The Catch-22 of inexperience

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In my clinical experiences, I’ve found that it’s really hard to get the opportunity to perform a new skill.

Picture it:

New patient admitted to the floor, assigned to the nurse you are following, and needs an IV started.

You (the student nurse): Can I start the IV?

Nurse: Have you done it before?

You: I’ve performed it several times in our skills lab (the response you’ve been taught to say when the only time you’ve done it was on a plastic arm)

Nurse: (looks at you funny) Have you done it on a person?

You: Um… not exactly (OK! So he was plastic –big deal!)

Nurse: No, you can’t start the IV unless you’ve done it before, our patients aren’t pin cushions.

I get it. I really do. I have a family full of hard to find veins (not that I tried to find them myself!). But what I don’t understand is that if we can’t perform a skill without experience, but can’t get experience until we’re allowed to perform a skill – when are we supposed to do it?

Our skills lab really trains us well, but it is plastic. And at our school, we aren’t allowed to practice on each other (at least not with anyone knowing). It just seems odd to me that if we aren’t trusted to perform a skill in person while being talked through it with a nurse (on a willing patient of course!), then why would our future employers want to trust us to perform these skills post-graduation?

Today I got the chance to draw blood – a new skill for me. I was walked through it by the nurse and with her explaining it to me step by step, I felt comfortable. It felt like I had done it several times before. I feel fortunate that I got the opportunity, and that I can now say “yes, I’ve done this before,” but I still feel like we’re held to this goal that remains unreachable until some very rare opportune moment.

What are the policies for new skills at your schools or workplaces? Have you experienced this Catch-22 as well?

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Ani Burr, RN

I'm a brand new, full-fledged, fresh-out-of-school RN! And better yet, I landed the job of my dreams working with children. I love what I do, and while everyday on the job is a new (and sometimes scary) experience, I'm taking it all in - absorbing everything I can about this amazing profession we all fell in love with.

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5 Responses to The Catch-22 of inexperience

  1. Sean Dent Scrubs Blogger

    Ani – my jaw dropped reading this post. This is THE problem we still have in our wonderful career – nurses not willing to teach and educate. How do you think that nurse learned his/her skills? Practice, trial and error, failure, etc.
    I welcome new nurses and student nurses to any and all new experiences – in fact I go looking for them when there is that rare experience that envelops.
    Don’t ever let a fellow nurse stop you from learning – be aggressive and stand your ground.

  2. kelly

    As a nursing student my experience in clinicals has been that the nurses understand that we have not yet successfully done some skills and they will allow us to do it under their supervision. During our earliest clniicals our instructors were easily accessible and we would tell the nurse “No, I have not done it, but I will get my instructor to do it with me if you like.” This was usually received well. I guess I have been lucky!

  3. Elisabeth

    That’s really not right and unfair. In my 2nd year at uni we had a skills lab every week and got to practice (once!) each new skill we’d learned that week. Now I’m in my 3rd year and we have no skills labs, so I only get to practice on clinical placements. However, I’ve been lucky in that every clinical I’ve been on I’ve had great nurses who encourage me to do everything I can and even go out of the way to find students to take part in or at least watch exciting procedures.

  4. So sorry your preceptors haven’t even let you try!
    You can’t ever learn if you don’t try.

    BTW I had a clinical instructor who let us practice on each other (most with very good veins) but some schools do not allow this.

    Practice drawing blood as many times as they let you, then go up to IVs. Many of the principles are the same.

  5. Wow I can’t believe this is still happening. When I was a student I was fortunate to get nurses who let me know when someone needed blood, an IV, foley, etc. That nurse would then ask the patient if they were okay with letting me attempt the procedure. Most patients were willing. When I have students, I try to let them do as much as I can for the skills they have already been checked off on in lab. How else is the student going to learn? If there are still nurses who don’t give students a chance how are we every going to convince the world we are professionals?
    BTW: We too were allowed to practice on each other IV’s and injections, so it the patient asked if we ever did it on a live person we can truthfully say yes.

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