I thought we learned that in nursing school!

[Emergent]

Our hospital is now doing check offs with a manniquin on inserting foleys.First we watch a video. Then, the infection control nurse checks us off. Of course, she, herself, hasn't actually inserted a foley in over 20 years.

We got new foley trays, which are essentially the same as the old ones, but they have towelettes to use before you start. The towelettes are folded up in tight, little squares, much harder to use than washrags. So, us incompetent nurses have to go back to nursing 101.

[nrsang97, BSN, RN]

We got those new foley kits too. Except our education was computer based. Those wipes are very difficult to open when putting in a foley.

Some of the things I see nurses do as a rapid response nurse is frustrating. The not knowing basic skills and such. I really wish we would do a skills fair and have blood draws and IV insertion added to the list. I would even be willing to help.

Can anyone give me an explanation as to why blood cultures need to be drawn 15 minutes apart. I understand the use of two sites, or even doing a peripheral stick with a central line or PICC in place. I just don't understand why the time difference.

[nrsang97, BSN, RN]

Either this skill is not being taught correctly or the nursing student was absent that day. I received a nstemi patient who was on plavix and heparin and was hemmorhaging from a foley inflated in the member. I can attest to the fact that there are working nurses who are not competent in this skill.

Nasogastric tubes are another potentially dangerous nursing responsibility that is poorly understood and should require a yearly competency. I can not understand how so many nurses-even good nurses- do not understand the mechanics and think it is acceptable to tie a knot in the pigtail. Drawing blood cultures is another skill that should require a yearly competency as well.

I was not too enthused about a mandatory inservice about CVCs ports and PICCS after working all night. It was very thorough and I learned a few new tips and tricks. These classes are sometimes held as part of a corrective action plan following an adverse event. It is always worthwhile to have a quick

review and update on EBP.

I have seen it happen when a nurse has inserted a foley in a man and the balloon was inflated inside the urethra and the patient had bloody urine. I have never seen such a furious urologist. To this day I go to the bifurcation on the tubing in a man and then inflate the balloon.

[icuRNmaggie, BSN, RN]

Bacteria multiply rapidly in bacteremia. If the specimens are obtained less than fifteen minutes apart it is considered a single draw. If the patient is in septic shock or if endocarditis is suspected due to IVDA, the blood cultures from two sites must be done urgently so that the patient can be started on antibiotics.

An inadequate sample leads to false negative and not disinfecting the vials - which are not sterile - with chloraprep produces a contaminated specimen. Draw the aerobic bottle first using a butterfly as the air in the tubing is needed for the bacteria to grow in the media.

[scottaprn]

No different than attending the wonderful bi-annual BLS for healthcare providers. I have yet to be checked off on the skills session by someone who had done CPR as many times as I have but I have been in classes where I was the only one who had done CPR.

They have no way of knowing who is competent and who isn't without the skills check off

[Miss.LeoRN]

I can see this... If the majority of programs are like my own; once we learn a skill in skills lab, that's it. We don't often revisit it in Sim, which we only have maybe once or twice a semester, and unless we get the chance in clinical we don't perform the procedure again. They're like... okay, you did it, that's great, lets move on. And when it comes to skills during clinical it's up to the nurse we're with to allow us to perform a skill.

We do have "open skills lab" that we can go to and practice techniques with, but IMO they're pointless. There is never a tutor, professor, aid, clinical instructor or anyone else to assist. It's just an open student lab, which is great sure.. but unless I do things perfect and know I am then I could develop some really bad habits with no one there to go "oh no no, it's supposed to be like this!".

So really, I could see this as a check list item a new job would want me to showcase I am capable of doing.

[nynursey_]

They're paying you good money to play with a mannequin rather than having to deal with potential troublemakers. Don't complain.

FYI, I get paid the same amount either way. Skills fairs are held during working hours on your shift. I'd much rather be providing patient care and staffing my unit properly rather than being pulled for the skills fair.

[nursy1, BSN, RN]

my hospital has everyone do check offs on almost everything, we first have a boring class, then we insert the foley/IV/change central line dressing, etc. Each institution will have their own specific equipment & policies, so just do the classes... I looked at class time as time for my feet to rest

[Gooselady, BSN, RN]

Every year we had 'yearly competencies' to be signed off on, and if you forgot (like I did a couple of times) your manager would get all wigged out and threaten to write you up if you didn't go demonstrate you could do an Accucheck, place and remove restraints, troubleshoot the Atrium chest tube system, and so on. On oncology, we had yearly 'competency' testing. It was a PIA, in the same way getting bi-yearly CPR is a PIA after 24 years . . . yawn.

When I was a manager with the chemical dependency hospital, we went through two JCAHO surveys, and I got to see the whole competency thing from 'the other side'. My director and I flew to Chicago prior to the survey to get down and dirty with what the Joint Commission was looking for, and WHY they were looking for it. It made those yawningly boring yearly comps make more sense, anyway. It is truly playing to the lowest common denominator. All it takes is ONE poorly skilled nurse to hurt or kill someone stupidly, and I think this yearly comp thing is an effort to catch the lowest achievers and educate them, wherever they are. That sounds so harsh lol.

[canoehead, BSN, RN]

I've worked in 6 hospitals and none of them needed the cultures to be 15min apart, just two different sticks.

[nynursey_]

I've worked in 6 hospitals and none of them needed the cultures to be 15min apart, just two different sticks.

I think my facility is the same way, but I'm looking into it. Floor nurses typically do not draw BC if the patient doesn't have a central line or PICC.

[nrsang97, BSN, RN]

I've worked in 6 hospitals and none of them needed the cultures to be 15min apart, just two different sticks.

Sometimes they are ordered that way and sometimes they aren't. I usually just do them in two different sticks.

[nrsang97, BSN, RN]

I think my facility is the same way, but I'm looking into it. Floor nurses typically do not draw BC if the patient doesn't have a central line or PICC.

We draw all our own labs at my facility. Central line, PICC , or peripheral.