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

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Do you have any tips on improving someone's chances of "mastering" this skill? My guess is that it might be blood draws, from the old, obese, and dehyrdrated. If not that perhaps accessments, given that this is a skill that can expand almost infinitely depending upon your knowledge base, and observational abilities that CAN expand with accumulated experience.

Specializes in Critical Care.

NG's I'm no good at inserting them therefore I always ask someone else to do therefore I get no better at inserting them.

My work station is always a mess! I clean everything up before I leave, but during my shift I have papers piled everywhere.

IV's took a long time to get the hang out it, but I'm pretty good now.

Now if I could just learn to keep my work shoes clean.....

Noney

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Specializes in ICU.

Hey Tweety, I picked up a great little chart in my ACLS re-cert this weekend that helped me out on reading my 12 leads as far as what part of the heart an MI has occured in. I look at 12 leads all day long, but some are just real hard to read!

For me my most diffucult skill to aquire and master has been the operation of an Intra Aortic Balloon Pump, simply for the fact that we do not see them very often. I have taken the class and am certified to care for these patients, and do. But we see them so infrequantly, that it is nice to have my reference guide at the bedside. :)

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Specializes in Med/Surg, ER, L&D, ICU, OR, Educator.

ABG interpretation.

I totally agree with above poster: NG insertions are vile! For me and the patient!

Agitated, potentially violent and confused elderly wanderers.

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Well for me its scalp vein IV's. Those SUCK. That and ABG interpretations. i really suck at those. HOpefully will get better over time tho. lol

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Specializes in LTC, assisted living, med-surg, psych.

As far as mastery of skills goes, I think IV starts were the hardest. For one thing, I was terrified of them; for another, I just didn't "get it"---anatomy, landmarks, or even the "feel" of the veins. It took me six years to be completely at ease with them; now I'm one of the "go-to" nurses when there's a hard stick. The only trouble I have now is with extremely obese patients whose veins are both invisible and difficult to palpate.......I can get the dehydrated little old ladies, the healthy young people with tough skin, the "rollers", you name it, but confront me with a 300-pounder and I can't hit the broad side of a barn. Oh well, nobody's perfekt...... :chuckle

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Well..I'll have to agree with a few of the poster's....I think that starting IV's have been my toughest skill. I still have problems with them...even after four years!! Of course..I really don't start that many. My favorite skill is inserting catheters'....yes...I'm crazy. I just have a knack for it. Even these 400 pound older ladies....(you guys know the ones)...I just seem to slide the darn thing right in... I just love when that urine hits the tubing....what a feeling...LOL...no...I'm not crazy... :uhoh3: I'm definately...the catheter "go to" person...LOL...

Snoop'

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Assessment skills.It takes time to be able to walk in a pt room .....and "just know" something is not right.the pts v/s may be ok.......but you have a built in sense that somethings amiss with your pt.this skill only comes with experience.It is the most valuable skill any nurse can have.

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Specializes in ICU.
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.

Tweety Sweety - with the 12 leads - has anyone ever taught you "vector analysis?? It is not as complex as it sounds.

I also have a real handy "rule of thumb" for ABG's taught to me by an intensivist but I am unable to reference it - it does work though and saves you having to remember those darn up/down arrows.

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Specializes in ICU.
Assessment skills.It takes time to be able to walk in a pt room .....and "just know" something is not right.the pts v/s may be ok.......but you have a built in sense that somethings amiss with your pt.this skill only comes with experience.It is the most valuable skill any nurse can have.

There is quite a bit of research supporting that this is "experiental" learning and is very difficult to teach so you are right!!!

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NG tubes are vile . . . I've only done a few in 5 1/2 years. I hate the whole intrusive and painful nature of them.

IV's are no problem nor drawing blood or urinary caths.

I hate intrepeting ekg strips . . why do they make the little dots in the box so dang little? And the vectors . . . it is all about electricity and I have a hard time figuring that out.

Also, ABG's . . .. arrgghh!

I've taken classes on all the above and studied at home but unless you use it every day, you lose it.

But that's rural nursing . . . we do a little bit of everything and are a master at nothing. :)

steph

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Specializes in obstetrics(high risk antepartum, L/D,etc.

One of the difficult things I have run into. Cathing little old ladies. They seem to hide their meatus' in the strangest places!

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But that's rural nursing . . . we do a little bit of everything and are a master at nothing. :)

steph

AMEN to that sistah! Good at what we know, but don't know all that much about anything in particular! :chuckle

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