IV starts in nursing schools

AdamantiteEnigma · Nov 12, 2014

It should be taught. Not much else to say on this issue. I've seen far too many new nurses fumble and flounder with basic procedures at the bedside. Frankly, it doesn't make sense to me to have new nurses so deficient with these things. Being a member of rapid response in the past it's just plain frustrating to get called onto a floor to start a line on an easy patient. It takes us away from patients that actually do need immediate assistance.

I've had some rather cynical thoughts when called upstairs from the ED to do a 30 second easy start on a patient I felt anyone could get a line into...

AdamantiteEnigma · Nov 12, 2014

Also, when I did the EMT program, we started lines on each other after signing optional waivers. The same was true in my LPN program. Since I am considered to be a big guy with sizeable veins, I was a pincushion from volunteering in both cases to assist my fellow students with their competency.

Phlebotomy was something I took an additional course for. I'm not confident that the curriculum would fit into most nursing programs. Even with the overlap, it's a lot of time consuming information.

Buggysmom · Nov 13, 2014

I went to an old fashioned hospital nursing school in Boston & BSN in Boston. We did not do IV starts. We had 24 hr IV teams (and a lot of them) in all the hospitals and most units had physician interns/residents right there 24/7. It actually was a non issue. Never had to start an IV in my life until I lived in rural Texas. Nurses can start IV's, but, only house supervisor can do PICC line start or removals. I've been a nurse almost 20 years.

runnergirl86, BSN, MSN · Nov 13, 2014

It was taught in my BSN curriculum in the first semester. Practice on the fake arms, classmates, and then in clinicals with supervision.

My first job in Seattle we had phelbotomy and did start our own IVs, however I never felt that confident. In the military they set you up to work in the lab for a shift, in the GI clinic for a shift (lots of IV starts) and of course practice on each other if needed. You draw all the morning labs and I feel my confidence and accuracy have gotten much better.

I remember one night shift at my last duty station we needed to get access on a combative pt whose veins were shot and the intern wanted to start an EJ. The intern himself stated he hadn't placed a PIV since practicing on a fake arm, so I rolled up my sleeve and had him practice on me. Later we got the EJ and the intern stated he was grateful I let him practice on me to show him a better technique and the mechanics of it all.

I think that a lot of schools have gone away from allowing students to practice, which really is a shame. The best of luck in revamping your curriculum.

firstinfamily, RN · Nov 13, 2014

Way back in the old days, 1981 in my ADN program we were taught to start IVs by starting them on each other in our clinical lab. This was a great way of learning the aseptic technique. As a hospital nurse, we had to go through IV class, but it was with the big arm with the gigantic well expanded veins. So unrealistic!!! I think every nursing student should have to have at least 3 successful IV starts on an elderly person. They are usually dehydrated or have rolling veins. The equipment varies from facility to facility and it is difficult to get use to a certain jelco/needle to start IVs. Also, with the cost cutting in hospitals many do not use IV teams any more. And as a previous post stated, you may have to wait until they are available to start an IV----that is not an acceptable action with today's health care environment as it delays patient treatment.

RN9742 · Nov 13, 2014

We were taught IV skills in our skills class, and we were allowed to start IV's during our 3rd and 4th semester clinicals. IV skills included venipuncture as well as hanging fluids and piggy backs. I just graduated from an ADN program in May. I honestly cannot imagine going onto a floor without knowing how to start an IV. I do one almost every shift now as it is.

SquishyRN, BSN, RN · Nov 13, 2014

Much like TheCommuter, I graduated from an LPN program in 2008 and an LPN to ASN bridge program in 2013 and neither taught anything listed by TheCommuter. It isn't taught in most (if not all) the programs in my area. Its all about liability, the hospitals wouldn't allow students to start IVs or do venipunctures. I wish we were taught it.

This argument about liability keeps coming up. What I don't understand, and I wish someone could explain to me, is why it isn't required to be taught at all, even in skills labs on fake arms? There is no liability if it's not being done on an actual person, but at least students would get to practice the motions and familiarize themselves with the steps. It would take no more time out of the curriculum than teaching NGT placement, foley insertion, sterile dressing change, etc... all of which are considered "basic" nursing skills, which I believe IV starts to be as well. The argument that "most hospitals in the area have IV teams" doesn't fly with me either because you never know what field of nursing you'll end up in after graduation. For example, none of the above skills I just mentioned would be used in assisted living, but that doesn't mean those nurses shouldn't be taught in nursing school. I work in Med-Surg and I start far more IVs than NGTs, yet I'm sure NGT placement is taught in just about every nursing program. I just really don't understand the rationale behind not including it in nursing school curriculums, because, again, there's no liability issue just practicing on fake arms.

Stitch3296 · Nov 13, 2014

I'm in an ADN program about 2 hours north of you, and IV starts are a part of out program, and all of the students have had multiple opportunities in clinical to start. I think it's an invaluable skill to have. When I was at the nsna conference this last weekend, I was surprised how many students don't have that opportunity.

imintrouble, BSN, RN · Nov 13, 2014

We practiced on the fake arm in the lab once. Then we were sent out to our clinical sites to practice on patients.:)

I think that was the second year, more than 20 years ago.

It absolutely should be taught.

I precepted a new grad last year who didn't know how to spike an IV bag:woot:

They didn't see my shock, but shocked I was.

akulahawkRN, ADN, RN, EMT-P · Nov 13, 2014

I recently graduated from an ADN program and we were taught actual IV starts during the final semester of the program. First semester we learned PO and PR routes as well as starting to do injection practice. We started with doing IV bag changes and hanging piggybacks during 2nd semester along with doing various injections. Third semester we were giving meds through every route except IVP and that was added during 4th semester along with IVP. As it pertains to IVs, they wanted us to become intimately familiar with IV stuff right up to the hub of the catheter before we could do IV starts because doing IV starts isn't usually too difficult and you'll get better at doing them on the job. If you're not so good at starting IVs, you're still extremely familiar with everything else about IVs by the time you graduate.

I'm a Paramedic and learned on a mannequin and then on (gasp!) each other... during nursing school, we could only use the mannequin arms and then actual practice on patients. Not being allowed to do IV starts on each other at least once or twice doesn't help your confidence the first time you get to do it on an actual patient.

ETA: The only thing that we weren't allowed to do, with respect to IV lines, was push code meds.

cp1024 · Nov 13, 2014

I graduated in October, and yes we were taught IVs. I even started one in clinical on an adult, and I did a venous draw on a 3 hour old infant in preceptorship. Got them both on the first try.

We were not allowed IV push of cardiac/high alert drugs but other than that we were allowed to do whatever skills we were able.

Something about doing IVs made me feel like I was finally doing "nurse stuff" and I'm very glad to have gotten the opportunity in school!

smartin13 · Nov 13, 2014

Yes we had a simulation lab where we "started" IV's on a computer program. After we showed we were competent with that we were able to start IV's in the clinical setting when ever we had a chance. No hospitals in my area have "IV" teams and starting IV's is not something that is taught in orientation. It is expected that you know how to do it upon graduation.