Clinical Sharps and the Lizard Brain

While wandering the wilds of the internet a day ago, I ran into a question about injections that tickled my fancy. Simply restated, it asked if nurses would be able to give themselves a ‘shot’.

Fun question!

I remember, long before nursing school, sitting on my couch sewing a button back on a shirt. I had to set the needle aside for a moment to tie off the string as I finished off the button repair. I put it point first into the arm of the couch beside me- the fabric and stuffing were thin, and right over solid wood.


You guessed it!

I forgot the needle (object permanence deficit) when *knock knock* happened to my door.

As I went to stand, I reached for the couch arm with my palm to assist as I stood up.

Surprise, surprise, my palm was impaled on the needle’s blunt end, leaving just a bit of the sharp end sticking out. The other part of the surprise was it didn't hurt so much as just 'register' its presence. Just enough was available to push down my thumb and index finger on both sides to get a fingernail grip and pull it out.

So, I met my worst childhood fears about needles getting pushed into me, and it wasn't really painful as much as surprising.

I got a lot out of that life lesson!

Unfortunately, it didn't stick (pardon the pun).

I still feared ‘shots' and blood draws (even though I didn't refuse them) sometimes enough to kick off the vasovagal reflex enough to get faint, or actually faint. That lizard brain of ours is one tough-to-convince critter.

Enter my nursing career, started around age 50 (late bloomer, eh?). Needles are a thing, and you either know, or will know, that’s something you want to get good at.

IVs, Injections, & Needle Mastery

As you start your nursing practice (or even if you just want to get better at IV starts and injections, invest in watching others techniques- especially those who are really good with the pointy tools we use. Be nosy, ask them to describe their thinking and technique as they are doing it. Anyone who is really good with IV placement or injections won’t mind, usually. Folks like talking about what they’re good at. That approach helped me immensely.

Thanks to watching and listening to the talented IV and needle ‘stars’, and making a study of it, I joined their ranks.

There is a price to pay, by the way- but don’t worry, it’s worth it.

Co-workers catch onto your skills quick. I can’t tell you how many times another nurse came to me and asked for help getting an IV started. If you have the touch too, they’ll find you. And they’ll really appreciate having you around. Your patients will appreciate you too- Gee, that didn’t hurt as much as I thought it would! -they’ll think, and usually tell you, too. Having confidence in your use of sharps takes the hesitation out of your steps, and well, feels good.

Confidence to teach

There are more benefits, as well. Confidence helps your teaching. A nurse ends up teaching a lot, it’s a big part of our practice. That includes teaching a patient to give themselves injections of all sorts- anti-coagulants, insulin, sumatripan, testosterone, and others fitting the home injection category. Insulin is the most common injection you’ll teach, but for any home injection you’ll have to communicate three things:

The patient CAN do it to themselves, by themselves, after training.

(Yes, they can delegate that to a ‘helper’- spouse, relative, trusted other- who will train at the same time they do if needed.)

They WILL do this with accuracy, correct technique, and confidence.

Confidence is key. There was still one last hidden hurdle for me in conveying confidence to the patient. When it’s your own skin facing the business end of a needle, it’s not like it is giving someone else an injection. There’s a big leap to make internally if you haven’t done this before - and, to our skin, the whole idea seems like a bad idea). Insulin needles are really thin- they're 25 or 27 gauge, which means they're 1/2 of a millimeter thick- if you think in inches, 2/100 of an inch thick. For comparison, most of the cheap little sewing travel kit needles (like the one I pulled from my palm long ago) are near twice that wide.

Still, sticking these needles into patient’s 'tummies' many times daily, I couldn't imagine it. One slow 12 hour night shift, I decided I had to know. I took a nurse friend with me, and got an insulin syringe, drew up a teeny amount of sterile saline, and carefully prepped my beloved tummy skin. I felt the trepidation a patient would go through. Still, I had to go through with it. Feeling my hesitation, my trepidation, my fear of 'the unknown', I took the plunge! I thought, immediately, how could I have missed?!? But my eyes saw the inserted needle, my brain registered no pain, just pressure.

Those needles really are tiny, and my beloved tummy wasn’t as sensitive as it told me it was. Understanding how it felt, directly, to realize you’re going to 'give yourself a shot' and feeling the inner barriers, the natural reluctance a patient does, is helpful. In my own case, that uprooted a hurdle to teaching confidence genuinely. Priceless!-

Looking back on that, even if I did take a friend and ensure it was an action that wouldn’t ‘go wrong’ somehow- I should have asked a supervisor (later, I did tell her about it- she was fine with the whole thing).

Fast forward 12 years. Experienced RN at home, and I’ve become one of those patients I was teaching. My health plan didn’t like paying for the testosterone supplement I had been smearing all over my shoulders/arms, and transitioned me to home injections. You’d think I wouldn’t hesitate, but standing there in the bathroom at home, the difference between a 25 gauge short insulin needle, and a 20 gauge 1-1/2 appears like the difference between a pea-shooter and a battleship cannon to my lizard brain. After a long pause over that difference, the confident nurse won out and got the job done.

There was a bonus.

I had an answer for the internet questioner we met at the start of this piece.

Yes, nurses can give themselves a shot. So can the patients I teach. Confidently.

Steven Bobulsky

My history is a bit unusual, but it provided a broad life experience (shorthand for “OMG how did I make it through all that?”) Teen summers walking behind a garbage truck; worked forging aluminum and titanium in to things from small widgets to Boeing 727 wings; Completed B.A., then went to M.Div. school, ordained an Orthodox priest. Pastored parishes; went on to work for EDS, and GM recruited me out of there; managed district dealers as their “factory contact” for Cadillac Motor Division; started a Computer/web service for dealers. Personal tragedies struck. A decision to pursue Nursing and passing my NCLEX (R.N.) opened up the doors in a career that I didn’t know I was looking for. All the experience a person brings with them is unique, and ALL of it can (and will be) put to use in the course of your patient care. Every good thing you go through, every difficulty you bear, knowledge from any field you’ve studied, any hobbies, talents, quirks, whatever makes one unique- will supplement and support the mind of a nurse, and the heart of your practice.