Considering ER but not good at starting IV's

NICUmiiki, DNP, NP · Oct 27, 2012

At the hospital I work at, the ER techs do a large percentage of the IV starts. I was talking to a tech (because I want to transfer to the ER as one) and she told me that getting used to these basic nursing skills doesn't take long because you do so many of them.

You can always ask for help when you need it.

TLS1 · Oct 27, 2012

I have grown to despise bedside nursing. I really enjoyed ER clinicals during school. In 3 more months I will have been a RN for a year at my hospital, which means a lot of opportunities will open up for me and I can start applying for other positions. I think I would like to be in the ER. This may sound silly, but I haven't gotten good at starting IV's yet. I know you have to start a lot of them and I am afraid I will get behind if I have to stick a patient multiple times or get someone else to start one for me. Right now I have about a 1/3 success rate. I can always get one in the AC if a patient has a good vein, but as you know a lot of them have poor veins. Any advice?

I would start to brush up on that skill now. Ask each nurse you work with to show you on the next pt. they start. Watch and you may catch the step that you can do to go to 80percent. I work in an ER and when I start an IV I place the tourniquet on the pt. then open everything and then rub vigorously with alcohol. I tell my pt. the truth this will be tight but we want to do this once and only once so we are going to work together. It will help you feel the veins that you can't see quickly. Tell your charge you want to do all the IV starts that are needed on the floor. Delegate something to the RN you are starting the IV for and get the number you try up and your success rate will increase. Your friend was right there are people there to help when you need but your pts need you. Don't put yourself behind before you start. Good luck the ED needs nurses that want to be there :)

ER__NURSE, LPN · Oct 27, 2012

Practice makes perfect, and you are sure to get more then enough practice in the ER. You will get proficient because you will have the constant exposure to the skill. Although, I would question the move since you don't like bedside nursing. You are still doing bedside nursing in the ER.

JessiekRN · Oct 27, 2012

Practice makes (almost) perfect. I rarely started IVs on the floor and felt incompetent in the ER when I started. When you have to start a line on almost everyone, thirty times a day, you get really skilled really quickly. Trust me! There is some bedside nursing, as the above poter mentioned, especially when you are holding patients waiting for tele, ICU, medical beds. But with that exception, it's a very rapid turnover- I really like coming in for my second shift an knowing it will be a whole new set of patients/ problems/ diagnoses, instead of the same issues I dealt with 12 hours earlier. Don't let IV starts hold you back.

LearningByMistakes · Oct 27, 2012

Actually, PERFECT practice makes perfect.

Altra, BSN, RN · Oct 27, 2012

We do not expect nurses to necessarily come to the ED proficient at starting IVs. At hospitals where I have worked, a new ED nurse will spend a full day with IV team for one-on-one instruction. And in the ED itself, you will pick up this skill quickly, because you'll be doing it ... every hour or so. You will get proficient in a short period of time.

hiddencatRN, BSN, RN · Oct 27, 2012

I started in the ER as a new grad with no IV experience. You do it so often that you become decent quickly and after a while you become pretty good. At just shy of the two-year mark in nursing I'm helping coworkers with their hard sticks more often than they are helping me.

Guest343211 · Oct 28, 2012

Some people and kids are hard as all heck to cannulate. It's just the way it is. And if those messed vessels have been hit over and over and over, they may well be super scarred up. I love how antecubs get hit so much, and then when people need a line again, guess what's messed up for use? The antecubs. Then I have crap for choices in a number of cases.

Try wraping that tourniquet tight and leaving it on a little kid while you are openning you stuff with mom's there and the kid is screaming her butt of. Ha ha. Good freaking luck.

TRUtraumaRN · Oct 28, 2012

Honestly, I think all new grads need to start off on a med-surg unit unless your hospital offers a very intense residency program in the ER. Reason being, I've seen so many new grads come into the ER and they're excited about trauma and codes and all the adrenaline rush. As a new grad, you probably won't be thrown into that stuff till you have some more experience. I know our ER hired 4 new grads this spring (3 of them worked as externs) and only one of them is really working out so far... You need to get a good background in general nursing and have time go develop skills and assessment techniques before jumping into the chaos of the ER. I've seen lots of people come and go because its not what they expected. Yes you do get traumas and critical pts but they're mixed in with all the "regulars" that everyone knows and dreads, the people with a runny nose and cough, the pts from the nursing home they're trying to get rid of for the weekend, sprained ankles and tons of other complaints that could easily be seen at a doctors office or urgent care. Maybe try for ICU or a step down unit that way you can mature as a nurse and master the skills needed for the ER. Good luck!

dmapp63, MSN, RN · Oct 28, 2012

There are other nursing skills that are much more important in the ER than IV insertion .... assessment, critical thinking, prioritization, collaboration, communication, pt education .......... "bedside nursing" has (hopefully) allowed you to enhance these skills ... are you "ready" for the ER?

amarilla, RN · Oct 28, 2012

I spent two years in med-surg and float pool before moving into the ED. I've worked two months now and can say that placing IVs are probably the least of your worries transitioning from the floor. If my IV and blood draw skills were adequate before, they are better all the time now; doing at least a dozen every shift will help you develop quick and in a hurry. That being said: if you *want* to be challenged, pushed, overwhelmed, made to think and question and act, do things you've never done with minimal help and hearty encouragement to get the job done (and now!), I think you'll be fine. If your skills are lacking because you hang back, watch, read on your own or avoid some of those patients who may challenge you...this is the bigger concern and it will become apparent very quickly when you transfer into the department. Maybe you can use the remaining time you're waiting to be eligible for transfer to cross-train to other departments and develop some additional skills and leave your comfort zone? Good luck :)