Agency Nurse doesn't know how to start IVs? - page 6

Yesterday, a new agency nurse showed up in our ICU to fill a hole. He arrived 2 hours early to be oriented because it was his first time at our facility, so I set him to work on a few things while I... Read More

  1. by   GardenDove
    I am sort of surprised that this turned out to be a little bit controversial, starting this thread. I thought it was a rather bland subject, actually, and I had zero emotion about the subject. It's going on almost as long as the circumcision thread!
  2. by   CritterLover
    okay, kind of late into this thread, but here is my take, for what it is worth

    if he filled out his skills checklist honestly, and the agency was honest with your facility about his skills checklist, then it isn't a big deal.

    if either of them lied, though, then it should be dealt with . are iv skills a requirement to work on your unit? did your staffing coordinator (or whomever....) excuse this lack of skill b/c you were so short-staffed and really needed help?

    i, too, would have been surprised, since i was expected to be able to start ivs as an icu nurse. however, none of the hospitals in this area have iv teams, so most icu nurses, even those from other facilities, have this skill. (this is especially true for nurses that come from non-teaching hospitals, since [in this area] getting a physician who is no longer a resident to place a central line just might cost you your first born child. )

    for the record, gardendove, i understand you confusion, and agree with jjoy that it was open-minded of you to ask the question here rather than assume the agency nurse was substandard for not knowing how to start the iv. if one thing this website has taught me, it is how different things can be in different parts of the country.
  3. by   RosesAreBlue
    Quote from GardenDove
    Yesterday, a new agency nurse showed up in our ICU to fill a hole. He arrived 2 hours early to be oriented because it was his first time at our facility, so I set him to work on a few things while I was showing him around. When I was going to maybe need another line, and asked him if he'd like to start it.

    He told me that he doesn't know how to start IVs because the place where he normally works has IV therapy. I can understand that because I had worked at a hospital with IV therapy and didn't learn to start IVs until I came to my present place of employment. Nevertheless, I was surprised that an agency nurse would lack that commonly used skill.
    Well, that is certainly...different. Agency nurses shouldn't be that limited. They move around alot, right? Why not train them to do basic things like that before they hit the floor? Then again...In CNA school, they didn't teach us how to do the ADL flow books, soooo...:uhoh21: Maybe the classes are going downward.
  4. by   GardenDove
    When I went to nursing school they didn't teach starting IVs. That was considered a technical skill that one learned on the job. They told us not to worry about that, that we needed to learn other things in nursing school. They were entirely correct about that.
  5. by   suzanne4
    Quote from worldtraveler
    I really wonder if those Nurses who claimed they were taught this in Nursing School(ADN, BSN, Diploma) could actually Document where in their Course(exactly what course)it was taught and how many hours was devoted to this area? As far as I know, the its is not requiried in any US based NLN accredited Nursing program. No more then Ventilator compentency, EKGs and various cardiac rythmn interpretation are requiried to be taught in any US Based Nursing school. For some odd reason many out of the Nursing field and some within, assume(and incorrectly I will add)that these skills are included in a Nursing Curriculum but you know what they say about the word "Ass-u-me" ,,,LOL
    Hate to say how many years ago that I trained, but all that you mentioned above were in my program. All but vent competency. And when the first ACLS courses were offered, the nurse was also required to be checked off on intubation as well as central line insertion. Intubation was on the dummy, and for the lines, you had to demonstrate what you would do exactly but not stick the person. Things do change.

    And when I first started, nurses were only permitted to start the butterfly. Physicians only could insert the angiocath. And very few of the docs were proficient at that. And if you could not start an IV you were supposed to call the physician to insert a line, only they rarely did.

    Skill requirements have changed thru the years. We never had ant models or dummies for learning to do procedures, all were on living and breathing patients. We did not use other students as out guinea pigs for anything. Not even the bath.

    And I went to a hospital-based Diploma program.
  6. by   worldtraveler
    I have yet to see a Nursing School where IV Starts were even part of the Official Curriculm; as far as I know, its not included on the list of Critical Compentencies(for legal liability concerns?) that Nursing schools are bound by state law to include in their instruction. After I graduated from Nursing School, I went to another school for this(iv), EKG Certification, Venipuncture and Ventilator Competency. Maybe they should include some Basic instruction on IV Piggy Backs as I actually observed a Nurse (who was the Valedictorian of her Class BTW) and she inserted two Needles(I'm really dating myself here) into the SAME Heplock Device. Anyone ever see this done before? Instead of inserting it at the Y in the mainline, she utilized a seperate needle and plugged it into the same heplock as the Main IV line Needle. The law of Physics does not allow this as it does allow a good seal,,, This of course started a major flood in the patient's bed not to mention loss of Medication. Valedictorian she was but of Common sense she had none,,,LOL
  7. by   bluiis923
    [QUOTE=worldtraveler;2102985] Maybe they should include some Basic instruction on IV Piggy Backs as I actually observed a Nurse (who was the Valedictorian of her Class BTW) and she inserted two Needles(I'm really dating myself here) into the SAME Heplock Device. Anyone ever see this done before?

    I nursed back when we used needles in the locks as well and I don't think I 've ever seen that done ...
  8. by   Gromit
    Quote from worldtraveler
    I really wonder if those Nurses who claimed they were taught this in Nursing School(ADN, BSN, Diploma) could actually Document where in their Course(exactly what course)it was taught and how many hours was devoted to this area? As far as I know, the its is not requiried in any US based NLN accredited Nursing program. No more then Ventilator compentency, EKGs and various cardiac rythmn interpretation are requiried to be taught in any US Based Nursing school. For some odd reason many out of the Nursing field and some within, assume(and incorrectly I will add)that these skills are included in a Nursing Curriculum but you know what they say about the word "Ass-u-me" ,,,LOL

    Ok, I "CLAIM" that my nursing (RN) -ADN- program DID teach IV insertion and monitoring techniques. We learned on the dummy arm with tubbing under the 'skin'. -it was well worn from plenty of previous classes.
    It was taught during the 'Fundamentals' section, toward the end of that semester. Students were instructed on the usual main sites of peripheral IV sticks, the preferred guages of needle/cathlons, and the mechanics of insertion, capping and flushing. They also covered the basics of drips (micro vs macro chambers -though we actually had three different ones to choose from) and you were taught the 'right' way to discontinue and remove the IV cathlon. The instruction lasted over two class days -counting labtime after each set of instructions. They also covered the mechanics of drawing blood (labs) -they didn't use the butterfly, but they did use the needle/vacutainer method.
    This was a community college in Tampa, Florida (HCC) and was only four or five years ago -and according to some of the students that are gracing our floor lately, still taught.
    By your "tone" you don't seem to believe that some schools DO teach it. It may well not be a requirement by the BON, but for my part, if someone "CLAIMS" that THEIR curriculum taught something, I'm inclined to believe them unless I have real cause to believe otherwise.

    To that point, the instruction was adequate as far as that goes. I of course already knew this stuff since I'd worked as a paramedic for years previously -but most of the class did not have that background.

    As far as EKG is concerned, I seem to recall that one of the instructors barely touched on it -just enough so that others would know what they were -but did not teach EKG interpretation since that is well beyond the scope of what we needed to know as far as the basics are concerned. We didn't learn intubation either -but DID learn about oropharyngeal and nasopharyngeal (trumpets) airways. Not much time was spent on either of these for the same reason.
    We learned to maintain and work in sterile techniques, we learned foley insertion and some of the students (I was one) were lucky enough to actually get insert one in a patient during clinicals.

    I guess some schools actually DO teach things they aren't required to teach. Good for them!
    Last edit by Gromit on Mar 9, '07
  9. by   SmilingBluEyes
    Please, keep focus on topic and not on attacking each other. Thanks for understanding.
  10. by   mstigerlily
    I'm a postpartum nurse so you can imagine I don't start many IVs. I used to be afraid to and call for help but after about a year on the floor I realized how stupid this was. How will I ever get skilled if I don't practice? So now when things are slow I ask any staff who is willing if they'll let me try to start one on them. I couldn't believe how many folks are willing to let me poke them. I've "started" four IVs just in the last few weeks on fellow staff members. Now, granted they had good veins but it gives me practice.

    If someone was an ICU nurse I would except them to be reasonably proficient at starting IVs and I would certainly expect them to at least "try" to start one. Surely with you willing to assist and provide encouragement, he would have a good chance of getting it.

    Quote from GardenDove
    Yesterday, a new agency nurse showed up in our ICU to fill a hole. He arrived 2 hours early to be oriented because it was his first time at our facility, so I set him to work on a few things while I was showing him around. When I was going to maybe need another line, and asked him if he'd like to start it.

    He told me that he doesn't know how to start IVs because the place where he normally works has IV therapy. I can understand that because I had worked at a hospital with IV therapy and didn't learn to start IVs until I came to my present place of employment. Nevertheless, I was surprised that an agency nurse would lack that commonly used skill.
  11. by   mstigerlily
    Hey thanks for the link, I'm always looking for more info on IV starts since my skills are fair at best. I can almost always get the flash but have trouble finding the right distance and angle to insert needle then advance catheter.

    We spent about 4 hrs total doing supervised IV starts during classtime so yes, I wish we would have had more.

    Quote from SmilingBluEyes
    Here you go, a site just for YOU:


    http://www.enw.org/IVStarts.htm

    good luck. It's indeed an art but can be learned with patience and practice.
  12. by   81Bubbles
    In the hospital where I am you need to be certified by the hospital to start IV's so no agency nurses are allowed to unless the take the certification. Which BTW none of them do because they're only there when needed on the floor.
  13. by   jamato8
    Interesting that you can start IV's on coworkers. An IV normally has to be ordered or part of the standing orders and to start one otherwise is practicing medicine without a license, in a normal situation. At least this is what I know to be fact where I worked. In China, where I just spent the last year and a half, the nurses start IV's only in the hands. So many antibiotics are used for Everything they get plenty of practice but I also heard many complaints of burning veins and blown IV's.

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