RN's who cannot insert IV's being Fired???

Tweety, BSN, RN · May 25, 2006

I am not good at starting IV's. I am not ashamed of that truth. I am so glad starting IV's was not on the NCLEX. Maybe I get 40% of my attempts after trying twice. Should I leave hospital nursing, or might I be fired? Maybe I should be. One of the biggest complaints of patients at my hospital is painful, inept IV starts. It's been 5 years.........is there any hope for me? I want to master this skill just don't get enough opportunity to reinforce the skill.

Of course you shouldn't be fired, because you try and you don't refuse.

Starting IVs is a gift some of us have and some of us don't have. I learned to start IVs by trying over and over and over and over again, and unfortunately missing people. The very first IV I tried in nursing school I got. Then I proceeded to miss the next 10. I was horribly discouraged and very phobic about starting IVs.

I can feel for this person who got fired. I'm not sure what the bad outcome was that made her phobic, and perhaps that should be respected because it was so bad she was willing to be fired. But, sometimes when you get thrown off the horse, you have to dust yourself back off and climb back on.

Tweety, BSN, RN · May 25, 2006

There's only one side to this post. There are steps to the discipline process before one gets fired, unless the patient outcome is very very severe. I have a feeling that there is more to the RN beingt fired than what has been posted.

I agree. Something bad happened that caused this nurse to begin refusing. It was so bad she was willing to be fired, because surely it wasn't a matter of her refusing one time and them being fired. Hopefully, she went through a disciplinary process and hopefully was offered education and support.

GooeyRN, ADN, BSN, CNA, LPN, RN · May 25, 2006

I don't think an RN should be fired for not being good at starting IV's, but should be for REFUSING to even try. Im not that good. I get them first try about half of the time. But I always try, unless I can not see or feel a vein, and know that it will be an unneccessary stick for the pt. Thats when I call on a more experienced nurse to start the IV. But if I see or feel a vein, I always give it a shot!

Katnip, RN · May 25, 2006

I was not taught IV skills in nursing school. I am terrible at putting in IV's. I only work two days a week and get very little chance to "practice". I feel so bad having to stick my patients multiple times to get a working heplock. I think the patients deserve a well trained, well practiced IV nurse, not me.
Luckily my coworkers help my patients out and I am more than happy to assist them with whatever I can. I have things that I excel at and I am always willing to share my skills with others.
How do you think those well trained, well practiced nurses got that way? It doesn't matter that you don't get a lot of practice. To be more successful, take your time before sticking someone.
I see a lot of newer nurses who think they've got to hurry and jump in and get that needle in. It's not usually necessary, and taking a few minutes to assess different sites can make a big difference.

azhiker96, BSN, RN · May 25, 2006

iv's, been a nurse 35 years and can count on one hand the times i have had to start one...thank goodness, because i bite at it.
but, unless it is out of my scope of practice i have never refused a task. i
agree that it is our responsibility to be advocates for patients...so i wouldn't want to do something for which i lack experience...but refusing?
got to be more to her getting fired than that

i agree. another thought, once she knew she couldn't do part of the job (iv starts), why didn't she give notice and find a nursing job that didn't require iv starts? she could become a school nurse, work in an office or clinic, etc.

LuvMyGamecocks · May 25, 2006

My school has a Continuing Ed class called "Basic IV Therapy"....maybe there's something similar in your area??? This is part of the class description.

". . .offers health care professionals the knowledge and skills necessary to insert and maintain peripherally inserted catheters. The student will gain hands on experience. . ."

I agree with most other posters here, though I'm only a student now. Regardless of what's taught in school, it seems like a basically necessary skill for RN's to possess. Ask someone for tips, seek out a continuing ed class, keep trying...but don't just refuse to do it. Think about that from an outsider's point of view. A nurse?? Refusing to do IV's?????

Medic/Nurse, BSN, RN · May 25, 2006

RN's who CANNOT IV is different from WILL NOT IV!

I was not very good at IV's when I started (a long time ago!), it hurt ME, just watching that needle pierce the vein, move, etc. I'd bet I closed my eyes at times. BAD for my patients and now, I look back and think - I was a bit of an idiot!

Now, I can put an IV in virtually anything with blood in their veins! Even a few dogs, cats! :)

It is a numbers game. The more you do the better you get, Now many patients compliment my skill (no locals, etc) Technique is EVERYTHING! AND it is a LEARNED skill! It can be done!

I tried to estimate and I think I figured the number at over 15,000 several years ago!

I will admit that as a paramedic, not being ABLE to do IV's would have had a serious impact on my ability to meet the standard of care! Nurses are rarely alone in their practice.

Anyway, not able is one thing. Now WILLING something very different!

RNKPCE · May 25, 2006

I agree not doing is different than can't do it. Also she once did it then had a bad experience. Give her some retraining, let her talk about her fears to someone.

We have several nurses that never try to start their own IV's. Or they will say they have looked and the patient is a hard stick. When I go in the room to start the IV for them there isn't even an IV start kit there with a tourniquet pulled out. How does one know the veins are bad without even applying a tourniquet?

One of the nurses who never starts her own IV's has real shakey hands. No one has ever addressed her shakey hands, and they should. I am waiting for my opportunity to ask her about it. I woudn't mind starting them for her because I wouldn't want to be the patient on the other end of her shakey hands but I want her to be open about her problem. And maybe offer to do something else for me in return. She is the absolute delagator in every respect when she shouldn't be but for IV's I think she should delagate them.

I also think where you work make a difference on whether needing to start IV's is deal breaker. If you work in an infusion center you'd better be able to start IV's. Otherwise starting IV's isn't that big a part of the job, there is so much more we do mentally, emotionally, and physically than starting IV's.

jnrsmommy · May 25, 2006

I have to agree, there's a BIG difference between not being able to and not wanting to. I have plenty of days where I can hit every vessel in sight, and others where I couldn't hit the broad side of a barn. The only times that I do not first attempt to do an IV (or foley, procedure, etc) is when there's a new nurse on the floor, and I'll ask them if they want a chance.

Also, in LA, LPNs can start IVs after being certified, can they also do it in other states? Just curious.

Antikigirl, ASN, RN · May 25, 2006

Yep, can't do the duty under the role of an RN, you don't get to keep your RN. I mean, IV's are important to patient health, so not doing them is going against the role and ethics of a medical professional right there!

Being from management in my time, I would wonder what else this RN would decline to do for patients! If the patient coded and we needed that IV and she declined to do it in the start of a code? Or an IV infiltrates that is giving heparin and declines putting another in when the patient needs it? Or even the painful pt that needs that IV stat for pain control via a PCA? Nope...she is outta there for the safety of my patients and other staff needs (can't be pulling way nurses for this all the time!).

HOWEVER, it would be benificial to discuss this with her, and perhaps get a plan in motion to help her overcome this fear. Hipnosis is one thing, taking the class for IV again, ride alongs in an ambulance sure broke that fear out of me!!! There are many things one can do for this...and I would be suggesting it, and once done...apply for the position again once comfortable.

Sorry to be a hard nose about that...but my fears or comfort level never ever is more than my patients needs. They depend on me for their very lives...I don't let them down even if I am nervous or scared of doing a tx I know I am trained to do! (I get a bit nervous with deep suction...I think I am going to vagal them or go too hard and deep...but I haven't yet, so I keep on doing it despite my nervousness!).

chadash · May 25, 2006

I think the best thing for this nurse is to have some retraining and get some counseling about the phobia. Phobias are very hard to overcome, especially if OCD is a factor. Sometimes, running into road blocks like this is what helps us overcome, heal and grow. For her sake, I hope she gets some training and help. I feel for her.

On the other hand, does she have some physical problem, tremors or something, that have changed her capacity to continue with a past skill? Wonder if there is more here than meets the eye.

Then there are crazy people like me who are like "oo! oo! teach me to stick them!"

Roy Fokker, BSN, RN · May 25, 2006

Then there are crazy people like me who are like "oo! oo! teach me to stick them!"

Sound like me! :lol2: