On Being a ‘Hard Stick’
On multiple occasions, nurses have a difficult time finding my veins and have been called a “hard stick.” As a sociologist who recognizes the power of labels, this has often bothered me. Even if I drink a gallon of water the day before an IV, it is still difficult for nurses to find my veins I used to be on a medication that would require an infusion every six months. Living in New Jersey, a friend would drive me to the infusion center at the University of Pennsylvania where, to my surprise, almost all of the nurses were White. Coming from a Nigerian family with many nurses and knowing the large number of nurses in the Filipino community, this always struck me as odd, yet typical of a society structured around race.
One of the nurses was assigned to me and would try to push a needle into my vein to give me my medication. After trying twice, she (all were women) would inevitably try to find a different nurse who would try again. Going through this process several times, I knew to ask for a “butterfly needle,” a smaller instrument. After a couple years of going to this center, I knew to ask for “the redhead” since she was the only one who could ever get my vein on the first or second try. Imagine my surprise to learn that not one but TWO redheads worked at the infusion center!
When my insurance decided that they no longer wanted to pay the high cost of an infusion center, they sent a nurse to my home to give me the medication. The first nurse they sent was a blonde in her mid-twenties, likely fresh out of nursing school. After four attempts, we were both disappointed and she was apologetic. The coordinator of the nursing contractor company sent a pediatric nurse to my home. A Black woman whose parents were from the Caribbean, she found my vein on the first try. After two years, when she took two attempts to insert the IV, I knew that my time with this medication was up.
After these incidents and several blood tests over the years, I suspected being a “hard stick” was not the only issue. Living in a segregated society means nurses likely have little opportunity to see what veins look like on a variety of skin tones, including my own brown skin. Most importantly, many nurses are not trained well on giving IVs.
For my forthcoming book, Hard Stick: African Immigrant RNs and White supremacy in US Nursing, I interviewed a 30-something woman who was born and raised in Nigeria and attended nursing school there. She discussed the hardship of the Midwestern hospital where she worked.
Interviewee: … I am ready to get out of there. They are using me too much. They don’t know how to come on and start IV [sic]. [laughing] It’s the simplest stuff, you
know you can do.
Interviewer: [laughing] Yeah.
Interviewee: Your patient can die because patient doesn’t have IV.... if the person… patient is in coma, you can’t give anything oral because that patient cannot salivate. So, if you have IV, that is the only way you can save that patient to save his life. Tell me if you have Bachelors’, you have Master’s, or some of them have 3 or 4 Master’s .... MBA or MSN or D[octorate], you don’t even know how to hold a needle and stick a patient. And you are telling me you are a nurse? What type of nurse is that? When I was in first year of nursing [in Nigeria], we … jumped around [learning a variety of things]…. I asked one of the American nurses [about this] one day. She said that the professor told her, “Don’t worry…when you graduate, when you start working, they will teach you.” Come on!
This interview compelled me to ask other African nurses about their experiences doing IVs. Sharing my own difficulties with my mother, I asked about her experiences working with Nigeria-trained RNs. She replied, “Nurses trained in Nigeria are very, very good.” I was surprised, given her own US training.
The “hard stick” label has been generously applied to many Americans. On the individual level, there is not much for patients to do, except drink gallons of water before our appointments. Technology, such as ultrasound-guided IV insertion, is increasing in use and making it easier to "stick" patients. However, it may be inaccessible in under-resourced or critical care settings.
Yet, this label may exacerbate already-existing inequities. We need health researchers to examine how the “hard stick” label maps on to people with darker skin, an “obese” body, who are non-binary, or otherwise stigmatized by our society. Most importantly, nursing schools should make sure their students are well-trained in this most basic skill across body types. As the Nigerian RN mentioned, patients’ lives are at stake.