I made it very clear when precepting under another nurse for my ED orientation. I can take medical-surgical patients all day long. Telemetry patients (patients on a heart monitor), well, they're basically med-surg patients on a heart monitor a lot of times, and I can take care of them competently and be able to ask a question or two about heart rhythms if I need to. Pediatrics, well they can be any kind of patient of course its just that they're.... pediatrics, so here we start to delve further out of my comfort zone because peds can change status quickly from good to bad and handling their medications is a lot more delicate when it comes to doseages. Not to mention babies have tiny veins and parents that dont want you hurting their babies which can make procedures a bit uncomfortable. Then theres kids, depending on age, they can almost be handled like adults, young ones can be very inquisitive, and from what I hear, VERY STRONG, like HULK strength almost. Try starting an IV on the hulk while he's thrashing around. Ok, then theres unit patients, like ICU/CCU (intensive care, critical care units). This is completely out of the realm of my comfort zone and off into a far away galaxy. Nurses on these floors usually take 1-2 of these patients and have them the entire shift as opposed to say taking 5 patients on a med-surg floor for your entire shift. These patients usually are in bad shape, and have like 456,000 IV drips all hanging at the same time keeping the patient somewhat stable. First off they're telemetry patients, on a million IV medications that I'm not familiar with. I could be the Johnny Depp of nurses and still show my true colors of fear panic and anxiety. So as an ED nurse, we take all these patients stabilize them somewhat and then send them to the appropriate floors. Don't get me wrong, I'm willing to learn, jump in and do what needs to be done but I wont be 100% comfortable.
So lets step back a little. About a week ago, I had a 45day old infant, came in with a fever and we need blood. Whatever, I'm all over this.. I can feel some veins, but its a tiny baby, so im kind of on the fence now because I feel a vein but you know, I'm not too sure. We got the smallest needle possible. We also, had a light we could shine through the babies hands and see all the tiny veins. Awesome, wait they look even too small for the tiny needle we have. So we go back to the antecubital (basically the elbow area but on the inside part of your arm that bends) nice.. i can totally feel the vein especially after my preceptor pointed it out to me. Does the parent know its my first time? No... but I have started a million and 5 IV's on adults before so this wasn't too bad. What made it weird was my preceptor was explaining everything to me, how babies have tiny veins, how they're hard to find when dehydrated, etc etc. What made it completely ok was that the parent in the room was responding with "ohh, ok, i see, oh ok". LOL he thought we were explaining it to him.. well in a way we were. BUT lil did he know, it was being explained to me too. So we have to hold the baby's arm down pretty well and poke the lil girl get flashback and im golden. See, when you start an IV or draw blood, you first wrap a tourniquet around the arm, the pressure in the vein kind of increases, you can feel the vein with your finger and when you poke through the vein, sometimes there'll be this sort of pop, you get blood in the chamber of the needle or IV or what have you and you know you're in. That "flashback" of blood goes with a sort of feeling of accomplishment especially with patients who are supposedly a "hard stick". This being my first time sticking a baby, that flashback was such a huge sigh of relief. Of course the baby wasn't too dehydrated which would have made it hard but for a first timer, it was great because 1. now i can with confidence say "oh yeah i've done this before" and 2. I somewhat know what im doing as opposed to previously had ZERO experience. This put me almost on cloud 9.
Lets step forward to a 2 year old I had about a week ago, after the baby. Little boy, super inquisitive, been vomitting for a few days. Dehydrated, needed fluids, not a baby, but kind of on the other end of the spectrum. We go in, of course he's scared, even cries and yells out saying he wants to see the needle. I did my best to sort of console him or explain things thoroughly and gain his trust of course. Tourniquet on his arm.. and guess what, i cannot feel a damn thing! his other arm has a lil green spot where he has some sort of vessel but I've learned you can't really rely on those, and I can't even see where its going , if its straight or curves or whatever. Nothing in his hands, nothing in the antecubital. I'll be frank, I was kind of scared shitless. My preceptor feels around and says she feels one in his antecubital and points it out and so i feel for it and my immediate thought in my mind goes something like, "oh ok i feel it wait what?". I felt a lil something, and then I didn't and wondered if i even felt anything. Now I have no problem trying but this poor kid, I dont know, I feel bad for him, i HATED needles as a kid. My preceptor says to me "here hold his arm" and im thinking "ohh ok god i hope she tries and doesn't make me do it". Honestly thats probably the first time i've felt the need to step back and ask someone else to do it for me. Its like she read my mind. So we tell this brave lil kid not to move when he gets poked because we dont want to have to do it again. She sticks him, advances, pulls back a lil advances a different way, pulls back a bit and advances a slightly different angle and gets flashback.. HALLELUJAH! And the kid didn't move an inch. Seriously he was a brave lil dude i didn't just tell him that for nothing. I get his fluids going and my preceptor and I talk about it. She says she had a hard time finding the vein and he was pretty dehydrated coz his vein was barely palpable and had no buoyancy, which it didn't, thats exactly describes what i was thinking in retrospect when i was feeling his vein. So i didn't do that one, which im glad i didn't, but it was still a learning experience. I have no shame in that one honestly, because had i had that patient on my own, that is one i wouldve had someone else do for me.
There are different degrees of difficulty with patients when it comes to IV's and other procedures. You kind of have to pick what your comfortable with and either try, or not try. Sometimes you'll fail and sometimes you'll succeed. Eventually your comfort level will get higher and higher. BUT, you have to at least try, I know floor nurses who never try and guess what, its safe to assume they suck. I dont think im all that bad at IV's. Some people come to me to start theirs but believe me it wasn't always like that. I would try and fail and have someone else try and today I still go to other people to start my IV's if i can't get them but it just happens a lot less often these days. So dont be afraid to try at least once and on the other end of the spectrum, dont be afraid to step back when you need to and ask for help. Nurses are great resources for help and advice. Not everyone knows everything, and when you feel you know everything, thats the day you need to quit because THAT is just scary.
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