1. IV insertion
Starting an IV is a core skill, and missing the vein on the first stick can throw off your whole shift. It stings worse when the family is watching or the patient is a fellow health professional.
The best response is to ask for help. If you miss once, you can try a second time, but reassure the patient so they don't lose confidence in you. If you are spiraling, hand it off to a coworker to break the streak. A failed attempt beats not trying, and there is always the next stick.
2. Foley catheter insertion
Foley insertion gets tricky, especially in older women. The mnemonic CUVA (clitoris, urethra, vagina, anus) marks the landmarks to look for. Use it discreetly and work efficiently so you are not lingering. The urethra is the second opening.
During indwelling catheter removal, remember to aspirate the balloon first, or you will cause the patient serious pain.
3. Patient breaks NPO (or any other order)
A procedure needs the patient NPO, so you give the order: follow the fasting window the team set. Then morning comes and you find out they brushed their teeth and drank water. It is your job to explain every procedure and confirm the patient understands, so this usually traces back to a misunderstanding.
Worth knowing: the old blanket "nothing after midnight" rule has been retired. Current American Society of Anesthesiologists guidance lets most healthy patients have clear liquids up to 2 hours before an elective procedure, since long fasts cause their own harm. Always follow the specific order for your patient, but don't treat midnight as gospel.
Tip: Include a family member in the teaching if the patient struggles to follow instructions, and use plain language.
4. Lost pens
Reaching for your pen and finding an empty pocket is a small frustration that costs real time when you need to chart on the spot. Most nurses guard their own pen for exactly this reason.
5. Last-hour admissions
A new case rolls in one minute before your shift ends, on the day before your day off. It is unavoidable, and you have to weigh helping against protecting your own limits. Like first aid, secure your own footing first. If other help is available, let them take it and go on your break.
6. Explaining that the internet is not the answer
Patients and families arrive armed with whatever they read online, right or wrong, and sometimes accuse you of doing it wrong. Stay calm. They are usually intellectualizing to manage their own anxiety, not testing you. Explain carefully and don't let it get under your skin.
7. Monitoring a difficult patient's vitals
Strict monitoring, say every 30 minutes, wears thin with an uncooperative patient. Explain the schedule up front to set expectations. Hold eye contact so they know you are serious, and keep your expression neutral rather than grimacing.
8. Bubbles in the IV tubing
Air bubbles seem to appear out of nowhere and eat time you don't have on a busy shift. Use clearing the line as a moment to connect with your patient instead of letting it annoy you.
Frequently Asked Questions
Do patients really have to be NPO from midnight before surgery? Not anymore as a blanket rule. Current ASA guidance allows most healthy patients clear liquids up to about 2 hours before an elective procedure, because prolonged fasting causes its own problems. Follow the specific order written for each patient, since some conditions and medications still call for longer fasting.
What is the safest way to handle a missed IV stick? Reassure the patient, limit yourself to one or two attempts, and then hand off to a colleague. Asking for help is good practice, not failure, and repeated sticks raise the patient's discomfort and infection risk.
Why aspirate the Foley balloon before removing the catheter? Pulling a still-inflated balloon through the urethra causes pain and injury, so the balloon must be deflated first. Catheters also carry real risk: each day an indwelling catheter stays in raises the chance of a urinary tract infection, which is why prompt removal is part of CDC CAUTI prevention (CDC).
How do I lower a patient's risk of a catheter infection? Use an indwelling catheter only when truly needed, remove it as soon as possible, and consider alternatives like an external catheter when appropriate. These are core points in the CDC CAUTI guideline (CDC).
How should I respond when a patient quotes the internet at me? Stay calm and don't take it as a challenge. People often repeat what they read to manage their own anxiety, so explain clearly, correct misinformation gently, and point them to reliable sources rather than arguing.