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.

[BULLYDAWGRN, RN]

A Rn That Dosent Know How To Start Iv's. I Would've Grabbed The 1st Iv Set I Could Get My Hands On And Taught Her (if Time Permitting) Then I'd Charge Her $85 For A On Site Iv Course.

[charebec65]

I know what you mean about the dummy arm Gromit. We used it for the first stick during the certification class. After that almost all of us volunteered to be guinnea pigs (of course we all had to sign waivers). The dummy arm was good practice for technique but it felt nothing like doing it on a person. My arms were like pincushions for two weeks because I have such great veins!

I wish you luck with your impending surgery. You seem so young but I'm only a year older and have my share of cardiac issues as well so I understand. Anyway, I'm sure everything will go fine. Let us know how it goes and I'll say a prayer for you...

[Antikigirl, ASN, RN]

When I graduated nursing school (which in RN school we practiced on fake arms, no humans)...lets see, first job...IV team so I didn't start IV's, second job...nope I was a camp nurse...third job 4 years in an assisted living..nope, no starting IV's! That was 7 years worth of NO IV experience!

So when I did the agency job, I really had lost that skill, however...I was very eager to re-learn it! I didn't ever say "no I don't know how"...I just would say, "It has been 7 years...can you show me and I will try the next one?".

Took me a little while, but now I am hitting the mark on first try each time! YEAH! But I will tell you, those first few...oh man I was like "you can do this you can do this!"...LOL!

Agency wise I said, do not put me into ICU or PCU or any type of critical care environment till I have some med surge experience to brush up on my skills. Agency was cool with that, hospital however...uhgggggg, kept trying to send me to fill gaps. I had to really stand up for myself and say to the hospital "Look, I love this place...but I need a little bit more experience and dust off the cobwebs before going to those units please!". They listened after two times!

Each person, be it nursing or not, have different levels of experience...my first jobs didn't have the opportunity, but I was eager to try again! Heck...truth be told I had never worked with a colostomy...so untill this year I really had never dealt with one, that is a basic skill too, and I just remembered what I was taught, talked to the patient..and got the job done :). Also I will ask for help from others :) (like my first blood transfusion and all the protocols I didn't know, doing my first NG tube, my first return flow enema, my first flip and drip autotransfusion, and so on...just never had the experience with them till this year, and well...I kick butt on them now! LOL!).

[jjjoy, LPN]

My RN program didn't teach starting IVs and I've heard others that don't either. Sure, we read about it, but they told us that the hospitals would teach us. We had one part-time instructor who snuck us some equipment and let us try once on each other, but she wasn't supposed to. Liability issues, perhaps? Cost issues?

Some agencies aren't as responsible as they should be in screening and sending appropriately qualified nurses in. At this one agency, I don't need or want the work now so I haven't kept my files up to date there. According to their files, I'm not even legally qualified to work, yet they call every now and then asking if I'd like to take a shift at XYZ hospital.

[Mulan]

I don't agree that a nurse is a nurse is a nurse.

That is the same asinine stance that hospitals take when they expect an OB nurse, just as one example, to funcion independently on a cardiac telemetry floor.

Very dangerous.

[Gromit]

Thanks Charebec. I have a good cardiology team working with me, and what has to be the absolute best primary care physician as my primary -I've known him for years, and he has literally pulled my can out of the fire twice now. I agree that I'm a bit too young for this crap! Close to a year ago, I had a virus attack my heart, and that began a long journey that I wish I hadn't had to take -but I have a sense of humor about it -and could tell you some things that would get a laugh -but this isn't the thread for it :)

Back when I was playing paramedic, I used to teach IV Sticks. I have good veins, and rhino-like hide (grin). Grew up on a farm, and worked outdoors most of my life, so I had a tough hide, respectable-sized veins and am a very laid-back individual (though ironically, I hate being stuck -but when I taught others, they used me as their pin cussion -its the only way to really know they were doing it right) -of course, I was also a bit younger then. I'd certainly not make any such habit these days -times have changed, and I've changed with them.

In any case, its very true that skills will grow 'stale' if you don't use 'em. On our floor, we rarely start PIVs (though I'm always game to give it a go, I'm nowhere near as skilled at it as I once was). Our patients usually come pre-lined, and pre-foleyed -though from time to time we do get to insert or change out a foley).

For that nurse, I'd certainly have taken a little time and taught him/her (whichever it was) to start an IV. Some of the comments here make me believe that there is a bit of resentment toward the Agency nurse (perhaps because of the bread they make) but I harbor no such resentment toward anyone -if I wanted to go agency, I certainly could -just as any of the rest on here could.

[Chaya, ASN, RN]

My school didn't teach IV's (late 90's) pleading liability issues. I took a cert course at my first job but never got to be any good at it (and it doesn't help that they kept changing the needles and catheters). Luckily I'm good at foleys so can usually trade off.

[TazziRN, RN]

Some of the comments here make me believe that there is a bit of resentment toward the Agency nurse (perhaps because of the bread they make) but I harbor no such resentment toward anyone -if I wanted to go agency, I certainly could -just as any of the rest on here could.

Agency nurses and travelers can be lifesavers!!!

[wildmountainchild]

UCSF in thier Master's Entry Program does not teach how to start an IV! This is a very respected, difficult to get into program. These nurses will graduate with a MASTERS in nursing and will not know how to start an IV.

So you can't blame the nurses necessarily, they were told that they would learn once they got a job. I've actually taught a few UCSF students how to start IV's b/c they teach us at my school and let us practice on each other as well (we didn't have to sign a waver either).

Oddly enough I've never heard of a program having a problem teaching suppository or enema skills, I even get to do them on patients with no nursing supervision.....and that seems waaaaay more invasive to me than an IV stick!

[caroladybelle, BSN, RN]

A Rn That Dosent Know How To Start Iv's. I Would've Grabbed The 1st Iv Set I Could Get My Hands On And Taught Her (if Time Permitting) Then I'd Charge Her $85 For A On Site Iv Course.

My, how supportive of you.

And would you charge a coworker on the unit or a new grad?

Many agency nurses (as with non agency nurses) have worked in places that do not practice certain skills. And we fill at the competency forms appropriately and are appropriately screened.

Many facilities, though, are so desperate form any warm body to fill a spot, that they do not review those issues. Or they figure that the rest of the "warm, mentoring" regular staff can pick up a little slack, happy to have one more knowledgeable licensed nurse on the floor.

For some reason, management believes that nursing should work as a team, with each individual contributing different assets. And many places, it does.

In others, there is the "agency nurse gets paid soooo much and I don't (despite the many other advantages being on staff has) attitude - that agency would have to walk on water.

The other issue, is that nurses learn skills on dummy arms, not on live, screaming, seizing, dehydrated patients whose loved ones insist that "only the most experienced stick with a 24 guage special order butterfly, and only after 45 minutes of emla" touch their loved one. How they expect someone to get "good with difficult IVs" without starting difficult IVs is beyond me. Book and classwork only go so far.

I have started IVs since I started nursing (actually before but that is another story). I am good with them, but had difficulty a few years ago learning to draw blood, theoretically an easier skill. I also have worked for 10 monthes or more in places that there was not one IV to start (BMT has all central access) and will get rusty. Also, virtually every facility has different equipment.

But I didn't have to do foleys for the first few years and was weak in placing those when I went agency.

But by the same token, I am the one that they go to about research chemo, new drugs, draining pleuradexs, transfusing cryo and WBCs, assisting bone marrows (nothing like seeing a staffer faint at the bedside), troubleshooting ports and quintons, etc.

Next time, I guess I will just have to charge extra...like a staffer.

[TazziRN, RN]

Every nurse has something they're very good at, and something they should know but are not so good at. I would rather a nurse tell me "I don't know how to do that" than say nothing and attempt a procedure with a sharp object.

[llg, PhD, RN]

Every nurse has something they're very good at, and something they should know but are not so good at. I would rather a nurse tell me "I don't know how to do that" than say nothing and attempt a procedure with a sharp object.

I agree completely. If we are all completely honest with ourselves, we will admit that each of us has a few skills that we either have never had the opportunity to learn or have not maintained over the years.

Staff RN's in my hospital rarely start IV's. Most of the common ones are started by the nursing assistants or by the ED techs. The more complex or difficult ones are started by our IV team. That doesn't make the rest of the staff "bad nurses" or anything like that.

If starting IV's is a necessary skill for a particular position, then the person who hired the agency nurse should have paid attention to that when the person was hired and/or assigned to that particular unit.