As all educators know, teaching students comes with unique challenges. Every student learns in their own way and in their own time. Trying to adapt your teaching techniques to fit each student can take incredible amounts of creativity and patience (and quick reflexes to avoid getting accidentally stabbed in the case of phlebotomy students). As a phlebotomy instructor, one of the common struggles I would see students go through was fear. There were typically two categories of fear that I would see most students struggle with; fear of getting stuck by fellow students learning their craft OR fear of sticking others and inflicting pain. Of course, it could be both things that they were scared of, but typically one was worse than the other. 

It wasn't uncommon for a student to be nearly in tears, overwhelmed with the anxiety of having to stick or get stuck, and it could be difficult for them to overcome. The fact that they even stayed around after hearing about possible risks and injuries during the class was impressive. I am surprised people didn't run out screaming when they heard that things like nerve damage were a risk of taking the course. Choosing to stay was a testament to their character. Not that it's that strange to have a fear of needles. It's quite normal for most people to NOT like having their blood drawn. People usually avoid needles whenever possible and dread the moment it's time for their next doctor's visit because it's hard to escape without being poked and prodded.

So what are some ways to help students such as these in a beneficial non-confrontational, or embarrassing way? Telling them to "Just do it" or "It's not that bad" (while sometimes true) does not help. We need to validate their feelings and help them work through the problem in a way that gives them confidence and a better understanding of the process. There are a lot of practices proven to help with stress and anxiety such as breathing techniques and yoga, and those can be very helpful, but I am talking about strategies instructors can implement to help in a rational step by step method. 

Let's address the first fear - the fear of getting stuck by a needle. Most commonly, the students who had a real true terror of having their blood drawn had experienced a traumatic event at some point. Maybe they spent some time in the hospital as a child or had poor blood draw with complications. Sometimes there was nothing they could pinpoint that caused their phobia, but it existed anyway. Whatever the reason, the fact they had chosen to join a class to learn how to become a phlebotomist was incredibly inspiring - what a brave individual to challenge their fears in such a direct way. Many of them want to be phlebotomists because they desire to help others avoid the terrible experiences they have gone through. 

My strategy when dealing with a student who was terrified to get stuck was to have them stick someone else a few times first. This helped them feel in control of the procedure and see firsthand everything involved in the process. Then when it became their turn to be stuck, they were familiar with what was going to happen. It helped them to work through their fears and showed them that their classmates who have been stuck before them have survived, and they will too.

Now, what do we do with a student who is afraid to stick? This type of person is terrified of inflicting pain upon others and hates the idea that they will make anyone suffer. Even if the draw goes really well, they usually stress that the patient may have felt some pain. Many times I have seen a student do an excellent stick, but as soon as the person they were practicing on showed the tiniest indication (real or imagined) that they were uncomfortable, the student would immediately remove the needle - which of course, is not usually the proper way to handle the situation. 

When dealing with a student struggling with this type of fear, I recommend that they get stuck before they start to stick others. Newbie sticks tend to be more painful as students figure out their speed and technique. They improve over time, so if a student who's nervous about inflicting pain can feel the sting of a slow stick or unsteady hand, it will teach them that while it may be uncomfortable, even the poor sticks are usually bearable. It really helps them to be able to envision what a normal draw should feel like and what a normal reaction to pain usually looks like, compared to someone who is just nervous, or someone who may experience unusual amounts of pain. Plus, they learn that they can stop the draw at any point if it becomes too painful or stressful, which others should do as well.

Sometimes students are terrified of both things. That can be a real challenge, but my usual approach was first to have them watch others practice a few times - again to show them that whatever problem may arise, the instructor was right there and would not let anything bad happen. Then, I let them choose what they wanted to start with - sticking or getting stuck. Then we walked through the procedure together and took it slow. Frequently I found they were determined to master these fears, but they needed a little extra patience to help them get to the point where they could manage it. 

Besides the techniques above, what other ways can we support these students to master their fears and learn how to push past their worries? It takes patient and gentle repeated reminders that phlebotomy is not meant to be painless. It's normal for a patient to feel some discomfort during their draw, and as long as they monitor the patient to ensure that the pain is nothing unusual, they can continue. Again, they are usually aware of this, but one thing I found that really helps is asking the person who was having their blood drawn describe what they felt - how bad the pain was - if they could deal with it - if it was different from other times they've had their blood drawn - and what the student did well during the draw that they liked. 

Constructive comments shed light on what they did well and what could be better for next time without pointing out mistakes in an obvious way. It turns into a discussion of how to improve, and really helps them understand what types of things hurt and what things don't. More importantly, students learn they have control and can stop the draw if needed - this was something we repeatedly stressed before they started practicing. They could always stop the draw or let us know if something was wrong. They shouldn't try to hide excessive discomfort. 

Techniques tailored to the student and open communication break things down so that learning these skills becomes less daunting for everyone involved. A healthy learning environment is absolutely critical to preparing good phlebotomists for working in the field. It requires instructors who can combine creativity, patience, and positive support for their students. It is a pretty special thing to find an environment like that, but I have met many instructors who have managed to cultivate exactly that type of place - their students admire and remember them forever.

To all instructors, thank you! Your role is so so important! 

Please feel free to add any strategies you may use for students struggling with overcoming their fears in the comments.

Newbie fears

Article was true to the point! Many students fears both aspects of the first sticks. I tell them that it's better to get his fear out in the classroom before embarking on their first live stick with a patient. They will be 10x more nervous and the more they practice in the classroom setting will help calm their nerves once the big day arrives and they are in front of their first "REAL" patient!

Terri McElhattan, 03/24/2022 10:13:08