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.
I don't think this has any commonly agreed on definition, but in my experience students or new nurses will often deem repeatedly advancing the catheter as multiple "attempts".
Sorry- I didn't know if there was another word for this. Yes, this was what I was counting as an attempt. She had to pull the angiocath back, reposition, and advance hoping to get the vein. The thing that was most shocking to me was switching sites and not cleaning said site at all, even after I insisted it wasn't cleaned.
I don't think this has any commonly agreed on definition, but in my experience students or new nurses will often deem repeatedly advancing the catheter as multiple "attempts".
And in my experience there are many nurse who would consider withdrawing the needle to where the tip is out of the skin to be no different than withdrawing it to where the tip is micrometers from the surface of the epidermis. Not saying I agree with that.
Indeed, there is no definitive definition. I imagined what OP meant was the student pierced the epidermis 7 times. I was wondering about how many IV needles were actually used. I actually had never thought about the exact definition of what qualifies as an attempt until I read your input on it. It is a gray area. Reminds me of a quote from former president Clinton "it depends on what the definition of 'is' is." LOL.
Indeed, there is no definitive definition. I imagined what OP meant was the student pierced the epidermis 7 times. I was wondering about how many IV needles were actually used. I actually had never thought about the exact definition of what qualifies as an attempt until I read your input on it. It is a gray area. Reminds me of a quote from former president Clinton "it depends on what the definition of 'is' is." LOL.
I had mentioned before this could be it's own thread, although for some reason these actual practice issues don't get as much play as drama-based threads, but we'll give it a try.
Indeed, there is no definitive definition. I imagined what OP meant was the student pierced the epidermis 7 times. I was wondering about how many IV needles were actually used. I actually had never thought about the exact definition of what qualifies as an attempt until I read your input on it. It is a gray area. Reminds me of a quote from former president Clinton "it depends on what the definition of 'is' is." LOL.
Two angiocaths. One for each site. Sorry- I posted while tired, only really looking for guidance on what to do next. I didn't think the topic would have gone in these directions or I'd have added more detail.
Could you imagine seven needles? I work in psych for a reason, I'm not sure I'd still be on my feet seeing that!
Two angiocaths. One for each site. Sorry- I posted while tired, only really looking for guidance on what to do next. I didn't think the topic would have gone in these directions or I'd have added more detail.
Could you imagine seven needles? I work in psych for a reason, I'm not sure I'd still be on my feet seeing that!
OH! Thank you for the clarification. It is not as grotesque as I had pictured from the original post. Nonetheless, piercing the epidermis without using a cleansing/chlorohexidine wipe is quite concerning. If only two needles were used to pierce the skin twice, I would consider that 2 attempts. Now, digging around the vein repeatedly, carelessly, and aimlessly is tantamount to some form of negligence in my book.
I had mentioned before this could be it's own thread, although for some reason these actual practice issues don't get as much play as drama-based threads, but we'll give it a try.
It is a nuanced discussion. It made me question my understanding of an attempt. You are right however on the clout drama threads accumulate. I suppose the adage "misery loves company" has stood the test of time.
I would hazard a guess that's exactly what many of us thought you were reporting. I did.
Yep, same.
This really disgusts me. Sedated or not, aware or not, these are PEOPLE. My mom was sedated in an ICU for almost three weeks this Summer, but she knew when I was there. And if I found out a student was experimenting on her, I would have punched them in the face. Hard. A lot. Not kidding. I am so over people being oblivious and entitled. Also OP, your school is awful if you are unsupervised like that. Those floor nurses aren't on the hook for your education, your school is, and they are doing you wrong.
This really disgusts me. Sedated or not, aware or not, these are PEOPLE. My mom was sedated in an ICU for almost three weeks this Summer, but she knew when I was there. And if I found out a student was experimenting on her, I would have punched them in the face. Hard. A lot. Not kidding. I am so over people being oblivious and entitled. Also OP, your school is awful if you are unsupervised like that. Those floor nurses aren't on the hook for your education, your school is, and they are doing you wrong.
This thread reminds me of a nurse I knew and respected quite a bit who had more experience than I have years on this earth. She told me a story once about how when SHE was a young new grad that when her ICU would have codes the supervisor and attending would round up all the students and residents to observe and when it was deemed the person could not be saved they would keep the code going so that the students and residents could "practice", she says they would practice femoral lines, art lines in addition to doing CPR. She told this as a horror story, and I really felt like such a situation is horrific. If my math is right, that scenario would have happened sometime in the 80's, was that a common thing back then?
This thread reminds me of a nurse I knew and respected quite a bit who had more experience than I have years on this earth. She told me a story once about how when SHE was a young new grad that when her ICU would have codes the supervisor and attending would round up all the students and residents to observe and when it was deemed the person could not be saved they would keep the code going so that the students and residents could "practice", she says they would practice femoral lines, art lines in addition to doing CPR. She told this as a horror story, and I really felt like such a situation is horrific. If my math is right, that scenario would have happened sometime in the 80's, was that a common thing back then?
No idea, I was in my teens in the 80s. But it wouldn't surprise me. I have made sure that students had opportunities to do chest compressions in the ED, but these were actual working codes. One time I had a PA student in the department when I was in charge in the ED, and we had a code come in. I sent him in to do chest compressions, and he really didn't want to. He actually went home early afterwards. I was like, this is what we do, sorry. But it was a working code, not a futile "Hey let's do more rounds so everyone gets a turn."
Ugh speechless,glad family not present.Anyway the secret will be found out,everything gets found out,either by Doc or RN.
5 hours ago, TheMoonisMyLantern said:
they would keep the code going so that the students and residents could "practice", she says they would practice femoral lines, art lines in addition to doing CPR. She told this as a horror story, and I really felt like such a situation is horrific. If my math is right, that scenario would have happened sometime in the 80's, was that a common thing back then?
Mercifully never saw or even heard of this happening anywhere.
This really disgusts me. Sedated or not, aware or not, these are PEOPLE. My mom was sedated in an ICU for almost three weeks this Summer, but she knew when I was there. And if I found out a student was experimenting on her, I would have punched them in the face. Hard. A lot. Not kidding. I am so over people being oblivious and entitled. Also OP, your school is awful if you are unsupervised like that. Those floor nurses aren't on the hook for your education, your school is, and they are doing you wrong.
I've never known of a nursing school, including supposedly 'top-ranked' ones that have a clinical instructor to student ratio of 1:1. Usually 1:8 is considered about as good as it gets. This means that yes, it is the floor nurses the students are assigned to that are supervising the students, and in this case the patient's nurse was apparently supervising the IV attempts.
Our ability as floor nurses to devote time to students is of course limited, and subject to appropriate prioritization, which may very well end up with a student just standing in the corner and observing, but still that is part of our job as direct care nurses.
ChickenHealer
14 Posts
Sorry- I didn't know if there was another word for this. Yes, this was what I was counting as an attempt. She had to pull the angiocath back, reposition, and advance hoping to get the vein. The thing that was most shocking to me was switching sites and not cleaning said site at all, even after I insisted it wasn't cleaned.