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. :)

[Neuro Guy NP, DNP, PhD, APRN]

Wow! I am suprised. My nursing school (BSN) has students do everything possible under the sun! IVs, Foleys, blood draws, cultures, wound care, anything that could possibly come up. I think all nursing schools should at least familiarize students with these things, so that you don't have to learn so on the fly. Sure, it takes many IV sticks to become an expert, but at least the basics should be taught.

[vickybabymama]

Wow, it is very surprising to me that venipuncture and IV's aren't taught in so many nursing schools! This seems like a fundamental skill that all nurses should at least be familiar with, even if later on it isn't needed for a particular position.

At the University of Texas, we practiced ON EACH OTHER, not to mention on the dummy arms in skills lab and our patients in clinicals (with our instructor's supervision). And thank goodness we did that because the hospital where I ended up working (in New York City) we draw blood, do blood cultures, and start IV's all the time. I understand if you work in LTC it's not really necessary, but I still think that it is a fundamental nursing skill that everyone should have at least learned.

[hiddencatRN, BSN, RN]

Isn't practicing on each other an OSHA violation?

[vickybabymama]

Isn't practicing on each other an OSHA violation?

I have no idea if it's a violation or not. It was completely voluntary though.

[Horseshoe, BSN, RN]

*** 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.

if a nurse could gain proficiency by doing 1-3 shifts in day surgery, then hospitals could easily do the same for their new grads. not all that expensive, and we're talking 1 to 3 shifts, right? your school actually has a pretty good idea, and good for the hospital for encouraging it.

i have a bsn and got pretty much the same clinical experience as the other adn's i knew (i did iv starts and blood draws in clinicals, though not all day in day surgery). my nurse manager said that the whole adn's being clinically superior to bsn's was a myth in her experience. she was a manager in icu for over 25 years at my hospital, so i believe her. how proficient a new grad was at starting iv's and drawing blood right out of the gate was very low on her priority list, and after working for years there in the icu, i agree that it really all comes out in the wash and there are far more important qualities that make for a good nurse other than whether or not a new grad needs a few shifts extra to become proficient at starting iv's.

[mindlor]

What the heck, if I can just wait and learn it at the hospital then why have nursig school? lol used to be that nurses went to diploma programs at hospitals LOL

Maybe we will come full circle

[hiddencatRN, BSN, RN]

What the heck, if I can just wait and learn it at the hospital then why have nursig school? lol used to be that nurses went to diploma programs at hospitals LOL

Maybe we will come full circle

I don't think the fact that I didn't learn IVs in school but instead learned them on the job doesn't mean that there was nothing to learn in nursing school. Idk, maybe it doesn't bother me so much because the skills come easily and don't seem like a huge deal. There are things about being a new nurse that are WAY more challenging than new skills and adapting old ones to smaller, wigglier patients.

[nurse.sandi]

When I was in nursing school..they made it a point to let us know it was their job to prepare us for NCLEX.

[Butterfliesnroses]

In my program they teach IV starts (which they say if you can start an IV then you can draw blood) the first qtr of the RN year. I did hear they are going to change it to the LPN year.

[Motivated grandma]

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

I'm doing a phlebotomy clinical right now, but was a patient just a couple of weeks ago in a highly rated hospital in the Houston area where the nurses do all the draws. My nurses were fabulous, but they didn't follow any order of draw that I could see. When I asked one of my nurses what order she used, she said, "Well, whichever tests I think are probably most important to your doctor, I'll do first."

I thought that was pretty interesting. I didn't say anything because - well - I haven't even been accepted into nursing school, yet. :) And they only used butterflies. I liked that as the patient.

[anotherone, BSN, RN]

A little baffled here,

Starting IV's is a foundational skill for an RN working in a hospital or outpatient surgery center?

What the heck?

Most nurses in my hospital don't do either.

[PMFB-RN, RN]

If a nurse could gain proficiency by doing 1-3 shifts in day surgery, then hospitals could easily do the same for their new grads. Not all that expensive, and we're talking 1 to 3 shifts, right?.

*** Well lets see. If a hospital hires (lets say) 20 new grads a year and in my hospital grads make about $31/hour. If they each do two 8 hours shifts learning to be come proficient at a basic nursing task we have $9,920. If they paid four experienced nurses (one instructor per 5 students, barely adequate) who make $40 and hour for two shifts = $2560. A total of $12,480 the hospital would spend to teach basic nursing tasks that should have been taught in first semester of nursing school. No wonder hospitals are reluctant to hire new grads.