Jump to content

Opinions from experienced nurses

Posted

Specializes in Emergency Dept. Trauma. Pediatrics. Has 6 years experience.

There has been a new debate going on in the student section about a topic and I am curious to know what those of you that have been working a few years or more think about it. I had never even heard of it being a problem or thought about it until now.

What do you think about hospitals having IV Teams, Phlebotomy teams and Wound care teams. Do you feel this has made it easier on you, or do you feel it's a waist of money to pay people to specialize in these areas?

I have done clinicals at 2 different hospitals, one has these teams and they are utilized often, the other does not, but I only see it from a students point of view.

mskate

Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU. Has 8 years experience.

I really like it. I work in the ICU where these types of teams are rarely used, but in other areas - I can see huge benefits.

If a nurse has a big patient load and 1 patient loses an IV - and that patient happens to be a really hard stick, it can take an hour of her time and possibly other peoples time to get a line in the patient. It is a huge time saver, allows that nurse to focus on her other patients and can speed up the care that patient gets because of their access.

Wound care teams are also great. Wounds are usually a big ticket item for a lot of hospitals and there is often issues with wounds not being properly documented, inconsistency with the dressing changes, etc... A wound care team can stream line this and I think its all an excellent resource.

MORE help is ALWAYS good thing. You can't OVER staff a hospital too much - the more help, the happier the employees, the better the patient care, the better patient satisfaction.

Up2nogood RN, RN

Specializes in pulm/cardiology pcu, surgical onc.

We have an IV team with PICC nurses but we are supposed to try to start our own IV's 1st before calling IV. This changed a few years back to save money since I guess the IV team bills the unit when they come up. Each floor in my hospital utilizes them differently. I think IV teams are a great service to a facility to help free up the nurse for other pt care needs.

We have a WC NP that will come see a pt if the MD has approved. We usually see her initially brainstorm solutions for pts with extensive fistulas, wound vacs, then the ostomy/skin care team takes over. We also have an ostomy/skin care nurse that sees the pt without MD order. We can order a consult for new pts who have skin and/or ostomy (new or existing) and they do all ostomy teaching in and outpatient.

Phlebotomy does all peripheral draws and nurses are responsible for their central line draws. It changed a few years back, previously the IV nurses were responsible for all central line labs. I do not have an issue with line draws since there usually is some down time between 3-5 am and have just incorporated into my daily routine.

I do work also at an LTAC and we have to do all our own labs in the evening since there isn't an in-house lab and it's a big PITA. There is a PICC nurse but no IV team so we have to start all PIVs one way or another, ultrasound is helpful on hard sticks but eats up a lot of my time.

HollyHobby

Specializes in critical care, home health.

I work at a hospital where we have a wound care RN, phlebotomists, but no IV team. We used to not have phlebotomists and we drew all our own labs.

I strongly support having a wound nurse. This is almost a separate field, where specialized knowledge is extremely useful. The wound nurse has up-to-date knowledge of treatments as well as knowledge of the myriad products at her disposal. This is a full-time job, just learning and utilizing this specialized training, and the results speak for themselves. She knows best what should be done for each particular wound; she can prescribe those treatments to us and we can carry them out. She doesn't have to actually perform every dressing change, but her wisdom is a great benefit to the patient.

Having a phlebotomist is a convenience in most cases. Often, I'm very busy and it is a great help for someone else to come and draw my labs. (I still have to keep an eye on the situation and often, I have to call and request that the phlebotomist come to draw those scheduled labs or just send me the labels so I can get them myself. In the time it takes to make that call, I could have drawn and sent them.)

However, being able to draw labs is a pretty basic nursing function; every nurse should be able to do it. Also there are situations when it is actually more convenient for me to draw them. Certainly if the phlebot is busy working a code, I should be able to draw my own time-sensitive labs instead of complaining that phlebotomist is late. If my hospital did go back to not having a phlebotomist, I wouldn't complain. In our case, the extra cost isn't really justified. In other places, that phlebotomist could be gold.

In the same way, starting an IV is a basic nursing skill. I can understand that in a large, busy hospital, it's easier or more time-saving to have an IV team. Where I work, the med-surg/tele nurses often call our ICU requesting help with an IV start. Often, I go up there to help out with an IV stick and the IV is easy. They just don't have time to do it. I'm happy to help them out.

There are also times when we ICU nurses call the ER for assistance for an IV start. We do this as a last resort, because we all feel like dufuses if we can't get the IV. If the ER nurse can't get it, that patient will get a central line.

My hospital is not large enough to warrant having an IV team. If we did have one, they would sleep about 24 hours and 55 minutes per day. I can see how they would be valuable in a very hectic, short-staffed environment.

Another maybe-not-needed ancillary department is EKG. Where I used to work, we did all our 12-leads ourselves. Where I work now, a nice lady comes in the morning and does them for us. Every nurse, particularly every critical care nurse, should be able to do a 12-lead EKG.

~Mi Vida Loca~RN, ASN, RN

Specializes in Emergency Dept. Trauma. Pediatrics. Has 6 years experience.

See I have seen it as a help as well. From what I have observed there has been no rule that the nurses CAN'T do any of these tasks. But I know for me, I am a really hard stick, I often get stuck multiple times by numerous people. Finally they call in someone and they get it first try. I would love to have someone come in and get it done the first time. (obviously emergency situations this wouldn't work). I would think that if a patient is a hard stick calling the IV team would be beneficial, that way it saves the patient on multiple sticks and whatever good veins are there aren't compromised. The IV team is called when there are problems with the IV as well. There are a few people on the IV team and they are always staffed so they usually arrive pretty quickly from what I saw in a 335 bed hospital.

The phlebotomist come around to do the routine labs every shift. Nurses can draw the blood, the supplies are there, the tubes are there. Most of them do them on the patients with Central Lines. Again, if their is no central line, patient is hard stick why not get someone in that is very good at what they do??

Of all of them I think the wound care team is probably one of the most important. We had a wound care nurse come and talk to us. She is very good at what she does and she has been published many times and come up with regiments that are used many places, when it comes to wounds she really knows her stuff. She was telling us how fast a PU can progress, one can develop in 2 hrs. Wounds can go bad very fast. Sure I can see nurses are capable of dressing changes, especially when the steps and products to use and the order to use them are written out very clear (since wounds are all individual and a persons healing abilities are individual) but they way the teams are used from what I saw, when someone comes in with any type of wound, (outside of like a cut) the WCT comes up, evaluates the wound, comes up with strict written order on how to treat and instructions on when to call back. The nurse can take it from there. Or the WCT might handle it if it's a really bad wound or slow to heal wound and so on.

Anyway, all in all I don't see the problem with specialized teams in these kinds of areas, in fact I think they can be extremely helpful. I wouldn't have a FP Doctor preform my heart surgery or do my care plan for my cancer treatment. I would go see someone specialized in those areas.

As a student and soon to be new nurse I would try to preform what I could on my own, (as far as the needle sticks) so I could become proficient, but just looking at it from what I have seen, I don't see the problems with having these teams at all. I was surprised to find out some nurses would have problems with this so I wanted to see what the overall consensus was.

Flo., BSN, RN

Specializes in Developmental Disabilites,. Has 7 years experience.

It's funny I was just thinking last night that my hospital has to expand the IV team. We have only 1 nurse on day shift, none at night. The rule is 3 sticks call then call IV. At my old hospital, IV therapy put in all IVs and evaluated them on a daily basis. It as so nice not to worry about it.

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC.

Thank goodness for wound care nurses and the IV team. :up:

I have worked where there was an IV team for tough sticks only--IV or phlebotomy, it was helpful. I have worked in a hospital where the lab sent phlebotomists for all draws (except central line draws which of course nurses had to do) to the floors so only ED and ICU did their own draws. Having transferred from ED to the floor I hated not being able to even be "allowed" to do my own draws. When I was slammed and I needed a draw that wasn't stat yeah it was helpful. However when I needed a draw stat and had to wait for them I would get really mad thinking it could have been drawn and in the lab and done by the time they get to me! So for tough draws its nice to have them there but to not be allowed doesn't work either. As far as a wound care team--oh wow now that I could deal with! That is really not a stat need and those dressings--especially a large wound with a VAC--can take a lot of time. I would soooooo love to work having a wound care team for my dressings. That would be awesome. And I agree the documentation would probably be better--the only thing we ever had was a wound care team you could call for a "consult" they would come and look and make a reccommendation to the team--MD/NP/PA/RN--caring for the patient. They would put it in the chart and then the MD would just order for that tx to be done. Helpful but if they actually came and did all the dressings for the floor....now THAT would be really good.

If the teams are taking care of all of the patients that fall under all of those categories, it can be a great deal of help. If you have these in place and never know when you will be drawing blood on, starting IV's and when you won't it can slow you down.

ObtundedRN, BSN, RN

Specializes in Critical Care. Has 6 years experience.

My hospital has all of these teams. I'm in critical care, so we try to do all of our own IVs and blood draws, however, we still sometimes need to call them. The IV nurses are great at what they do. And they are able to do ultrasound guided insertions. Some of our floors don't even carry IV supplies (however I disagree with that practice). The IV nurses are trained to do PICCs, but since we have so many interns and residents, they usually reserve the PICCs for them.

The lab team is great for the little old people with nothing for veins and for one reason or another, only can be drawn from one arm. The lab techs are really good at getting those sticks.

The wound care team is also great. Although they don't work nights, so we are left to do it ourselves. The wound care team comes in handy, because they know what is going to be the BEST dressing to use on a wound. And they can get orders for special dressings. They are also able to do surgical debridement. On nights, we just try to follow what they recommend, but do it ourselves.

~Mi Vida Loca~RN, ASN, RN

Specializes in Emergency Dept. Trauma. Pediatrics. Has 6 years experience.

The wound care team is also great. Although they don't work nights, so we are left to do it ourselves. The wound care team comes in handy, because they know what is going to be the BEST dressing to use on a wound. And they can get orders for special dressings. They are also able to do surgical debridement. On nights, we just try to follow what they recommend, but do it ourselves.

Wounds are deffinitely "not my thing" but I was really impressed with the Wound Care nurse that talked to us, she for sure knew her stuff better than most of the regular nurses, my CI is an Acute Care Hospital NP and even she didn't know some of the stuff and tips and tricks she was telling us so I can for sure seeing it be beneficial for hospitals all around to have a wound care team. I mean thinking about infections and going septic and all the things that can go wrong with a wound not being treated effectively, I think this could be a huge resource. At one of the facilities I am at it's the wound care team that can authorize the use of the special air mattresses as well for patients with PU that are immobile.