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

[Roland]

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.

[mattsmom81]

I agree with Deb that the toughest 'skill' to master in our job is juggling uncooperative and combative/hostile patients and families while being a patient advocate and keeping him safe, getting him well. The clinical skills (NG,ABG, etc)skills are the easiest part of the job for me....the interpersonal stuff is always the bear for me. Getting the job done 'in spite' of patient and family, etc.

[rn-jane]

I used to be uttelry terrified to have to do an iv, but now i'm on the hospitals iv team, i still don't think i'm great but most of the time i can find a vein somewhere. I really hate to do ng's but i can do them. I'm comfortable with ekg interpretation, don't ask me where the leads go though, our monitor tech does them. I think i'm most uncomfortable when there is a dying patient, and dealing with the family. Sometimes i'm just for loss of words to comfort. I feel that as a nurse i am growing everyday though, and i will continue to grow no matter how long i am in nursing.

[K O'Malley]

The most difficult for me was endotracheal intubation. We have to do it on dummies in order to pass ACLS. Half the time I would put it into the esophogus. I sure would hate to do it on some poor live person.

[laurakc]

For foleys, I found that--find the privy parts-there is an upside down v just below it, and urethra is just under that---occassionally this does not work--I think twice in about hundreds, possibly thousands of people...

IV's, labs--there is always a good vein in everyone between the ring finger and pinky..tap it, rub alcohol on it...up it comes..

NG tubes---I think I would rather be intubated or something...I try to get orders for Ativan if possible, Cetacine spray and use Lidocaine gel on the tube...works much better..Occassionally have used Morphine instead of Ativan and it helps also..

As for EKG's, had to take the class more than once..then one day, I got it!

Difficult patients or families--just never let them know that they are getting to you! By the way, this is still the most difficult for me also. I like to send them for a therapeutic time out whenever they are just too much...Just, I am so sorry but we have a lot going on right here now, so I would like for you to wait here until I come and get you (when I am relaxed enough to handle it again, but would not tell them that)

[Stephanie D]

Starting IV's was the hardest skill I had to learn.

[healingtouchRN]

My hardest skill has been the skill of reading the MD's mind, or for that matter, the client's mind or the family member's!!!

Otherwise, 12 lead interpretation & lab interpretations. I am blessed, however, to have good sources of reference from which to learn.

[JustMe]

The hardest skill for me to master was organization. It was hard during nursing school and it's hard now. I mean, gathering all my supplies at once, not having to make two trips. I can usually multi-task, but tend to get side-tracked with answering the phone, questions from visitors. You get the picture. Also, I became a nurse to do everything for my patients. When I couldn't do that in MedSurg (i.e. pills to bedpans), I went into Critical Care where I was able to do that. I've been a CCU nurse for over 20 years and I STILL have problems--making two trips for supplies, two trips to the linen cart, etc. I even have this problem at home, so I know it's genetic.

[ascnbe, ADN, RN]

I always use lidocaine gel for NG. Put it in a 3cc syringe and push some in the nare. Let them "snuff" it up, wait 2-3 minutes and second dose. Wrap the NG around your hand to let it kind of roll a bit. Then push it in slowly letting the patient have some control and breath. Once it gets into the throat, get them to try to swallow and then push it in. The lidocaine also decreases the potential for the small traumatic bleeds that sometimes occur. The big trick though is doing it slowly and letting them relax with the lidocaine easing the pain. Control is an amazing thing, having some is precious, losing it is scary.

[teeituptom, BSN, RN]

Patience with idiots that come in was the hardest thing to learn

They used to make me mad

then they used to make me laugh

Now, I just shrug it off

[Agnus]

Blood draws easy. Starting IV's difficult. But like people here have implied. No matter how difficult the task. Practice can over come it being difficult.

It is generally the task we must do on occasion but don't do enough to develop skill.

I used to have a very tough time with rythm strips. I could not keep it in my head that the little square was .04 sec. I had a mental block about it and wanted to make it .02sec.

[lazyrocking]

Just a suggestion but I learned blood draws and IV's in the back of an ambulance. You don't get time to think about it and they become automatic. You might try to get in with your local service and do some ride a longs. You learn to start and draw in all types of situations including the dark, blind sticks, moving sticks, etc.

[Roland]

What is the latest technology available for practicing these skills and where can they be found? For instance someone mentioned in a different thread a mechanical "Bob" where you could practice a variety of skills (I think including IV starts). However, my school doesn't have this device. Is it possible that some of the local hospitals might, and let nursing student practice on them? For that matter how many hospitals if any (especially larger ones) have "skills centers" where you can go to practice your skills (watch videos, get guided instruction ect) on your own time to perfect your clinical skills?