IV start in Assisted Living Facility - page 2

by CrazierThanYou 4,029 Views | 17 Comments

I work in a small assisted living facility (6 residents). There are 3 CNA's and the administrator. The administrator was a CNA years ago doesn't have her certification anymore. Here is my question: She told me the other day... Read More


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    I've worked as the RN for an ALF. I always called in a home health IV agency to start the IVs, due to the liability, and the fact that there was enough work to do already. I instructed the caregivers (usually CNAs) in how to do personal care around an IV site - beyond that, they weren't allowed to touch them. The IV therapies were usually short term, for hydration, or for IV antibiotics managed by the agency nurses. If the resident is really sick and unstable, they should be in a hospital, or have a hospice agency involved if they're needing terminal care. The administrator will always object to hospitalization, even if it's best for your resident, because the resident doesn't pay rent while they're admitted. The admin will want to do IV therapy, because in most ALF companies, they can then charge more for the RN in-house to monitor it, because the level of care has gone up. For the admins, it's ALL about income. The families should be told these things, but sometimes aren't. Your resident will get safer care in the hospital - maybe fewer personal touches from kind caregivers like yourself, but at least safe care.

    Even if your state allowed CNAs to start IVs, you're not being paid enough for that kind of liability. We're all better off sticking to what we do often, and do well.

    And beware of administrators in assisted living, or LTC, that used to be CNAs or even LPNs. These folks think that since they've had some management training, they know everything that RNs know. They are "wannabe" nurses who quite likely were not good CNAs - otherwise they'd still be involved in nursing. They are being paid good money, as long as they bring in income for the facility. Admins. who were never nurses tend to know their limits. Steer clear of this woman until she does something to embarrass or anger the owners. You could also report her anonymously for her statement about IVs, to the state board of nursing, and they would make a random drop-in visit to check on things.

    Good luck to you! Keep up the good work.
    jerenemarie and scoochy like this.
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    Quote from BeenthereRN
    I've worked as the RN for an ALF. I always called in a home health IV agency to start the IVs, due to the liability, and the fact that there was enough work to do already. I instructed the caregivers (usually CNAs) in how to do personal care around an IV site - beyond that, they weren't allowed to touch them. The IV therapies were usually short term, for hydration, or for IV antibiotics managed by the agency nurses. If the resident is really sick and unstable, they should be in a hospital, or have a hospice agency involved if they're needing terminal care. The administrator will always object to hospitalization, even if it's best for your resident, because the resident doesn't pay rent while they're admitted. The admin will want to do IV therapy, because in most ALF companies, they can then charge more for the RN in-house to monitor it, because the level of care has gone up. For the admins, it's ALL about income. The families should be told these things, but sometimes aren't. Your resident will get safer care in the hospital - maybe fewer personal touches from kind caregivers like yourself, but at least safe care.

    Even if your state allowed CNAs to start IVs, you're not being paid enough for that kind of liability. We're all better off sticking to what we do often, and do well.

    And beware of administrators in assisted living, or LTC, that used to be CNAs or even LPNs. These folks think that since they've had some management training, they know everything that RNs know. They are "wannabe" nurses who quite likely were not good CNAs - otherwise they'd still be involved in nursing. They are being paid good money, as long as they bring in income for the facility. Admins. who were never nurses tend to know their limits. Steer clear of this woman until she does something to embarrass or anger the owners. You could also report her anonymously for her statement about IVs, to the state board of nursing, and they would make a random drop-in visit to check on things.

    Good luck to you! Keep up the good work.
    O.....M.....G That statement right there describes her PERFECTLY! You would not believe all the things she thinks she is an expert on when in truth, she has no idea what she is talking about. For example, her "knowledge" concerning diabetes is alarming. She obviously knows nothing at all about the disease. She has a lot of the old beliefs about DM e.g. table sugar is the only thing that matters, never considering carbs. My knowledge is so much more extensive than hers but I learned quickly not to argue with her. Let her believe what she wants and mind my own business is the best approach.

    No, I would NEVER do anything like start an IV. Ever. Not until I'm a nurse, anyway... I'm a nursing student so there is no way I would anything to screw that up!
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    Do you even have supplies to start IVs?
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    In my state with the laws around Assisted Livings I don't believe it is legal for an AL nurse/cna to start and maintain an IV in the AL. If an IV is needed home care is brought in.
    scoochy likes this.
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    Quote from blondy2061h
    Do you even have supplies to start IVs?
    Highly unlikely. Believe me when I say the woman is a real loonytoons.
    blondy2061h likes this.
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    Quote from Flo.
    She is way off base. With no training you can not start IVs and as others have said even if you could there is no point in starting one as only an RN or higher can give IV meds. IVs can cause serious injuries and should not be attempted by an untrained person.


    Actually, in some states LVNs/LPNs give IV meds. But as others have already pointed out, what would be the point of starting an IV if there is no one there who can use it? If a resident needs extended IV therapy the doctor can have a PICC line put in and home health can come by to do the administration.
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    I found out from my very bad experience working in an A.L. facility is that administrators will do anything to keep the residents from being hospitalized as they are all about bringing in the bucks!! I.V. sites must be monitored every shift for signs of infection, infiltration, etc & who is going to do this...the staff that is hired off the streets, what a joke?!? What about the labs that should be done for I.V. meds...like peak & troughs? I can think of all kinds of things that could go wrong by having I.V. therapy done in an A.L. facility; this administrator is nuts in my book!
    Thanks,
    jerenemarie
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    Per Catiwampus:

    "And beware of administrators in assisted living, or LTC, that used to be CNAs or even LPNs. These folks think that since they've had some management training, they know everything that RNs know. They are "wannabe" nurses who quite likely were not good CNAs - otherwise they'd still be involved in nursing. They are being paid good money, as long as they bring in income for the facility. Admins. who were never nurses tend to know their limits. Steer clear of this woman until she does something to embarrass or anger the owners. You could also report her anonymously for her statement about IVs, to the state board of nursing, and they would make a random drop-in visit to check on things."

    Wow wrong thing to say on here! Again, and without sounding like a broken record.....LPN'S ARE NURSES.
    I am the administrator of an assisted living home, and have been for 10+ years. I am also an lpn. I am licensed by the state of Wisconsin as a NURSE. And yes I, along with other LPN's do take great offense at your obvious mistake. I am not a "wannabe" at all. I am right where I "wannabe" in my career. I went to college, took the state boards, and passed (I did very well, actually.). I have no desire to be come an RN, NP, or anything else. Although I am the administrator, I am still a nurse. I function in the role of administrator, and do stick to my job description, which is wise for any nurse administrator. I have worked at hospitals, in home health, and in rehab, and now in administration, but I will always be a NURSE.



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