Dear Precepting Student:

Lucky you...what if we never learn that in our nursing program? I work at a large Boston hospital and there are many limitations on what I'm allowed to do in my clinicals. Nurses working there don't even put in their own IVs or draw blood. There are special nurses who are paged to come to the floor to do that. If I am assigned to a preceptor at a community hospital, and he/she expects me to be able to do that, like you seem to, I deserve to be failed?

If you never learn in your program? Then I highly don't recommend that program. If you aren't taught basic skills, what DO they teach as far as skills go? That hospital I believe, may contribute to some healthcare budgeting issues we are having today lol. What's the reasoning behind nurses not being able to start their own IV? They are paying nurses to run around sticking people all day? I can understand PICC nurses or some phlebotomists, but regular IV's and drawing labs on an RN salary??? Suppose a patient is going bad, take 5 minutes and have the nurse start an IV and draw labs on the floor or wait...30 60 90 minutes for the IV nurse to come from their other stop(s) to start one. We have PICC nurses but they don't start the regular IV's for us. In a RARE instance if NO ONE on our unit can start an IV, we may call over to ICU because most of their nurses are really good. After that we put in a PICC consult. As far as labs go, we have lab collectors in the event that we TRY and are absolutely unable. IV's are such a basic and important skill, hence the reason this thread has mentioned it a LOT.

Here's what I would hope every takes out of this thread: "Attitude is everything."

We can teach knowledge and skills, we can't teach attitude - and that's the thing most likely to get you hired... or not.

I agree with this statement

It seems that a lot of people on this thread have an "everyone is out to get me" attitude. The slightest criticism and they start saying "preceptor hates me", or "such and such will fail me". Maturity is something that cannot be taught in school and that's the reason that some have such a negative perception of what we're saying. People won't hold your hand your entire life. If you go to a school that teaches you nothing you need to learn in the real world...2 things. 1-that sucks, 2-explain to your preceptor the situation. Do NOT just sit there and try to cover it up with other experiences you may or may not have. A lot of times people greatly exaggerate their skills or whatever. Also don't assume people hate you or want you to fail. So many times, students will believe that the "teacher wants us to fail". Come on now...

When good threads go bad.....the neverending saga

And here's a bone to all the people who think I'm a "meaner" (to quote my kid): This week I happened to work with this student again. I don't know if something was said or if they just figured it out but the 'tude had mellowed big-time and the student was actually helpful.

Perhaps their intent to get hired into our current opening helped temper their abrasive nature.

Regardless, it was nice to see the 'tude held in check. We'll see how goes it next week.

And again, props to "my" student who remains cooperative, friendly, helpful, flexible, and eager-to-learn... I could not have communicated my approval to them more clearly than I did when I provided a face-to-face introduction to one of our managers who's actively hiring.

If you never learn in your program? Then I highly don't recommend that program. If you aren't taught basic skills, what DO they teach as far as skills go? That hospital I believe, may contribute to some healthcare budgeting issues we are having today lol. What's the reasoning behind nurses not being able to start their own IV? They are paying nurses to run around sticking people all day? I can understand PICC nurses or some phlebotomists, but regular IV's and drawing labs on an RN salary??? Suppose a patient is going bad, take 5 minutes and have the nurse start an IV and draw labs on the floor or wait...30 60 90 minutes for the IV nurse to come from their other stop(s) to start one. We have PICC nurses but they don't start the regular IV's for us. In a RARE instance if NO ONE on our unit can start an IV, we may call over to ICU because most of their nurses are really good. After that we put in a PICC consult. As far as labs go, we have lab collectors in the event that we TRY and are absolutely unable. IV's are such a basic and important skill, hence the reason this thread has mentioned it a LOT.

It really does depend on your area. We are taught the skills (if you want to call it that) in our program. Our program does have a good reputation at the local hospitals. That said, they briefly go over a teacher demonstrating an IV insertion, than 5 minutes on the fake arm. That is hardly going to prepare you for actually doing an IV on a real person. Same with Blood draws. A group of us have taken it upon our self to practice outside of school because we wouldn't feel comfortable trying one on a patient without the training we got.

That said, we have 4 local hospitals. 2 of them do in fact have IV teams, the work 24/7 and do all of the IV's (I am guessing the emergency room would be an exception since you don't have time to wait for the IV team.) but their are a few people on the team so they get to patients pretty fast. They also have phlebotomy team and one in the ED. They also have a wound care team that deals with majority of the wounds. It actually seems to work out well overall and frees the nurses up to worry about other things. I am currently doing clinicals though in the other facility where the nurses do it themselves and that is good experience as well because I do want to become proficient in them. Even if it is just on my teenage son

Just a side note for the students talking about doing the skills on the dummies and not feeling ok on doing it on real people. When you are in clinicals, let the nurses no that you would love to do any of these skills if you're able to on their patients, even if it's not your co-nurse and patient. 2 weeks ago I did 2 foley's on a man and woman, and a couple IM injections and none of the patients were my patients, the nurses let me know the task came up and asked if I wanted to do it because they knew I needed the practice. You have to put yourself out there and let your co assigned nurses know what you are wanting.

Another thing I did this week, I really felt like I was simply shadowing and doing skills but not learning how to do the full aspect of nursing. Apparently our practicum we "are" the nurses and the preceptor is there to oversee. Well I didn't want it to be like that when I am in my last semester so last week I felt really comfortable with my co-nurse, I had been with him the previous 2 weeks. I asked him if he would let me run the shift in the morning and basically him shadow me. We had 4 patients, but that way I got a better feel for what I will be doing. He was completely cool with it and it was a good experience. Had I not asked though he wouldn't have known.

Just a side note for the students talking about doing the skills on the dummies and not feeling ok on doing it on real people. When you are in clinicals, let the nurses no that you would love to do any of these skills if you're able to on their patients, even if it's not your co-nurse and patient. 2 weeks ago I did 2 foley's on a man and woman, and a couple IM injections and none of the patients were my patients, the nurses let me know the task came up and asked if I wanted to do it because they knew I needed the practice. You have to put yourself out there and let your co assigned nurses know what you are wanting.

This is so true.

We've had many clinical groups on our unit. I'll go to the instructor and say "My pt need staples removed - do you want one of the students to do it?". Some will jump at it - so we continue to offer more and more chances to do skills. But then others will say "Well, we haven't covered that yet" or "Well, I don't know.." so after a few turn downs, we stop offering.

So my advice to students - let the nurses and your instructor know that you want to do things. Trust me - they will come you way.

That said, we have 4 local hospitals. 2 of them do in fact have IV teams, the work 24/7 and do all of the IV's (I am guessing the emergency room would be an exception since you don't have time to wait for the IV team.) but their are a few people on the team so they get to patients pretty fast. They also have phlebotomy team and one in the ED. They also have a wound care team that deals with majority of the wounds. It actually seems to work out well overall and frees the nurses up to worry about other things.

I would not want to work at a hospital where special groups of nurses are the only ones to start IVs, do wound care, central-line care, and draw labs. At some point, there's precious little left. What's next? Only infusion nurses do pushes? Foley teams? Teams to pass high-risk meds?

What will be left for the floor nurses besides assessments, charting, and passing out stool softeners, Norco, PO Lasix, and food supplements?

How marketable is a nurse who can't start an IV, do complex dressing changes, or put in a catheter?

Doesn't that specialization lead rather obviously to reduced nursing roles and an ever increasing transfer of work to UAP?

Perhaps I will start a new thread on this topic.

Not to mention the salary being paid to all those teams. You have 5 people doing the work of 1, waste of resources. They say it depends on the area. But if in my area the nurses are handling 5-6 patients AND doing all their own skills..plus we leave on time most mornings or nights, why can't other areas do the same? And that's true about being marketable. If you work in a hospital where someone has been starting all your IV's and doing all your venipunctures and woundcare(and say you work 10 years there), how's it gonna go down when you change to a hospital where you do all that yourself? I'm not bashing or saying anything bad about those places, but it just seems kind of wasteful. We do have a woundcare team who comes and evaluates all the new patients and do the inital dressing changes, but they write their woundcare orders in the chart and from then on, it's on the nurses.

Well, this is off-topic but since it's "my" thread, I feel like I have some moral authority to accelerate the tangent...

I would not want to work at a hospital where special groups of nurses are the only ones to start IVs, do wound care, central-line care, and draw labs. At some point, there's precious little left. What's next? Only infusion nurses do pushes? Foley teams? Teams to pass high-risk meds?

What will be left for the floor nurses besides assessments, charting, and passing out stool softeners, Norco, PO Lasix, and food supplements?

How marketable is a nurse who can't start an IV, do complex dressing changes, or put in a catheter?

Doesn't that specialization lead rather obviously to reduced nursing roles and an ever increasing transfer of work to UAP?

Perhaps I will start a new thread on this topic.

Well from what I have seen they are a really good hospital to work for and personally I will work wherever I can find a job given the present state for new grads. But I believe the reasoning for this is to give better patient care. People specializing in needle sticks are more likely to get the stick done right the first time. I personally am a hard stick, I would rather have a person that is really good at their training and have them stick me once and it be done rather than have 3 different nurses try numerous times (yes that has really happened). Not to mention when you have someone that is a hard stick you don't want to ruin the only veins that might be accessible.

I don't believe their is a policy in the hospital that you HAVE to call the IV team. If someone comes in and is admitted with a field stick that has to be re done and the person has good veins and the nurse is fine with it than I am pretty sure the nurse is able to do it. But when something goes wrong with the IV or their is a hard stick you have the IV team to come look at it since they are specially trained in it. I am sure some nurses will take advantage and just call them for anything.

Same with wound care, sure nurses can change dressings and the doctors orders for the dressing changes are pretty clear cut. I have seen nurses change their patients dressings. But when the patient has a really bad wound, pressure ulcer and stuff it benefits the patient to have someone come in and look for it and write a plan of care that specializes in wounds. They usually do the first dressing and write strict plans for future changes and protocol to call them back. We know how bad (and fast) pressure ulcers can get.

Nurses still very much have their roll and are kept plenty busy from what I saw. We have Doctors that specialize in a field. I wouldn't want my general practice doctor preforming my heart surgery.

So I don't really see what the problem is personally. I wouldn't rely off the IV team unless there was a really hard stick, I want as much practice as possible to get proficient in it. I also want to make my way to the ED where they do their own sticks. My next-door neighbor works on the IV team and I am fully taking advantage of that to get myself the tips and help I need to become proficient.

So, do you believe a student is SUPPOSED to know how to insert an IV out of nursing school? Because if that's the case, the law is being broken. Only an RN, not a student is allowed to start an IV. (And remember, you're not a nurse until you pass the NCLEX). You could be a graduate of a nursing program, but not an RN. So if you expect said student to start an IV right away, the law was broken somewhere.

And if you're volunteered as a preceptor, you could always JUST SAY NO.

I call 'em as I see 'em, too.

In some states students ARE allowed to start an IV with supervision. I have let students do their first hospital stickon me.

closing for staff review

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