Agency Nurse doesn't know how to start IVs?

Gromit · Mar 9, 2007

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!

SmilingBluEyes · Mar 9, 2007

Please, keep focus on topic and not on attacking each other. Thanks for understanding.

mstigerlily · Mar 9, 2007

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.

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.

mstigerlily · Mar 9, 2007

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.

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.

81Bubbles, BSN, RN · Mar 9, 2007

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.

jamato8 · Mar 10, 2007

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.

TrudyRN · Mar 10, 2007

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!!

brandi, i love your dance in the rain thing but have to disagree that a nurse is a nurse is a nurse. that said, i do think an icu nurse should be iv competent. :balloons: :balloons: :balloons: :balloons: :balloons: :balloons:

mstigerlily · Mar 10, 2007

Well...didn't you practice starting IVs in nursing school? We did, just on one day unfortunately. The managers on our floor also (at our request) hosted an "IV start class" where we could sign up to practice starting IVs on each other. And our charge nurses have always seemed ok with us practicing on each other as long as we have free time and both consent. I found it very helpful to be able to do this, I'd never thought of it as practicing medicine without a license...

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.

jamato8 · Mar 10, 2007

Well...didn't you practice starting IVs in nursing school? We did, just on one day unfortunately. The managers on our floor also (at our request) hosted an "IV start class" where we could sign up to practice starting IVs on each other. And our charge nurses have always seemed ok with us practicing on each other as long as we have free time and both consent. I found it very helpful to be able to do this, I'd never thought of it as practicing medicine without a license...

In Tucson, where I worked, you started an IV if ordered by a doctor or it was a standing order otherwise we were told in no uncertain terms, we were doing a procedure that was out of our scope of practice since a nurse can not order this. Maybe it is different other places.

indigo girl · Mar 10, 2007

The state I work in requires IV certification to work with IVs. If you do not have it, you can not change or hang IV fluids, or start IVs.

IV certification programs are generally taught by instructors from the large pharmacy systems, and paid for by the facility that employs you in LTC. Hospitals have their own instructors.

Nurses that have worked thru agencies for many years rather than being on staff somewhere, may not be IV certified. The agencies do not require it for LTC, and it is not uncommon to be lacking in this particular skill. The agencies do not provide any opportunities for their nurses to become IV certified either.

These nurses may have many other skills, but not be IV certified. Strange but true.

Gromit · Mar 10, 2007

IV Certification is not required here (at least not for RNs) -but I'll certainly keep that in mind for the future -when I become a traveler, I'll try to be quick about getting certified in whatever state I plan to work in.

Personally, I wouldn't mind if Florida adopted the requirement. Many nurses are so rusty at it, that a refresher would be welcomed. My floor has standing orders that EVERYONE has to have IV access of one kind or other (central, PIV, whatever) -though USUALLY they have central lines already installed and its a non-issue. However, from time to time, the need arises, and if I'm available, I'll usually jump for the opportunity to stick.

jamato8 · Mar 11, 2007

The floor where I worked, a pccu, normally had 5 to 10 iv starts a day. I have started more IV's than I can remember. It never occured to me that any RN would not have plenty of experience with IV's. I have never b een certified but work with everthing from picc's, all central lines, caths and IV's. I guess it is one reason I like the higher acuity of cardiac pccu.