It's just one of those things that have become irritating. When I was a new grad I wanted to learn how to do my job the best I could. So if I needed to ask someone to start an IV, I was in there watching the technique. And I became good at starting IVs. Not magical, but good. Now, if I start an IV for anyone, the word goes out I'm good at IVs and every nurse wants me to start their IVs. One person tries to schmooze me with how I'm the greatest she's ever seen; I've seen this RN start one once in 3 years and her hand was shaking like DTs. Wel I'm at least better than that I admit.
Now, when I'm charge, about half the RNs on the floor don't even try to start their own, and if I ask them, did you try once? I get the standard response: "No she's a hard stick and I know I'll just poke her and make her mad."
I guess I'm venting now. I just want people to learn how to do a clinical skill, it's not that hard to learn the technique, but I'm thinking of 2 nurses right now who are way too lazy to want to do that. Just another annoying thing I guess.
I don't consider myself lazy, but I am scared to do IVs. I was trained during orientation for a measly 3 hrs, with someone over my shoulder showing me what vein to go after, etc. I don't feel comfortable doing IV starts, I haven't done one since orientation. We have IV techs that we can call, and our nurse aides are supposed to be trained to do them also. When I first started my job a few months ago the aides would try and do IV starts if needed, now they don't seem to at all (they also do blood draws). I know I should dive in and try, but I am very timid about it. Not sure how to get over that. My pt population are mostly people that have hidden veins (obese pts) or have tiny veins, which doesn't help.
I get that you're scared to do them, but he truth is the people who are good at them, or even just proficient, are the ones who kept trying to do them. When I started work in a small, rural hospital with only a well baby nursery, only one person was ever was able to get the baby peripheral IVs started. I know we didn't do them often, but when we needed one we NEEDED one and ended up calling in that RN, who was the manager and an excellent RN, or waiting over an hour sometimes for transport teams to arrive to get an IV started.
I asked the manager very early in my orientation why no one tried to get the baby IVs or barely tried before calling the manager. I thought there was some rule or something against RNs starting the peripheral IVs. Her reply was that people are afraid and won't try. Well, from then on I asked to try on EVERY baby who ever needed an IV. If I couldn't get it after 3 sticks then the manager would try if available. IF she didn't then occasionally a FP doc would try an umbilical vein, or we'd wait for transport. When transport got there I would watch and ask them about starting the IVs, after all they did it routinely and sometimes even they had trouble.
After a few years, I was the one who was the IV starter on the unit and even in the ER. I didn't learn it by NOT doing it or hiding. I learned by trying over and over. My mission was to teach all the RNs I worked with how to do baby IVs, especially since once we had a pediatrician on staff we kept many more sick babies. I would always have the inexperienced RN look for a vein and then agree or suggest another one, then help her get it started. Usually, once they got one or two under their belt they were more willing to try again.
By the time our unit closed, there was always an RN on a shift who was reasonably comfortable with starting these IVs. So, moral of the story...TRY, TRY and watch someone with good IV skills as often as you can, ask them for their tips (every RN has a different set of tips), and just keep working at it. In time, you'll get more comfortable with the task.:)
I don't see the need to start an "older nurse" debate where IVs are concerned. As one of those older nurses I've been starting IVs for 30 plus years and it's been literally YEARS since anybody had to start one for me.
just an aside here ......I was shocked reading here that there are any facilities that allow non-licensed people to insert IVs. Especially when I have worked in places were they only allow the "IV/PICC team" (a nurses only team) to put in all IVs. I guess when they allowed all floor nurses throughout the hospital to place them they had way too many cases of Phlebitis, infection, etc. Having techs do Phlebotomy is different then IVs-- being that the IV stays in for a period of time. Can't say that when I am a patient I would ever let someone who was not a nurse put in my IV (other then a paramedic, but that is different--they have the training.)
are you really that shocked? i mean i can understand not letting EVS do it but hey..... im not so sure that phlebotomy vs IV insertion poses any more risk of infection because ive never seen a study done.
I don't see the need to start an "older nurse" debate where IVs are concerned. As one of those older nurses I've been starting IVs for 30 plus years and it's been literally YEARS since anybody had to start one for me.
A thousand pardons. Change "older" to "more experienced" in my post. It's what I meant, and I should have been more specific. Indeed, in my post I should have also specified that not all experienced nurses ask for IV assistance, as my comment was only in reference to those that do.
I am so-so at IV starts, and always have been since becoming a nurse 19 years ago. I have watched the "best", asked for tips, and stay late every time we have an inservice on a new angiocath.
But if i'm not sure I'm gonna get it, then I ask for help. For several reasons:
My hands shake when I'm not sure--and that doesn't help at all
I have lost some mobility and sensitivity in my fingers so threading a tiny vein is tricky
I am a hard start myself (anesthesia had to do mine) and it just plain hurts!
And I always trade tasks, we are a team, after all.
I would be willing to be that the majority of the time it has less to do with being lazy and much more to do with not having the confidence to do it well.
The proper response is to never agree to do it until the nurse has tried x number of times, you fill in the X with whatever number you feel is appropriate or meets your facility's guidelines.
This thread caught my eye because I am one of those annoying "Can you start my IV" nurses and I hate it. I have shadowed a day in endo, followed around the IV team nurse, swat nurse, and I always go with the nurse who ends up starting my IV to watch. All to no avail. It is so embarassing because I feel I am a pretty good nurse otherwise. I just cannot feel veins...ever. Even when it is a perfectly healthy 18 year old with veins you can see from the hallway.....I cannot get them. I feel terrible about this because if my patient was ever crashing I know I wouldnt be able to get access.
I am great at NG's and foleys and will trade any task with the person who starts my IV. I'll suction your trach pt. change your colostomy pt. give an enema, bed bath, pass your meds etc. I recognize that the person who is starting my IV is doing me a favor and I always try to return it.
See, here's the problem. My hospital has a two start and you're done rule. The third failure screws up the world. We've had the lab refuse to do blood draws on those patients.
I've been a patient, who's had three attempts by the RNs on the floor and wound up with the line going in in the OR. I really didn't appreciate three failed attempts and being told my veins are hard to find.
I have two approaches. If I know and they know that they suck at IV insertion I do them. If I know and they know that they are just scared they go with me, watch a time or two then try one themselves with me there for guidance and moral support. I have, on at least one occasion, talked a terrified, crying nurse through her first successful stick. Mind you, the patient was an easy stick and knew ahead of time that the nurse was going to be a basketcase but was more than willing to be a guinea pig. Should have seen that nurse's face when she actually got it...priceless. Either way I do not gather supplies. I expect them to be in the room. I'll do my own set up and clean up though.
NPinWCH
374 Posts
I get that you're scared to do them, but he truth is the people who are good at them, or even just proficient, are the ones who kept trying to do them. When I started work in a small, rural hospital with only a well baby nursery, only one person was ever was able to get the baby peripheral IVs started. I know we didn't do them often, but when we needed one we NEEDED one and ended up calling in that RN, who was the manager and an excellent RN, or waiting over an hour sometimes for transport teams to arrive to get an IV started.
I asked the manager very early in my orientation why no one tried to get the baby IVs or barely tried before calling the manager. I thought there was some rule or something against RNs starting the peripheral IVs. Her reply was that people are afraid and won't try. Well, from then on I asked to try on EVERY baby who ever needed an IV. If I couldn't get it after 3 sticks then the manager would try if available. IF she didn't then occasionally a FP doc would try an umbilical vein, or we'd wait for transport. When transport got there I would watch and ask them about starting the IVs, after all they did it routinely and sometimes even they had trouble.
After a few years, I was the one who was the IV starter on the unit and even in the ER. I didn't learn it by NOT doing it or hiding. I learned by trying over and over. My mission was to teach all the RNs I worked with how to do baby IVs, especially since once we had a pediatrician on staff we kept many more sick babies. I would always have the inexperienced RN look for a vein and then agree or suggest another one, then help her get it started. Usually, once they got one or two under their belt they were more willing to try again.
By the time our unit closed, there was always an RN on a shift who was reasonably comfortable with starting these IVs. So, moral of the story...TRY, TRY and watch someone with good IV skills as often as you can, ask them for their tips (every RN has a different set of tips), and just keep working at it. In time, you'll get more comfortable with the task.:)