Agency Nurse doesn't know how to start IVs?

Nurses General Nursing

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Yesterday, a new agency nurse showed up in our ICU to fill a hole. He arrived 2 hours early to be oriented because it was his first time at our facility, so I set him to work on a few things while I was showing him around. When I was going to maybe need another line, and asked him if he'd like to start it.

He told me that he doesn't know how to start IVs because the place where he normally works has IV therapy. I can understand that because I had worked at a hospital with IV therapy and didn't learn to start IVs until I came to my present place of employment. Nevertheless, I was surprised that an agency nurse would lack that commonly used skill.

"I don't know how" could mean I haven't vaguest idea and I'm hoping I'll never have to try; or it could mean they never taught us in school and I've never had formal training on it; or it could mean I haven't done this on a real person before and it's six months since even trying on a piece of plastic; it could mean I've tried this a few times before and always blew the vein and unless I'm going to be doing this regularly it would be faster for all of us if someone else would start it...

He told me that he doesn't know how to start IVs because the place where he normally works has IV therapy. I can understand that because I had worked at a hospital with IV therapy and didn't learn to start IVs until I came to my present place of employment. Nevertheless, I was surprised that an agency nurse would lack that commonly used skill.

Agencies are as hard up for skilled, qualified nurses as are hospitals. Ideally, agencies would only select the most adaptable, independent nurses but they aren't always as choosy as they could be. Because there's such demand, agencies can overly rely on the nurse's self assessment of ability - asking someone not qualified for, say critical care, if they'll take a critical care shift.

Maybe he has worked in an ICU where everyone has major lines, if you have plenty of lines you don't have much of a chance to start IV's. Lines are usually the first thing that goes in at our unit. But, if I were him I wouldn't have admitted that, I just would have done it and if I had a problem I would have asked for someone else to try. ICU nurses in our hospital can start IV"S but have some difficulty. They usually call those of us in ER to do it if their is diffuculty. It's not that they are less of a nurse , it's just that in

ER we do it many, many times a day. If you ask a ER nurse to DC chest tubes or a Swan cath, they would about pass out. Now if the RN was never trained in iv starts in nursing school , well then that's another issue. (a big can of worms will open on that subject):chair:

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

If his other ICU skills are good, cut him some slack, I say. IF he is "bad" all around, report this to the agency as you can't use him in the ICU.

But like others said, unpracticed skills become handicaps in new areas/jobs. For example, I know for a fact, I would have a heckuva time dropping an NG tube. I did like TWO during school and went straight to OB where we just don't tend to use NGT (OGT on babies on occasion, but different story, of course). I would be very hard-pressed to do colostomy care---I don't do that either in OB. Some skills are lost as we move into specialized areas. A lot of hospitals indeed do have IV therapy teams and nurses have no choice but to use them---so their IV skills become history. It happens.

So if he is good all-around, how about doing the nice thing and cutting him slack? Maybe, he can teach YOU a thing or two, you know.

Specializes in acute medical.

When you talk about "starting IVs", are you talking simply about connecting an IV med to a cannula, or are you talking about the whole process - ie insertion of the cannula, then administration of medication, and monitoring of medication / fluids...Where I work, whether you have had education in insertion of cannulas at uni, you cannot do it until you have completed the hospital course. Then you have to have it renewed every three years. And at the moment the courses are "out of date" and are being redeveloped, which is really annoying me. If the nursing staff are unable to insert it then it is left to the RMOs - which is most of the time...:trout:

Specializes in Emergency Nursing, CPEN, Pediatrics, Obstetric.

It gets pretty bad some nights at our hospital. I used to work peds, and it wasn't very busy, so the house resourcenurse/supervisor would have us running around starting other floors "difficult sticks". I finally began asking the floors if they tried first. Of course they always did, but mybe they thought I never asked the patient where the nurse before me has tried......:doh: :doh:

Specializes in Oncology, Research.
No that's not true for RN schools. I went to a well known school that's affliating hospital has an iv team and phlebotmy team. no ivs or blood draws for nurses. My job taught me how to do it. My job had the fake arm with very worn "veins". It still took me a while to get it down. On my busy meg surg unit sometimes you don't have the time to stick a pt, good veins or not. So your expierence can be limited.

Same here. I also went to a top school where we were not permitted to learn this skill. They told us that MD law prohibits unlicensed personnel from doing these kind of procedures. I also learned on the job, but rarely used the skill as phlebotomy teams were put in place at my facility to cut down on infections, bad sticks, etc.

Specializes in Med/Surg, Geriatrics.
If his other ICU skills are good, cut him some slack, I say. IF he is "bad" all around, report this to the agency as you can't use him in the ICU.

But like others said, unpracticed skills become handicaps in new areas/jobs. For example, I know for a fact, I would have a heckuva time dropping an NG tube. I did like TWO during school and went straight to OB where we just don't tend to use NGT (OGT on babies on occasion, but different story, of course). I would be very hard-pressed to do colostomy care---I don't do that either in OB. Some skills are lost as we move into specialized areas. A lot of hospitals indeed do have IV therapy teams and nurses have no choice but to use them---so their IV skills become history. It happens.

So if he is good all-around, how about doing the nice thing and cutting him slack? Maybe, he can teach YOU a thing or two, you know.

:yeahthat: :yeahthat:

I'm back now, I see there are alot of responses to my opening post. This fellow was 27 and had been a nurse for a few years, and in ICU for 1 year, and his primary job is in a hospital with an IV team. I think otherwise his skill level was adequate. I'm certainly not surprised that an ICU nurse might not be skilled at starting IVs or even not know how to start them at all, but I was more surprised because I thought agency nurses were more versatile. I'm pretty competant starting them, so I would just do it if working with someone less skilled at that task.

Yes, he said he didn't know how to start them, that he had started on years ago, but never did them where he worked so didn't know how to do it.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Agency nurses are like any of us. Many of them specialize just like we do. Why not see how things pan out before getting up in arms over lacking one basic skill? Maybe he is skilled in other areas that some lack. You don't know til you get to know him and how well he can do. Agency nurse does not equal "Jack of all Trades".

Specializes in Psych, M/S, Ortho, Float..

I worked on staff at a hospital for a year, then went to agency nursing after doing some outpost nursing in the back of nowhere. I went back as agency at my old place and I still had to take the IV start class over again. I'm working Psych LTC at the moment and I haven't started an IV in 2 years. Even though I rocked at getting the hardest IV's back then, I would still want a refresher before doing it again.

We did not get the training in school. It was strickly an "on the job" skill and I was one of the very few agency nurses that could start IV's.

Specializes in ICU-Stepdown.
maybe he has worked in an icu where everyone has major lines, if you have plenty of lines you don't have much of a chance to start iv's. lines are usually the first thing that goes in at our unit. but, if i were him i wouldn't have admitted that, i just would have done it and if i had a problem i would have asked for someone else to try.

ok, now that is scary. if a nurse is unsure or just does not know a skill, i pray they do admit it, and either ask for assistance or seek instruction -not just 'try' and fail, then ask someone else.

i have a lot more respect for those who admit their shortcomings than for those who don't, and will just try anyway. this isn't a puzzle you're trying to fit together, its someone who may suffer if its not done correctly.

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