Ok, so I'll vent a little bit...
I think the reason I have this deep seated dislike of sheath pulls is once you're in, you're in. Here's what I mean. If you are able to pull the sheath (out of the femoral artery after stent placement) you are then responsible to do it for the entire hospital. The time that I would need to do this role is only when I am charge nurse and there is no one else available to do it- and I just don't like that.
Our floor has the cardiac resource nurse, that is their main responsibility it pulling these sheaths around the hospital- they are some of my favorite people. However, they are currently not staffed on Sunday's, work 8 hr shifts, and can call in sick too. Therefore, there are many times when the charge nurse has to pull the sheath. I do not like being charge nurse and having to go to the ICU pulling a sheath there, then having to go the the Med-Tele unit and pull a sheath there... I find it to be draining as well as doing all the other responsibilities of charge.
If you look at the nurses who have left our floor for outside jobs or other units at Virginia Mason, lots of them have been prior charge nurses- responsible for pulling sheaths. I don't want to wear out my patience with my floor. Therefore, I generally try to avoid being in this situation.
The other way that stents are placed is through the radial artery, these I actually enjoy managing. Most of the new Interventionalist's that VM hires prefer the radial approach. However, in time of STEMI the groin is always used. And... as we are a cardiac floor we are no strangers to the STEMI.
Since I really do like thinking of myself as a totally competent cardiac nurse and have every opportunity to learn how to be a good sheath puller- in the future I want to tackle this topic. Maybe once we finish our BSN then I will try embracing the role of sheath pull. Because I want to keep learning new things and expanding my role as an RN, I suppose I could some day step and volunteer as a resource nurse. I feel like I would have a lot of respect for myself the day that happens. In the meantime, I will kind of side step and kind of mentally prepare.
I think one other reason I dislike sheath pulls is there are so many variables and sometimes I worry about keeping them all straight. So maybe I need a good old-fashioned chart and a refresher day with the anti-coagulation machine. Depending which anti-coagulant the patient got in the cath lab we have to check their ACT- activated clotting time. But in order to check the ACT you have to put three- no more and no less, drops of blood in this little piece of plastic and enter all the various data into the machine.... But every few days the machine has to be recalibrated so there is another step I need a refresher class on too:)
Long story short that it the honest answer of why I do not like pulling sheaths. I look forward to someday embracing it head on, in the mean time I'll keep slowly trying to come around.
Perhaps you can do an in-service about sheath pulling? That way you can get brownie points towards your CV and promotions or what not. I smell a project brewing for you Sunny Sup :) You are a vital resource to the hospital right now, a rarity~! You should market yourself for advancement.
ReplyDeleteI'm guessing if your patience runs out with this dilemma, you'd probably stop floating to other wards to pull sheaths? Thereby making the hospital to take notice and address the issue? What happens if you transfer or quit your current job?
What a lot of responsibility! I hadn’t realized that once you pulled a sheath, you had to do it all over the hospital and that it would pull you off your floor. I would probably back away from that too.
ReplyDeletePeople sometimes wonder how/why I have stayed so long at my current position, working in the restaurant. With my experience, I could have moved up through all the assistant management positions and be managing the whole restaurant. However, when you look around, I’ve been there longer than anyone else. I’ve outlasted the entire front and back of the house staff. I’ve outlasted more than a half dozen general managers and over 150 servers. Why? Very simply, it is because I’ve carved out a niche for myself, I excel at it, but I stay there. There isn’t any benefit for me to try to climb the corporate ladder so to speak. It’s not what I want to do with the rest of my life. Yes, I could be making 25 cents an hour more as a supervisor or couple dollars an hour more as a manager, but I don’t want more responsibility. I don’t want staff to be able to call me at 2am with a problem. I don’t want to be on-call all the time, just in case somebody gets sick, gets in an accident, got too drunk the night before. I want to do my job well, and then go home and forget about it. This doesn’t totally happen, since politics and favoritism exist even in a restaurant, but I have a lot more freedom than I would if I were a manager or a supervisor.
I don’t begrudge you at all for looking long and hard at this new task and the responsibilities it brings. It sounds like you might need to evaluate if this is something you really need to do to maintain your status in the hospital. If so, then maybe there are other nurses who would also benefit from having a refresher day as well. And like you already alluded to, everyone always loves a good, easy to read, easy to use chart. Perhaps if you need to pursue this, you might jump on board with creating one for the whole hospital to you. However, if you design it, not only will it make sense to you, you’ll remember the steps far more intimately than you would if were pulled off the internet or pulled out of a facility guidebook.
Good luck on whichever path you choose.
I think you are wise to “side step” for now, until the BSN is over. If you will be pulling vacation days next quarter to balance school, I personally wouldn’t be interested either in tackling the sheath issue until the dust has settled and you can focus on it with energy, freshness, and enthusiasm. I heard an Olympic athlete interviewed before her race today. They asked about her epic fail at the Vancouver Olympics. She said medaling of course was something she wanted… but ultimately she just wasn’t mentally prepared for attaining it at that time. Buying time until you are mentally ready sounds right. It sounds like you would like to do this sheath thang, but maybe now just isn’t the time. Which is different than never ever wanting to do sheath pulls (although I can see the frustration of being pulled from the floor!). The chart/card is a great idea, something you can use as a cheat sheet in the meantime and, as Jason and VM said, develop into a tool for others later on. I think while facing the fear of sheath pulls was one of your goals (I’m not 100% positive… I’m offline right now and can’t check…), you definitely gone as far as possible with it for now: you’ve visualized when why and how you would like this all to happen. Hooray!
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