What do you think is the MOST difficult clinical skill to acquire in your experience?

Tweety, BSN, RN · Feb 10, 2004

For me blood draws are easy, but starting IVs is much more harder. That's probably been my most challenging skill or task. Sometimes I can't hit someone with veins the size of ropes, other times I can get one that six people have missed.

The other challenges I have are more cerebral such as:

12 lead EKG interpretation is a hard one for me. Remembering which lead looks at which part of the heart, and what it all means has been a tremendous challenge.

ABG interpretation, metablic acidosis or respiratory????

Fluids and electrolytes, why am I hanging D5LR and not D5-1/2? What are the symptoms of hypomagnesia. Why does this patient have anasarca yet is dehydrated with rhonchi?

Sorry I don't have any hints, but to always keep your mind open and be sponge and hopefully some knowledge and skill makes it's way in there.

TraumaQueen · Feb 10, 2004

Stopcocks, they're the debil!

Other than that.... maybe learning how to interpret hemodynamic readings, and what interventions you need to use to improve cardiac output/index, cvp, pwcp, svr, pvr ..etc....

Learning where everything is in the crash cart! And, of course, I finally learned it all, and they rearranged it! (the med section anyway)

I agree with 3rdshiftguy on the 12-leads.... never can remember...

Although this is something that is no longer a challeng to me, but as I precept new nurses, I see that it presents a major challenge to them.... the different types of ventilator settings, and how to troubleshoot the different alarms, pressures, etc.... is something that takes time and patience to learn

Ask lots and lots and lots of questions. Ask respiratory therapists questions, other nurses, radiology techs, phlebotomy, IV therapy, etc.... There is soo much to be learned from all of the ancillary staff. When I talk to doctors and don't understand why they ordered an intervention, I ask why.... and it's all in your presentation of the question too... if they think you're questioning them, they get pissy, but if they can understand that you are trying to learn, most of them are happy to educate....

:)

zacarias, ASN, RN · Feb 10, 2004

Originally posted by 3rdShiftGuy
For me blood draws are easy, but starting IVs is much more harder. That's probably been my most challenging skill or task. Sometimes I can't hit someone with veins the size of ropes, other times I can get one that six people have missed.

Tweety,

I am just the opposite which I think is really weird. I'm not that great at peripheral blood draws but I'm pretty on with IV starts!! What's wrong with that picture? Who knows...

Unless you're a cardiac nurse, you don't need to be that skilled at EKG/telemetry reading although I myself find it fascinating and just bought two new books on EKG interpretation!

**canoehead, BSN, RN** · Feb 10, 2004

Toughest was subtle visual cues, like color of skin, and patients not looking right, but once it came to me that skill has been extremely valuable.

Worst skill is NG insertion. No matter how you do it, it's a vile procedure for the patient to go through, and if there doesn't seem to be any skill to it- if it won't go after 3 tries it probably won't go no matter who does it or how.

I much prefer a tough IV stick because you can work and get better with time.

Tweety, BSN, RN · Feb 10, 2004

Tweety,
I am just the opposite which I think is really weird. I'm not that great at peripheral blood draws but I'm pretty on with IV starts!! What's wrong with that picture? Who knows...
Unless you're a cardiac nurse, you don't need to be that skilled at EKG/telemetry reading although I myself find it fascinating and just bought two new books on EKG interpretation!

Now that is strange. But you've probably been hearing how strange you are all your life. :chuckle j/k

I work in telemetry and do o.k. with rhythm strips, but the 12 leads are a bear for me.

Erin RN · Feb 10, 2004

The hardest skill that I had to get the hang of was straight cathing baby girls with those tiny little tubes...

Alnamvet · Feb 10, 2004

None of the aforementioned posts have ever been hard to master...only thing I can think of is memorizing Eponyms

oramar · Feb 10, 2004

I was always very good at interpeting EKG. Several inservice educators have commented on it. However, I am not so good at anything to do with starting IVs, drawing blood and that includes getting blood out of lines. I think by the time people get to rehab the lines are very old and you can have a lot of problems with them. Interpeting blood gases and electrolyes always have me looking things up. I have friends that can glance at a printout from blood gasses and totally know what is going on with patient. I much admire them, they are seem to be the same nurses that can get a line in anyone. I suspect it is related to critical care backgrounds.

SmilingBluEyes · Feb 10, 2004

Dealing with combative patients and difficult families. I can handle clinical mechanical tasks just fine...with practice, they all become old hat soon enough...but...dealing with violent or difficult people.......

I always find the above toughest for me!

Jay-Jay, RN · Feb 10, 2004

For me, it's a toss up between starting IV's and doing blood draws from a central line/PICC line.

The blood draw is the more mentally challenging of the two. You have to make absolutely certain you've got everything laid out and ready BEFORE you put your sterile gloves on. Otherwise, it's gonna come back and bite you.

I always try to remember to have a couple of extra syringes of NS ready, in case the blood won't come back, and I need to do repeated flushings to try to get blood return.

bellehill, RN · Feb 10, 2004

I can do blood draws, IV starts without a problem. Love placing NG tubes...my problem is foleys/straight caths. I hate to cath people, I can do it but hate it.

For me the most difficult skill is dealing with death/dying issues. Dealing with the family and patient...very hard. I agree with smilingblueyes, the mechanical stuff becomes second nature.