Q&A: Teaching Vascular Access Nursing on the Run

Even in the midst of the coronavirus disease 2019 (COVID-19) pandemic, positions in hospitals still have to filled and the people who want to fill those positions still need to be trained. Maya Gossman, RN, is a vascular access nurse at Stillwater Medical Center in Stillwater, Oklahoma. Wait: “a” vascular access nurse? For about six weeks, Gossman was “the” vascular access nurse at Stillwater; the other vascular access nurse left for another job. But now she’s training two people to become vascular access nurses, which means that eventually the workload will lighten for Gossman, who is a member of Infection Control Today®’s Editorial Advisory Board. In the meantime, though, she’s not only the only vascular access nurse on staff, but she has to be an educator as well, and that means even more work. “We really needed to get some people on board,” Gossman tells ICT®. “And I think they’re going to work great. But it’s been a challenge; the training and trying to logistically think through in my head how I was going to do this with two people during a pandemic has been a lot.”

Infection Control Today®: Has there been any change in the way vascular access nurses are trained because of COVID-19?

Maya Gossman, RN: Yes, there definitely have been changes. COVID has changed everything. We still have to go through the same training protocols, obviously. But it’s definitely made it more difficult. We want to preserve the PPE and not expose our trainees to the COVID patients. And in addition, those patients are the ones who are needing the most vascular access at this time, at least here in Oklahoma, where I’m at. We’re still experiencing a surge. And so, we want the most skilled inserters inserting those lines, because we’ve found those patients to be hypercoagulable. We don’t take our trainees into the room. And when I’m going into a COVID room to do something, that leaves my trainee to find something else to do. It’s not as hands-on as it was in the past.

ICT®: I know you’re training two vascular access nurses this week. Did you ever think about postponing training because of COVID?

Gossman: I would love to have been able to do that. But we’re a 117-bed hospital and at the point that…. I started training these two on Monday of this week actually. I was the only one. I was the only vascular access nurse. Our other vascular access nurse decided to take a different position. The stress was just a lot. And I think that’s universal in healthcare right now. But when you’re in a small hospital, and you’re a team of two, it’s a lot. I have been the only one for about six weeks now. We really needed to get some people on board. And I think they’re going to work great. But it’s been a challenge; the training and trying to logistically think through in my head how I was going to do this with two people during a pandemic has been a lot.

ICT®: How long is a person a trainee?

Gossman: It’s an orientation period. They’re my orientees right now. One of them actually has some vascular access experience in the past, which is really helpful. I think she’ll be off of orientation within probably three weeks. She just needs to learn the hospital system and how we do things here. The other one comes from a background of ER and NICU, so she doesn’t have any vascular access specialist experience. And so that’s probably going to be closer to six weeks.

ICT®: Does this make your job harder? Not only are you doing the job of two people, but you’re doing the job of two people and one educator.

Gossman: It makes my job harder. But the end goal is that we’re going to have more help. So, training and teaching is always harder than just doing, but you have to think about the long run and what it’s going to do for the hospital and our patients in the end. I took it on and it’s going really well so far. They’re really great.

ICT®: You mentioned that they can’t go into a COVID patient’s room. What else is it that you have to watch out for that you didn’t have to watch out for before?

Gossman: There’s a lot more disinfection that’s going on, obviously, of our machines. Our probe because we only have the one ultrasound in the building, in the hospital. We have one for our outpatients. That one stays clean completely from the COVID patients. But the one that’s in the building, we have to take it into all of the rooms. There’s a large disinfection that goes on after it’s been in a COVID room. So that takes time out of the day. And they don’t really help with that yet because they’re not in the COVID room. So, it’s different.

ICT®: You mentioned that there’s a COVID spike going on there. Does that mean elective procedures and elective surgeries are put on hold for a bit?

Gossman: We’re not at that point, right now. We’re still doing the elective procedures. We did stop them in the spring, when everything first hit. We stopped them for a while. And then we started again, and we haven’t really had any problems with them. We have a lot of patients in town who do need those elective procedures. We have continued that, but they do COVID-test them before they come in for their surgeries. And there are extra precautions. Visitors are limited. And everyone wears masks in the building. I’m in a room right now with my mask off. And I feel like oh my gosh, what am I going to do? Because I’m in the building without a mask on, which is weird. But I’m by myself with the door closed. Everybody wears masks.

ICT®: You wrote for Infection Control Today® about working with infection preventionists. Is your infection preventionist involved in the training? Or is it just two different fields and there’s no involvement?

Gossman: Right now, it’s two different fields, because she is so busy with COVID. But our infection preventionist has trained me in the past with the PPE use and the infection prevention measures. And so, I’m passing that on—the knowledge that she’s given me—I’m passing that on at this point to my vascular nurse trainees, my orientees. And we’ve actually taken on another infection control helper. We’re going to have two people now, because it’s just been so overwhelming for her.

ICT®:Is it much harder to do job now? You mentioned several times that you have to put on PPE, so I guess that makes it harder, right?

Gossman: It’s more time consuming. It’s definitely more time consuming. It was harder in the beginning because the PAPR that we wear; it limits your vision. Whether you’re wearing a face shield or a PAPR, whatever direction you go. It limits your vision. There’s a glare on there when you’re looking at the screen of the ultrasound. It was definitely a learning curve. And I’m glad that I was already as knowledgeable as I was when COVID hit because had I been a new vascular access nurse, it would have been overwhelming to me. It definitely is more time consuming and has added a level of difficulty that wasn’t there before.

ICT®: You just said that if you’d been a new vascular access nurse it would have been overwhelming. Are you keeping that in mind as you’re training the two new vascular access nurses?

Gossman: Yes.

ICT®: How you doing that?

Gossman: I’m going to try to slowly introduce them to it. We’ll probably do some practice in an empty room with the gear on, with the PBE on. We were lucky enough that we have a vein block for ultrasound, so we can practice with our ultrasound and a vein block without having to practice on patients. I’ll have them do that with the PPE on to get used to it and practice donning and doffing, and all of that stuff. Being in a room for a while in the PPE you get hot, you get overwhelmed. I had a patient two weeks ago. I think that it was warm in the room already. And I just thought I can’t make it through this without passing out. Luckily, I did make it through, and it was fine. But it gets very warm.

ICT®: Are you asking patients for more input about what you’re doing as you’re doing it?

Gossman: As a vascular access specialist, we have always taken into account the patient’s preferences. For what their lifestyle is. What kind of device they feel would best fit their lifestyle. So that’s always been a piece in my assessment before I place a line. I don’t think that I’ve changed that. Except that it’s a little bit harder to hear sometimes. And so maybe I might be asking less actually, to be honest, in the COVID rooms. Just because it’s such a foreign environment. You feel like you’re on the moon in a spacesuit. It’s hard to communicate. I may not have those conversations and you can’t go in and out of the rooms. Before when I would do my assessment, I would go into the room without any supplies, without anything. Do a full assessment and decide on what device needed to be placed. At this point, you don’t want to be going in and out of those rooms, because you want to limit the exposure. I just take everything and leave it outside the door. And then when I make my decision, I grab it. It’s definitely limited the assessment piece and the deciding with the patient what we’re going to do. I still try. But it’s made it more difficult.

ICT®: What is the hardest part of training someone to be a vascular access nurse? And has that changed because of COVID?

Gossman: I think the hardest part of training is the pressure that they’re under, because by the time here, that we are called, we don’t do all the inpatient IVs. I know there are teams out there that do all the inpatient IVs We’re not at that point yet. So, by the time we were called, usually the patient’s been stuck several times. They’re upset. The nursing staff is upset because nobody wants to not get an IV. Everybody’s upset with themselves when they don’t. And so, you’re under a lot of pressure to be the one to get it. And so that personality piece, that being able to handle the pressure, has been something that we’ve struggled with here. And I don’t think that’s changed because of COVID. The pressure might be a little greater. But I don’t think that’s changed. The skills can be taught, and the personality piece; you have to guide them to that.

ICT®: Infection prevention is a big deal now. Even bigger than usual. Do vascular access nurses get education from infection preventionists?

Gossman: Absolutely. Yes. She shares information with us. She will forward emails to me. Our offices are actually in the same hall, two doors apart. She’ll stop by and tell me if she has any new information she needs me to have. We talk about different things. Goals that we have. Issues that have come up. We definitely coordinate with each other, even though she’s very busy with COVID. She is still taking the time. We speak almost daily.

ICT®: What’s the most important educational tool you have now? And is there an educational tool that you had before that you wish you had back again? I’m assuming it’s more hands-on. Without masking and that sort of thing?

Gossman: The most important educational tool is just giving them the knowledge base that they need to make the right choices. The skills come secondary. The skills can always be picked up. They’re definitely difficult. It’s not an easy job, but the skills they can practice on their own. It’s the knowledge. And we do training through our medical device companies. They offer a lot of online training for that kind of thing as well. I have journals and we go through those together. We look at textbooks together. It’s just giving them that whole picture. They can look at things holistically and make the best choices for the patients.

ICT®: Any information out there for anybody else who might be either thinking about becoming a vascular access nurse or someone in your position who is training new vascular access nurses?

Gossman: I think that if starting IVs and keeping an eye on the IVs is a passion of yours, and you like patient advocacy, then I think it would be something you should look into. It’s a growing specialty. And we are huge patient advocates. We always want to do the best thing for the patients, which I know all nurses do. But we specifically look at those devices that we’re placing into their veins. Ninety percent of patients have an IV of some sort—whether it be a central line, a PICC, a midline, a peripheral IV—when they’re in the hospital. We touch patients from all areas of the hospital and we’re able to really advocate for them.

This interview has been edited for clarity and length.