Considering ER but not good at starting IV's

hiddencatRN, BSN, RN · Oct 29, 2012

Honestly, I think all new grads need to start off on a med-surg unit unless your hospital offers a very intense residency program in the ER. Reason being, I've seen so many new grads come into the ER and they're excited about trauma and codes and all the adrenaline rush. As a new grad, you probably won't be thrown into that stuff till you have some more experience. I know our ER hired 4 new grads this spring (3 of them worked as externs) and only one of them is really working out so far... You need to get a good background in general nursing and have time go develop skills and assessment techniques before jumping into the chaos of the ER. I've seen lots of people come and go because its not what they expected. Yes you do get traumas and critical pts but they're mixed in with all the "regulars" that everyone knows and dreads, the people with a runny nose and cough, the pts from the nursing home they're trying to get rid of for the weekend, sprained ankles and tons of other complaints that could easily be seen at a doctors office or urgent care. Maybe try for ICU or a step down unit that way you can mature as a nurse and master the skills needed for the ER. Good luck!

The OP is not a new grad. It sounds like your hospital has a poor track record orienting new grads to the ER. That doesn't mean other ERs aren't successfully able to take on new grads.

nurse2033, MSN, RN · Oct 30, 2012

Yes, take the ER job and do lots of IVs, that will make you good at it. No one is born to start IVs, the more you do the better you get.

happyinillinois · Oct 30, 2012

I have grown to despise bedside nursing. I really enjoyed ER clinicals during school. In 3 more months I will have been a RN for a year at my hospital, which means a lot of opportunities will open up for me and I can start applying for other positions. I think I would like to be in the ER. This may sound silly, but I haven't gotten good at starting IV's yet. I know you have to start a lot of them and I am afraid I will get behind if I have to stick a patient multiple times or get someone else to start one for me. Right now I have about a 1/3 success rate. I can always get one in the AC if a patient has a good vein, but as you know a lot of them have poor veins. Any advice?

It is all experience! The more you do, the better you will become. Don't let that stop you!

rebels25player · Nov 3, 2012

you will attempt more ivs in 1 week then u did in a year on the floor. if the ac is there go for it...half your pts are going to get a contrast scan anyways and they prefer a 20 in the ac ne ways. all of the other ones just remember to anchor them. hand and wrist veins love to roll.... so pull the skin tight as you can while u can still see the vein.....my technique is to come in at a pretty steep angle til i get blood return then to make like a sewing motions as a pull the vein up with the needle inside...so i dont go through it....then slide in the catheter...but site selection site selection is the real key...take time to look at both arms to pick the best site.....you will get the hang of it and before long you will not fear them...everyone has good iv days and bad iv days....work as a team and help each other out.... after that your real problem with the er is dealing with all the dam pts who come in just looking for pain pills....thats about 80% of our clinentail .....and those pts are so rude and you are obligated to smile and do your best when u really just wanna slap them

turnforthenurse, MSN, NP · Nov 4, 2012

Inserting IVs is a skill that comes with time. With practice you will get good at it. Where I work the ER techs are the ones putting in the IVs most of the time, or if a patient arrives via EMS they will already have on in place by the EMTs.

mary ann rn · Nov 4, 2012

I was not good at starting IV's when I came to the ER either. I learned really fast !!!! I had some great nurses that said you can do this and I did with a lot of practice.

ecerrn · Nov 4, 2012

If you can at least get a line in the AC, you shouldn't worry about that. However, to brush up on your skills now, watch and learn. If you miss it and some on better, hang around and see what they do, and why you missed? 2 out three ain't bad, but it aint great either. You will get alot more experience in the er, heck, some of the patients will even help you, but if someone else has to start your lines all the time, you will owe me. Just so you know.

Rhi007 · Nov 6, 2012

My experience as a patient and with bad veins (I played pin cushion for interns and new ED staff) keeping the skin over a vein taut stops the vein rolling. You also develop your own way of doing cannulations in regards to approach. I don't like the AC area on principle but I know doctors who will only put jelcos in the hand as a last resort because its "painful" duh of course it is but it hurts the same in the AC area as well ( I've had 30+ cannulations over the past 18mths and 7 have been in my foot, a tattoo is less painful!!)

~Mi Vida Loca~RN, ASN, RN · Nov 9, 2012

Once you're in the ER you'll get good at them. I have a pretty good success rate. Our techs can start them but I always try to start my own because I like doing them. If I have a patient where I am just not feeling anything, I will go get someone really good at super hard sticks. I love doing Iv's though. I have had to get in some pretty funny yoga type positions to do a few. But as you start doing them a lot you'll find your niche and various tips and tricks. I went from doing them rarely to doing probably 30 a week.

Passion8RN · Nov 12, 2012

You will become good at them. I would feel on my own veins to get a good feel of what I was looking for before I became an ER nurse. Learn the anatomy of veins. ER nurses usually become experts at IV's. All days won't be good days. Don't let IV's hold you back. I work with plenty of nurses who had no IV experience before ER and are now excellent at IV's.

DC Collins, ASN · Nov 20, 2012

We are *all* bad at IV starts when we start out. If you have a decent facility, even though you have a year of experience as a nurse, they will preceptor you for a time in the ED. Work with your preceptor on your IV skills.

DC :)

born2circulateRN · Nov 25, 2012

I am too considering ER but totally suck at IV starts and venipunctures. I'm a new grad and recently started working at a LTACH so I don't get much practice because the majority of the patients have central lines- and blood labs come from there. However when I do get a chance, my low confidence and doubt unfortunately reigns over me because before I began - it's like I know I'm going to fail (which I shouldn't think) because I barely get any practice. Recently, I had an opportunity to draw labs from peripheral - the charge was with me and told me to aim at the cephalic vein I believe (which was barely visible) and had scar tissue over it along with being extremely edematous with tiny/fragile veins - what an ideal stick. I went for it and unfortunately went too deep....what a disappointment and confidence breaker! The lady is a hard stick - for most nurses on the floor, but when the charge nurse did it - pop, there's blood return on the first stick. I felt so incompetent.

Personally, I think it has a lot do with having knowledge of the anatomy of the veins (as the previous poster stated), knowing the appropriate depth, and having confidence of course. But everything takes time and practice. Good Luck!