I cant start IV's!

I agree, lots of practice, and working in an ER, you will get many chances to practice. I was really bad at starting IVs when I first started working in the ER 4 years ago, but have since become much better, though I am, by far, not the best stick in my ER. Remember, you work as a team in the ER. Someone will have your back, and if you are in a situation where you need and IV quick, there is usually someone there that can step in to attempt an IV if you can't get it.
I know how you feel, though. This was one of my biggest stressors when I first started working in the ER. I used to frustrate me so much to not be able to start an IV successfully, after having been a floor nurse for 5 years before transferring to the ER.
Good luck, and, remember, practice, practice, practice. Try first, and only ask for help if you can't get it after 2 trys.

Thank you so much. I'm a new ER nurse and I feel like I'm bumbling because of my IV record. I keep trying, no matter what, 2 sticks per patient, and some days are better than others, but I'm working hard to not let it be a complex.
The worst is the feeling: "I can't start the IV. If I can't start the IV, I can't work in the ER. If I can't work in the ER, I'm going to lose my job..." commence downward spiral into despair.

One month of doing this. My record is already getting better, but it's slow progress.

Sorry if I am repeating what was already mentioned ( I have not gone through all of the previous messages)

As terrible as it sounds, when a patient tells me that they are a hard stick and everyone always misses, I actually feel less nervous, because if I miss, the patient is not disappointed or angry, and if you get it, they are impressed. Of course I care about missing, and I always try my hardest, but if I relax and tell myself it is ok to not get it on the first try, I usually do better (and shake less too!)

A few things that I do are heat application to dilate the veins (I had access to heel warmers, used for baby heal stick blood draws, hot towel works too). And as simple as it sounds, make sure you use gravity. Dangle the arm, hand down! Don't forget to stabilize the vein.

I don't know how professional it is to "claw" someone but advice that I have been given by nurses for times when you feel like you lose the vein before you stick, but do not want to palpate and recontaminate the site is to make a small indent with your fingernail at the point in the vein that you want to insert the needle, and another small indent about an inch above the first, still on the vein path. That way if you forget where you wanted to enter, and the direction you want to head in, it's mapped out for you. My concern for infection control is all of the bacteria under one's fingernails, and then indenting another person's skin with your nail, but you can always use the end of the plastic cap that covered the needle, or improvise. Make sure you clean the site well regardless of what you use.

Go to pre-op for a day (busy surgery center with 40 or more cases).

You will be good by the end of the day.

At least in the technique--now on trauma patients--that's going to be a different story.
Hopefully the huge gauge IV in the AC that you may or may not get from FR works until you get something else.

I have a little different perpective. Many people say always try.

From an educational perspective, I think you learn more from success than failure. Ask your coworkers to get you when there is an easy stick. It will boost your confidence, and make you more familiar with the feel of getting into a vein. It will also help you smooth out some of the mechanics, like advancing the canulla, and hooking a line up without making a mess.

From my perspectivem, I am happy to let a newcomer have as many of my easy sticks as he or she wants. I will even cover a task or two for them while they try

Call us crazy, but the nurses were so wonderful about letting me practice on them when I was training as a patient care tech (of course it benefited them, because I could start their IVs :-) . And I was terrible. But when new grad RNs and new PCTs came in I lent them my arm - my way of giving back lol.

Here is a good one for this topic. In the hospital I work at we are not allowed to put in an atecubital. Their rationale is it increases chance of infection. Really limits the success of IV's in the dehydrated frail veined patient.

Interesting... in my nursing school we were told the same thing. I don't buy it though. At the end of the day it's our nursing skills that the patients need. If we can't perform these procedures easily and flawlessly our patient care suffers.