Do you do venipunctures as a nurse?

[CassB]

I have my BSN and have been out of school for a year and a half now. Since graduation, I have worked in the psychiatric field which I love! I recently started working for a home health agency doing visits for psych patients. During the orientation, I had to complete a skills lab. One of the skills I had to complete was drawing blood. I was never taught how to do this during nursing school and have never had to complete this task in either clinicals or on the job. My hospital has a phlebotomist come in for all the blood draws. Regardless, drawing blood is not that difficult of a task and I was able to get it right on the first try. What bothered me was the comment from the lady leading the skills lab saying how it was "scary" when I mentioned I had never done one before. This nurse is probably double my age, so nursing school is probably quite different from when she went. I was just wondering if any other recent grads did this during nursing school. I don't think my school taught it because 1) the majority of hospitals have their own lab people for blood draws and 2) if you can do an IV, a blood draw should be no problem. I was just a little offended by her comment and the possibility that she may have thought I was incompetent simply for never having done a venipuncture. In the end, it doesn't really matter because I was able to do it easily...but it just sparked my curiosity as to what other nurses have done. :)

[hiddencatRN, BSN, RN]

A couple of them even complained to management that they didn't feel it was appropriate for masters prepared nurses to be precepted by ADN prepared preceptors, this despite the fact that those preceptors have vast amounts of experience in the SICU and CCRN certification, and the fact that our nurse manager is an ADN prepared nurse.

Wow, that's pretty obnoxious! I wonder if word has gotten back to the schools. They might be interested to know how their graduates are representing the program.

[Chaya, ASN, RN]

I was a direct-entry master and I do feel that basic skills were neglected. We were force-fed nursing theory and other pure academic "stuff" but no hands-on phlebotomy, IV starts, or how to place a catheter or NG tube. We were told it was b/c of liability. (Huh? what about passing meds or doing dressings?) We also had next to no exposure to OR or Critical Care (one day to observe in ONE of those settings.) Ask me how many times over the years Nursing Theory has come in handy? Now ask me how many times I've wished I had some background in or understanding of Critical Care!

[hecallsmeDuchess]

Wow, I'm surprised! I had assumed these skills were taught in all nursing schools, I guess this is because my school(BSN program) took it very seriously. We even had clinical days that were specifically spent in an outpatient ambulatory center starting IV's on patients' that were going in for surgery. While I didn't get perfect then nor am I perfect now, it's a skill I enjoy especially when I get what I need with one stick...

[Horseshoe, BSN, RN]

i was a direct-entry master and i do feel that basic skills were neglected. we were force-fed nursing theory and other pure academic "stuff" but no hands-on phlebotomy, iv starts, or how to place a catheter or ng tube. we were told it was b/c of liability. (huh? what about passing meds or doing dressings?)

that's probably because those types of skills can be quickly learned in the work setting. even schools which do expose their students to these types of tasks can still only offer cursory exposure, certainly not enough to become proficient.

we also had next to no exposure to or or critical care (one day to observe in one of those settings.) ask me how many times over the years nursing theory has come in handy? now ask me how many times i've wished i had some background in or understanding of critical care!

i would be willing to be that very, very few graduates of any nursing school can say that they had much meaningful exposure to the critical care setting. there is only so much time in school and so many different experiences to which the students must be introduced.

most critical care or or settings solve this problem by offering critical care internships to new grads or nurses from other backgrounds who are hired into their units. it is known that critical care requires additional, expansive education and careful teaching from expert and experienced preceptors. my critical care internship lasted 6 months and included many, many hours in the classroom and lab in addition to being paired one on one with expert nurse preceptors in the various icu's. a nationally renown critical care internship at a large teaching facility in our city lasts a whole year and is extremely vigorous in its curriculum. there is no way a person could be prepared for these types of settings in nursing school.

[mindlor]

I was in a very prestigious direct entry program......lasted a week, saw the writing on the wall and I am now in an ADN program and I am going to save about 150 THOUSAND dollars

[Rob72, ASN, RN]

Something I have found interesting is different labs (that I have encountered) have different orders in which the tubes are drawn. I've always made sure that when dealing w/ a new lab, I find out what their policy is on that.

There should be very little, if any variation, as there are clinical reasons for order of draw. Without going too far into the topic:

1) Biologicals- culture tubes/bottles, drawn first to avoid contamination

2) No additive- generally red

3) Gel/silicone- tiger top/gold

4) Citrate- blue drawn asap to "freeze" specimen as fully in situ in the clotting process as possible

5) Li/Na+ heparin- green top, drawn after blue to avoid heparin contamination

6) EDTA(K+ based)- purple, drawn last because of anti-coagulant additive, and after chem tubes (gold/tiger/green) to avoid K+ contamination

7) FDP- fibrinogen degenrative products. Causes immediate coagulation, and will contaminate any other specimen.

Again, there may be minimal variation, based on what an individual lab finds with its processors and reagent batches. Essentially, this order is standardized by the ASCP, for consistency in laboratory assessments.

Cass, I'll disagree strongly on the "critical thinking model". While skills are not terribly beneficial without the direction of critical thinking, critical thinking is neither critical nor functional, unless it is based on practical application of skills. I know this critical thinking paradigm has become popular with the "professionalization" of nursing, but I have seen little to endorse it, as seperated from skill application, over the past 20 years.

The top two complaints, relating to hospitalization, are waiting for response to a call light...and poor venipuncture. Before being overly cavalier, remember, you're discussing learning the most invasive technique we perform, overseen by people who have only the most limited understanding of the tools of the trade. To be blunt: done improperly, it hurts; done improperly multiple times, it is unprofessional and inhumane.

-RC

(former) PBT-ASCP

[mindlor]

Awesome post Rob, totally agree, a critical thinker with no skills is great in a classroom, but incompetent on the floor

[CrunchRN, ADN, RN]

I was a nurse for 16 years before I had to learn venipuncture. So glad I did. I have problably done well over 200 sticks now and some are easy and some are near impossible and just when you start to think you are the bomb you will be humbled. Trust me on this.

[ImThatGuy, BSN, RN]

It's covered in my program, and you may get to practice once on a dummy arm. That said, you could easily go through our rotations without ever having to do an IV.

When I first came to this site I routinely read articles of nurses leaving schools not having learned (or been certified ??) to do IVs among other things. I mean what the heck? What are they teaching out there?

I'd have to say one benefit of paramedic school was that you had to master your skills and achieve certain numbers of them in rotations before you could continue. Then of course that was part of our national test as well - practical then written.

[steelcityrn, RN]

You do alot of venipunctures in homecare. I would say we see as many labs ordered as I.V.'s.

[Horseshoe, BSN, RN]

i was a nurse for 16 years before i had to learn venipuncture. so glad i did. i have problably done well over 200 sticks now and some are easy and some are near impossible and just when you start to think you are the bomb you will be humbled. trust me on this.

yep! spot on.

[PMFB-RN, RN]

that's probably because those types of skills can be quickly learned in the work setting.

*** maybe but it's an added expense for the hospital and one more reason not to hire a new grad. i don't think it is unreasonable for a hospital to except that new grads have a modicum of proficiency in the very basic nursing skills.

even schools which do expose their students to these types of tasks can still only offer cursory exposure, certainly not enough to become proficient.

*** oh i don't know. my school sent (sends) student to out patient surgery for 1-3 shifts where one can easily do 60-80 iv start attempts and gain a fair degree of proficiency.

i would be willing to be that very, very few graduates of any nursing school can say that they had much meaningful exposure to the critical care setting. there is only so much time in school and so many different experiences to which the students must be introduced.

*** i agree with you but when i look at the curriculum for some of the bsn programs it appears to me that somebody must have been looking to kill students time. seems all of the theory and some of the "leadership and management" could be converted to meaningful clinical experience.