Advice please

andrea3434 · Oct 30, 2018

The only practice we got with IVs in nursing school was on fake arms. I've worked as an RN for 4 months now on a medical-oncology floor and have never started an IV. At our hospital we have an IV team that does all ivs except on labor and delivery. I could easily work here for years with never starting one. So it's not that odd to me OP doesn't have experience with this. It was never brought up verbally or in our employee paperwork that starting them was a core competency.

Daisy4RN · Oct 30, 2018

You are definitely over thinking this and worring for nothing. You will learn the skills you need and even if you learn on the job with no IV start classes it will still be easier for you than a new grad related to your experience because you are not learning everything at once. ACLS is usually required and not a huge deal, 2 day class, study the material and you will be fine. All night nurses figure out the timing so if you are not sure ask them or your manager. Remember that your coworkers had to learn these skills also so they should not be upset about you needing to learn, ask a friendly coworker or charge for help. This is probably why they have a lower patient ratio, because they expect the nurse to do the IV's etc. Good luck, you got this!!

cayenne06, MSN, CNM · Oct 30, 2018

I totally understand the stress! But the previous posters are right- take a step back and look at the big picture. These are things you are *more* than qualified to do. The only real problem is getting trained. It should be no big deal to adjust your schedule to accomodate the needed classes and/or preceptorship- and hopefully it goes without saying you should be paid for your time. Your unit manager shouldn't even blink an eye if you come to her with this issue.

When did you find out you would need to be ACLS certified, and start IVs/draw blood? Ideally this should have been identified during the onboarding process, so they could give you the needed training up front.

loriangel14, RN · Oct 30, 2018

My previous employer allowed me to work a paid shift up in day surgery and all I did was start IVs all day. It helped a lot.

guest358111 · Oct 30, 2018

You've received some good advice already.

I have a few ideas:

1. Work with management to get the time to take the classes.

2. Jump in and learn from the other nurses how to do what you don't know what to do

3. Don't feel embarrassed asking for help. In order to succeed you need to ask questions and jump in there...doing IV's etc. don't come from a class or watching, they come from jumping in and trying again and again even when flubbing up a few times.

4. Don't listen to the negative ones who say that certain classes etc. were useless, etc. make your own judgement on that.

You will do fine. You have a skill set already, and sometimes, the best training comes when you least expect it. Just speak up for yourself in the middle of a situation if you don't know what to do, and jump in when you can to do something you are not familiar with. It's basically having to work out of your comfort zone...but you will get through it and be fine I am sure! Best wishes. :)

murseman24, MSN, CRNA · Oct 30, 2018

No biggie, you can do it. I wouldn't recommend quitting for another position that will most likely require you to have these skills.

ACLS = buy the book, memorize algorithms, take test, move on. It's not a big book, and you could probably get by without the book if you took a longer course.

IV/blood draws = practice makes perfect. YouTube. Not rocket science.

You can do it!

hawaiicarl, BSN, RN · Oct 30, 2018

Aloha OP

I have noticed during my career that the hospitals where I learned the least are the huge teaching hospitals. Like you said there are code teams, phlebotomists, IV teams, let alone all the damn interns, and residents trying to get their skills checked off. People also tend to get pigeonholed into specialty areas and lose what skills they had from school in areas not in that specialty ie Cardiac vs Neuro ICU. This makes it a poor learning environment for nurses I have found. I worked in a small regional hospital like you described, and learned more in 6 months than I did 4 years at the big University hospital. Stick with it, pick up every skill you can, and it will only make you a stronger more well rounded nurse.

Cheers

allnurses Guide · Oct 30, 2018

ACLS is not that big of a deal. They teach you absolutely everything in the class. It's not that hard to push 1mg of epi. You should know how to run a code whether or not you are on a "code" team.
I work at a big teaching hospital. We have no code team, no phlebotomists, and no IV team.
It's not a big deal. You learn.

No phlebotomists in a big teaching hospital? Are you serious??

Even my little tiny hospital has phlebotomists.

Every hospital that I've worked in has had them.

The only time I've ever had to draw my own labs was in home health.

Even the psych hospitals that I've worked in used phlebotomists.

I really want to call BS on that... but I try very hard not to

be rude on here.

LovingLife123 · Oct 30, 2018

No phlebotomists in a big teaching hospital? Are you serious??
Even my little tiny hospital has phlebotomists.
Every hospital that I've worked in has had them.
The only time I've ever had to draw my own labs was in home health.
Even the psych hospitals that I've worked in used phlebotomists.
I really want to call BS on that... but I try very hard not to
be rude on here.

Nope. We draw all our own labs. And we are a teaching hospital/level one trauma.

brownbook · Oct 30, 2018

My first job, a big hospital, the 11 - 7 RN's were responsible for routine morning phlebotomy. I never needed their services, thank goodness, but I assume they were available for emergencies during the night.

Accolay · Oct 30, 2018

To the OP:

Buck up. Find a way to take the classess offered and move on. It does take time for these skills to develop but it will be ok. This is free useful training that will help you become a more rounded nurse. You need to change your thinking about why learning these skills, although stressful, is a positive.

To continue the conversation:

That being said it's hard to comprehend that you have been working med-surge for 2.5 years and never started an IV. In every hospital except psych this is a core competency, When I was in Nursing school we practiced IV starts and venous access on each other in skills lab.

When I started in a teaching hospital on med-surg, IVs and blood draws were just not something nurses did very often. It was not taught during formal orientation, not a core competancy but a handy skill to have. We were too damn busy and our population didn't have the easiest veins for a beginner to practice on. IV starts and blood draws were OJT. 7am-11pm had an IV team and the night crew always knew the person who was good at IV starts or those who could get blood out of a rock.

Sometimes if choosing to attempt an IV start or wait for the team the deciding rationale would be: should I get some practice on this poor patient or should I find the team readily available with an experienced hand who wont have to beat on someones arm?

Also, I received my degree from a nursing program with a good reputation from a Big Ten school and we were not taught there either.

p.s. IMHO lack of training bleeds over from the corporate fantasy world where executives don't know what nurses do and so would rather have a nurse chart on an increasing number of patients then train them and expect them to have actual skills.

Hoosier_RN, MSN · Oct 30, 2018

I recently transferred to a new hospital but still in the same system due to better patient to nurse ratios and it is a lot closer to my house.
This new hospital has their nurses do blood draws, start IVs, Be ACLS certified and a few other minors things just for medsurg floors. While I am sure this sounds dumb to a lot of you. I am coming from a large hospital where I had a code team, 24/7 phlebotomy and IV team.

You mentioned the better nurse to patient ratios in the new hospital. This is probably why. The other hospital probably took into account that these tasks would be managed by the appropriate group. There is no shame in not knowing this skills, as others have said, they are skills to be practiced, ACLS is a class that teaches you. You can do this!