medical residents & other HC students practicing suturings & intubations on cadavers in the autopsy lab. I doubt there was ever any consent given.
Wuzzie, I agree with your position. But a sedated pt may still TRULY need an IV line. But NOT for 7 tries by an uninitiated, inexperienced student! For heaven's sake, it was a HOSPITAL! Dang! Couldn't they get some type of interventional service for its insertion?!?
I still think FOR ME, I would have breathed easier and felt more comfortable knowing that the pt would not feel my feeble venipuncture attempts. (I believe that 'sedated' means aff cognitive status.) Perhaps that relief would allow me to do my sticks more 'confidently' and successfully. Just hypothesizing here.
But NOT to do venipuncture for the sake of practice!! For that I apologize that I was not clear enough.