Agency Nurse doesn't know how to start IVs?

[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.

[Bluehair]

Hmmm. Makes me wonder what other skills he did not have that I would expect from an ICU nurse....

[nursebrandie28, BSN, RN]

i think that is crap. as an agency nurse, each agency has a check list that states what you can do and what you cannot do. that nurse was probably making $30-40ish dollars an hour plus more if it was icu.....i would have to the charge nurse and sent him home or the iv class!!!

a nurse is a nurse is a nurse and nurses start ivs!!

[angel337, MSN, RN]

that's ridiculous. what some people won't do to get by....i find it very hard to believe that this guy is naive enough to think that he can work agency without that basic skill. make him a DNR right away (Do Not Return):smackingf

[NurseguyFL]

I would not be so quick to judge or criticize. True that starting an IV is a basic nursing skill, but it is a skill that even some experienced nurses are not very good at. I disagree with nursebrandie's statement becase all nurses do not possess the same skill levels. I've worked with experienced ICU nurses who are terrible at starting IVs, but they provide expert care to their patients otherwise.

The nurse is not solely to be blamed in this case. All agency nurses fill out a skills checklist, and it is the manager's responsibility to review that checklist before agreeing to bring a nurse into the unit. It is also the agency's responsibility not to send a nurse to work in a unit that requires skills that the nurse does not possess.

Was this an experienced ICU nurse, or did the hospital ask the agency to just send anyone available because they badly needed a body to cover the shift? Just because this nurse isn't an expert at starting IVs doesn't mean that he's not a good nurse otherwise. Some might look at this situation as a bad nurse being in a place where he had no right to be. However, it could also be viewed as a missed opportunity to be supportive to a colleague and to teach something.

[nservice]

I'd have mercy on him. This really is becoming a problem with the implementation of IV teams. I've encouraged my nurses to always try and start their own IV's at least once a week to stay in practice. This is something he should have done if he wanted to become a registry nurse. I would wait and see if there are any other problems before I DNR'd him. In the meantime, I'd have him start all of the IV's on the unit. He'll get it pretty quickly that way!

[charebec65]

I am an IV Certified LPN and am going into an LPN-RN transition program. Please excuse my ignorance but don't they teach IV starts in nursing school for RN's?

[TazziRN, RN]

Yes, schools teach IV starts......but if you never use that skill because of IV teams, you're not gonna become proficient.

He may have been able to complete the checklist when he was hired at the agency but that doesn't mean he's comfortable with his proficiency.

[Gromit]

Yes, schools teach IV starts......but if you never use that skill because of IV teams, you're not gonna become proficient.

He may have been able to complete the checklist when he was hired at the agency but that doesn't mean he's comfortable with his proficiency.

Not only that, but unlike in the past, (at least in Florida) the schools teach it on a dummy arm with a tube under the "skin" to simulate a vein. Only the theory is learned this way -in no way is it like starting an IV on a living person. I first learned to start IVs back in the very early '90s in Paramedics' class -we learned by sticking each other in class. Understandably (imagine the potential liability issues this created) this is certainly not done today!

If his hospital had a team that did it, its very possible that he thought ALL hospitals worked that way, and therefore did NOT learn to do 'em (at least not on a live person). On my floor, our patients nearly ALWAYS have lines of one type or another -peripheral IVs are rare -and very difficult to obtain when you have to do it, because the patients are so sick, usually third-spacing like crazy (you stick 'em, and get water ). I've never worked Agency -and would like to eventually, but with my heart issues, insurance is a major considderation for me (my facilities' insurance plan is very very good, and has saved me a fortune over the last year -just last monday I was back in the hospital (as a patient) about 5 hrs after going home after getting off shift. I was discharged yesterday, and will be getting a defibrillator tuesday. Won't cost me a penny (now THAT is insurance! ). Anyway, I agree that one would have thought the agency would put the guy through an IV course -after all, this reflects on THEM.

[charebec65]

I guess I'd not thought of that Tazzi. Thanks. It just seems like around here the nurses start IV's. Come to think of it, I've not started an IV since I bacame certified because I work with peds and LPN's cannot start IV's on anyone under 18 even if certified. Hopefully I'll get some practice during the RN program.... It looks like I'll get to start in September.....(keeping my fingers crossed).

[Cmariehart]

If you don't practice the skill then you're not going to remember how to do it!!!!! That goes for ANY skill.

I work LTC and I haven't put a foley cath in a pt for over a year now, and I've been out of school for 2. Where I work day shift does all these things. I've asked them if they would wait until I came in so I could do it, but it never happens!!!!!!!

So go ahead and laugh or think I'm stupid but none of us are perfect. And I'm sure there's skills each of us has forgotten how to do... So give the poor guy some slack and see it as a teaching opportunity...

[fultzymom]

Did he mean that he did not know how or that he was not good at it? We have nurses at my facility that do not like to start them because they are not good at it. It is something that takes practice to get good at it et some of the people here do not get the chance to do it a lot. So when one comes up they will call me or another nurse here that is pretty good at it.