Needles

It’s Thursday evening, and it’s finally the weekend. Tomorrow is my pinning ceremony(I still don’t know if I want to go), I have three days off ahead of me. Two back to back twelve hour shifts feel so normal to me now. It’s really no big deal. I never thought I’d feel this way! I’ve worked 14 hour days before but never as a nurse. As a new grad it can feel like a marathon.

I had an interesting experience yesterday evening. The day had gone by slowly and easily, up until the last half hour(of course). I remembered that there was a patient scheduled for a monthly IM shot of Haldol AFTER I had done medpass. Suddenly I was on a time crunch, and I could not rely on the new nurse to help me because she was not quite independent yet.

The first thing I did was to read the order and notify the CO that I was going to need a patient to come down to medical. I then turned my attention to the nursing drug book in order to research this medicine. I have never given Haldol IM before, and wanted to see if there were any special instructions. My hunch was correct: the drug book recommends that this drug be given via Z-track in the gluteal muscle.

A challenge was suddenly presented to me. I have never given a ventrogluteal shot before. My professors haunting words came to me: ventrogluteal shots are often contraindicated due to the high risk of hitting the sciatic nerve.

I was like….uh uh. There is no way in hell I am giving the shot this way. Panic rose up from my root. I decided to speak to the patient, to let him know that this particular method of administration was recommended. He refused, saying that it was given in his deltoid last month and he has always taken in that way.

I was relieved. Recommended or not, the patient’s decision and refusal supersede all other decisions. Then a brilliant idea occurred to me: call the doctor.

We have a super sweet, soft spoken yet firm, exceedingly polite psych doctor who happens to be Jewish. I connect with her in that way because my wife is Jewish and I have fond memories of Chanukah.

Calling the doctor was brilliant because 1) the medication was ordered by her 2) she would more than likely know the patient’s history of taking this in his deltoid muscle and can provide instructions for administration.

She did just that. She told me that it should be fine, unless I feel that it is too much volume to deliver in one arm. She said if I had to, I can split the dosage in half, giving a half per arm. This is a very objective call to make only because the patient was rather thin.

The pressure of time caught up to me, as the night shift nurses rolled through the door. I was nowhere near finished with my tasks for the day, and I still had this shot to give. They walked into the clinic, casually asking “whatcha got there?”

Now I love both of these nurses, I had great rapport with them and they were quite kind to me. Both have been nurses for years. You can imagine the waves of relief that I felt knowing that I had some support if I needed it.

I communicated the situation to them both, and they quickly decided that there was no way I could give this Haldol anywhere BUT the gluteal muscle. It was simply too viscous, too thick and heavy. I held the Haldol vial upside down. The substance oozed like honey, dripped like maple syrup. I gulped.

Remember though, the patient’s decision supersedes most things. He refused to take it in his buttocks. Everyone conceded to the final decision, which was that I would give it in his arm.

The one night nurse raised a quiet warning: The size of my needle will cause some resistance. The IM needles I had on hand were 23G, and the drug book recommended 21G. It was my closest option. We are not a hospital: what we have is what we have.

I prepared to withdraw the medication. The fluid had to quite literally be pulled into the syringe. I asked for someone to watch me give the shot.

I sought my landmarks on the shoulder. As the needle approached the skin, I asked the patient to take a deep breath. To be honest, I was really saying it to myself LOL. When I tell you my hand shook, it really shook.

I pierced through to the muscle. Another word of advice: give yourself a while to get used to the sensation of piercing skin.

Once the needle was in, my stomach dropped. The plunger was nearly impossible to push. Panic filled my mind, and adrenaline forced me to think straight. There was no way out, no pulling out and asking for somebody else to take over. I had already given a little of the med, and it would cause problems if I were to quit now(how would we transfer the medication into another syringe?).

I rapidly accepted my fate. I had a needle in this guy’s arm, I have to suck down the fear and just do my fucking job. I squeezed as hard as I could, taking care not to dig the needle deeper into the muscle. I squeezed until the vanish point needle activated and the shot was completed. I checked the skin: it was hot and slightly red, but patient tolerated it well.

The two things I learned: they were not fucking around in nursing school when they drilled it into your head to use your drug guide and NEVER give a medication that you are unfamiliar with in anyway. Never act like a robot, do not act on orders that you are not familiar with just because you are operating on autopilot.

Secondly, I didn’t believed in any of the sappy shit people say about nursing until that panic moment mid-shot. Nursing takes courage. You cannot quit when challenges arise and you experience some sort of difficulty. You still have to care for your patient and protect their wellbeing. You are not always afforded the space to doubt yourself because it could impact patient care.

No matter where you are in life, being a nurse requires you to have a reserve of self confidence even if you may not have the best self-esteem. Maybe you are not perfectly aligned yet. Perhaps your mental health is not always as strong as you would like for it to be. Regardless, accepting your duties as a nurse means Challenge Accepted.