Do you do venipunctures as a nurse?

hiddencatRN, BSN, RN · May 5, 2011

*** 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.

Or, in my hospital's case, the new grads take the same 4 hour class on IVs all new employees take and practice is accomplished during the standard 12 week orientation with preceptor that all new employees go through in my department.

It would be interesting to know too things though: is the new grad job market better in regions where schools teach IV skills and are new grad orientations in general shorter in those regions as well.

Horseshoe, BSN, RN · May 5, 2011

I think way too much is being made of IV skills and phlebotomy. These skills are not that difficult to learn that it should be a major deciding factor on whom to hire. It comes pretty darn quickly if this is something your job requires on a frequent basis, and though there are always going to be patients who are hard sticks, those patients are hard sticks for even experienced nurses and those individuals who just have a gift for it are called in.

I did some IV starts in nursing school. I began an internship with some other new grads who had not. It was not a huge advantage-I didn't stand out as a better investment for my hospital-everyone picked it up pretty darn quick.

There is so much more to nursing than IV/blood draws.

Rob72, ASN, RN · May 5, 2011

And they only used butterflies. I liked that as the patient.

;)The bevel on a butterfly needle is much steeper than on a straight (read- it pushes tissue, rather than slices). The functional advantage of a butterfly is hydrostatic pressure modulation, IOW, the greater surface area provided by the tubing decreases the pressure applied to the vessel as the puncturist aspirates- meaning you won't collapse the vessel.

Much like receiving a script for an antibiotic everytime a pt sees the GP, butterflies have a huge placebo component. They contribute to poor technique, and are roughly 3 times as expensive as straights. Obviously, I have a bias, having done 20-30 sticks between 0630 and 0900 6 days/week for several years . I'm not knocking anyone, but this a subspecialty of expertise.

No, it is very unlikely that anyone will be hired or fired(providing you don't lacerate an artery) on the basis of venipuncture skills. But. On the "higher level", poor site selection, improper equipment selection and ignorance of practical theory do increase patient dissatisfaction, increase length of stay, and may determine whether an infusion is done outpatient or inpatient. Those are very significant considerations, with the increasing examination of reimbursement criteria.

Increasingly, we see acceptance of, "close enough is good enough". To some degree that has to be true. However, if it is "acceptable" to leave an ABG at room temp for 45 minutes, versus the clinical standard of

If you gain expertise in a specialty, and practice to that level consistently, when a problem arises, you may be reasonably confident that the problem is not an error.

PMFB-RN, RN · May 5, 2011

No, it is very unlikely that anyone will be hired or fired(providing you don't lacerate an artery) on the basis of venipuncture skills.

*** I don't know. If I was considering hiring a new grad nurse who had not learned a very basic nursing skill I would wonder what other basic nursing skills they had not learned.

Maevish, ASN, RN · May 5, 2011

In my ASN program we learned how to do IVs in school (had to have 3 successful ones or we didn't pass the lab-of course doing them on each other sucked cause non of us knew what we were doing!) and after that, we could do them during clinicals if the chance came up.

FLmomof5 · May 5, 2011

Wow. :eek:

I just graduated an ASN program this past August. We had to perform all our skills on dummies before being allowed to go to clinicals and then we were expected to perform all those skills while at clinicals. I performed numerous IV's and venipunctures. I was thrilled to get the vein I couldn't see on a very large pt and I got it on the first try! We did leave the seriously hard sticks to the 'resident Guru' nurse, though!

Not all hospitals have ancilliary staff to perform these tasks. Even when they do, sometimes there isn't the time to wait for them. I knew there were some hospitals that don't have these done by RNs, but not even to TEACH it in school.....wow.

NJ2008 · May 5, 2011

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. :)

I never learned this in school. I'm suprised at how many people in this thread did learn venipuncture because most recent grads I know did not learn this skill either. Maybe it's just the area where I live?

Anyway, I don't know why the lab teacher was acting so "scared". Judging by this thread half of us did not learn venipuncture so I'm sure you not the first she's ever met, lol. Don't feel bad.

Nurse Leigh · May 5, 2011

my adn program did not teach either skill as a part of the required curriculum. there was an iv course offered, but it focused on types of fluids and in what circumstances they would be ultilized. we had one day where we learned to place an iv on another student then spent a few hours in a pre-op setting. (i only had one pt to "practice" on during my time). those nursing students not in the iv class could opt to come in just for the lesson on placing ivs if desired.

in my facility, we have both iv teams and phlebotomists. in some areas, such as ed and icus, the floor nurses will perform these tasks (unless pt is a difficult stick; then it is iv team to the rescue). it is not even an option for the floor nurses to perform these tasks on med-surg/tele/ortho floors. (this seems to also be true for the other large hospital in my city). i do understand this rationale: when a pt comes to us from either ed or the or, they have already have iv access. if they are a direct admit, the iv team will come to place an iv. the iv nurses keep track of the types/guages/sites of our pts ivs and are responsible for rotating as appropriate. they are also excellent at trouble-shooting sites, and can often perform some "magic" to help pt avoid needing a new site.

i guess my point is that we as floor nurses would not have enough opportunities to become proficient in placing ivs and i would much rather see my pts have a relatively pain free experience than have to suffer with me, a novice at best, attempt it.

as for lab draws, there are times it would be nice to be able to draw from a pt with those "good veins" (which are pretty scarce on my floor, let me tell you) but again, better for the pt to have the "expert" perform this while i perform those tasks only a nurse may do.

whew, i hope that all made sense. :)

nurse leigh

joanna73, BSN, RN · May 5, 2011

What about therapeutic communication skills? Communication really is the foundation of all nursing practice. Just like IV skills, communication is an art, too. I guarantee you, some nurses may be great at IVs, but maybe not so great with communication, or vice versa. We are all good at different things, and knowing how to insert an IV does not make someone a better nurse.

RNJill · May 6, 2011

Yes, I have to do IV starts and venipunctures as nurse-we do have an IV team, but we are expected to make reasonable attempts and/or have someone more experienced try before we call them. I do feel like I had an excellent nursing education overall, but the fact that we were not allowed to do ANYTHING with blood draws or IVs was not a good thing. I'm on a unit with a lot of patients who are hard sticks, and let me tell you that it is sooo hard (in terms of providing care and my own confidence!) to constantly come up against this issue and fall short!

I think nursing school SHOULD train students as well as possible in this area, because in the hospital, you can't escape it!

KareBear0609 · May 7, 2011

I just finished up a PCT (patient care technician) course, which was one semester. That was a big part of our skills learned - we had to demonstrate that we could do finger sticks and venipunctures. It surprises me that nurses aren't being taught this because if I was on the floor and needed help, I would turn to a nurse to help me.

fem · Jun 12, 2011

Hi. Thanks to ALL of you who have participated in this discussion thread.

While I'm hoping to be accepted into MDC.edu ADN/RN school for Aug.2011, it is

not a done deal yet. I'm trying to figure out what to do in August

if I'm not accepted into RN school.

Do I take pharmacology at PBSC.edu? (PBSC.edu encourages students

to take pharm. class - in advance of being accepted to their RN school)

Do I instead sign up for LPN school?

Do I take the HESI which opens the door to apply to other RN schools?

My point is this - during my state of wondering what to do next -

my friend has suggested doing a phlebotomy course.

So, I look online thinking it would be EZ to locate a local school.

There were plenty of online phlebotomy courses, - blew my mind.

I'd think the whole point is to get hand-on experience.

Local phlebotomy schools with hands-on experience are hard to find.

The closest one I found was in Miami at Lindsey Hopkins Technical.

Anyway... reading this debate has helped me understand if I'm

just waiting to get into RN school, doing a hands-on

phlebotomy program certainly won't hurt me.

Further - on the flip side - if I don't do phlebotomy class

prior to RN school, it is not likely to hurt me either.

So, again, thanks for the debate on this topic.

Sincerely,

RNfem