1. Kelly, Tracy DNP, RN


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I reviewed the chart the night before-"40 units of NPH insulin subcutaneous before breakfast"-then went home to practice the technique. With a tiny needle and a small volume of medication, I used an orange to simulate the skin and gain confidence in how to puncture the skin and push the plunger to inject the medication.


As I entered the unit with my fellow classmates the next morning, I felt prepared to give my very first injection. I removed the insulin from the refrigerator and began to warm the vial between my fingers. I carefully selected the 100-unit insulin syringe. As I slowly drew up the dose, nervously flicking the air bubble out of the top of the syringe, my clinical instructor watched from the side.


Before we went into the room, I checked the record for site rotation-right side of belly. I swallowed hard. We knocked and entered the room, introducing ourselves and our plans for the patient's morning insulin. The older man lying in bed nodded approvingly. When I pulled up his gown and searched the right side of his belly, I began to have doubts. I hadn't practiced an injection in the belly and the man's skin was dry and wrinkled-nothing like the smooth skin of the orange I'd used the night before.


I swabbed the area with the alcohol pad and then picked up the syringe. When I looked up at my instructor, she smiled and nodded supportively. A drop of sweat ran down the back of my neck and I felt a bit nauseous. I positioned the syringe at the 45-degree angle for a subcutaneous injection, then looked back at my instructor again. She moved closer to me for support. I pushed the needle into the skin, but it didn't go. I tried again, but the needle bounced off.


Feeling frantic, I looked at my instructor. She quietly told me, "It's okay. Try it again." I looked up at the patient, but he seemed unaware of my anxiety. Again, I started to push the needle into the skin, but at the last minute retreated. I doubted my skills. I couldn't do it. As the tears started to fill my eyes, the instructor came up behind me. She took my hand with the syringe still locked in position and together we advanced the needle into the man's belly.


"Push the plunger," she instructed. I did. Then she said, "Now remove the needle." I did. The patient looked at me and smiled. The instructor beamed with pride. I had done it! I'd struggled and needed help, but I'd given my first injection. I was going to be a nurse.


I have never forgotten the instructor's belief in me and the support she gave me almost 40 years ago. As a fragile student, I could have easily given up that day. But she urged me to continue. It was worth the effort.


My nursing career has been rich and devoted ever since. I learned to give many injections in many places in many parts of the world. In a hospital in Cambodia I started IVs on children with malaria. Once I became an advanced practice registered nurse, I perfected my skills in spinal taps and bone marrow aspiration in cancer clinics. In West Africa, I placed intraosseous needles into the tibia of children dehydrated from Ebola. And in the pediatric ICU I advanced PICC lines into infants with sepsis.


Recently I signed up to volunteer to inoculate health care providers with COVID-19 vaccine. As nurse faculty, I was no longer on the front line and so would wait my turn while paying it forward by vaccinating. My shift started at 6:30 AM and the line of ED nurses and ICU physicians was long, many having worked all night.


I scanned the busy room before finding my station. I proficiently drew up the dose, swabbed the upper arm of the nurse, and swiftly injected the medication into her arm. I withdrew the syringe and placed a Band-Aid on her arm, then smiled. As we locked eyes, I saw the tears she had endured over the last several months, the fatigue of a battle that seemed endless, and the joy she felt at receiving the vaccine. I took her hand, as years ago the instructor took mine, and beamed with pride.