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

Daytonite, BSN, RN · May 26, 2006

Just wanna know if it is mandatory for all RN's to insert IV's? Can a person really be forced to do anything that she is not comfortable and has developed an aversion to it. Is it fair to the hospital and to the nurse?

No one can be forced to do anything they don't want to do. Not wanting to start IVs because of developing an aversion to it sounds pretty weird to me. The hospital, on the other hand, has the right to set the requirements of a job. If starting IV's is one of the requirements and a person won't do it, then that person's fate is pretty much written on the wall (or on their pink slip).

Daytonite, BSN, RN · May 26, 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 think the patients deserve a well trained, well practiced IV nurse, not me.

What a load of crap! Most nursing schools teach the basic theory behind IV therapy. And, even if they don't, which I highly doubt, hospital nursing educators give RNs and IV certified LPNs inservicing on it during their orientation as new employees. Every single hospital I've worked in over the years did this. Learning to put an IV in someone is no different a skill than inserting a foley catheter or N/G tube. We all had to do them multiple times before we finally got good at it. You become well trained and well practiced at any skill or procedure by seeking out opportunities to do them. You'll never learn by taking on a "hide and hope the problem goes away" mentality. Remember how your clinical instructors in nursing school used to search out opportunities for you to do procedures? Once you're out of school you have to be autonomous and find those opportunities on your own. Duh!

catlady, BSN, RN · May 26, 2006

What a load of crap! Most nursing schools teach the basic theory behind IV therapy. And, even if they don't, which I highly doubt, hospital nursing educators give RNs and IV certified LPNs inservicing on it during their orientation as new employees. Every single hospital I've worked in over the years did this. Learning to put an IV in someone is no different a skill than inserting a foley catheter or N/G tube. We all had to do them multiple times before we finally got good at it. You become well trained and well practiced at any skill or procedure by seeking out opportunities to do them. You'll never learn by taking on a "hide and hope the problem goes away" mentality. Remember how your clinical instructors in nursing school used to search out opportunities for you to do procedures? Once you're out of school you have to be autonomous and find those opportunities on your own. Duh!

Judgmental as always, eh? I have been an RN over twenty years, and my program DID NOT ALLOW students to touch an IV, much less start one. We couldn't hang meds, push meds, flush lines, dress sites, or start IVs. As a new grad, I did not start IVs. The IV team did the IVs. There was NO training in IV starts. I have never seen IV training by "hospital nursing educators" as part of nursing orientation. My only consistent exposure to IV starts was two years in CCU back in the 1980s. I tried to start IVs, but had a very low success rate. I guess now I should use our geriatric patients as guinea pigs for a skill I will almost never need to use. Yes, I would feel better if I were good at IVs, but should I tear up my license because I'm not?

I just am amazed at the attitude in this thread that IV starts are a critical part of what makes someone a registered nurse. When I was a nursing instructor, I spent a lot of time trying to show my students that it wasn't learning a collection of tasks that made them nurses. Guess not everyone gets that.

ZASHAGALKA, RN · May 26, 2006

I just am amazed at the attitude in this thread that IV starts are a critical part of what makes someone a registered nurse. When I was a nursing instructor, I spent a lot of time trying to show my students that it wasn't learning a collection of tasks that made them nurses. Guess not everyone gets that.

I don't see this as an issue over a task, per se.

It's about the UNPROFESSIONAL attitude that a nurse can just dump an undesireable aspect of their jobs on their co-workers.

I'm VERY good at starting IVs. I get called as a 'resource' person ALL THE TIME. But, I WILL not be that resource person for someone that consistently doesn't even try. If they just do not want to improve themselves w/ an essential skill (and for floor nursing, it IS an essential skill), then I'm not going to empower that attitude. Every single time I go out to the floors to start an IV, it takes 15 or more minutes away from MY pts.

As a matter of teamwork, I'm perfectly fine sharing my expertise when needed. But, dumping on me and MY pts is NOT AN EXAMPLE OF TEAMWORK.

IV sticks are NOT necessarily an essential task of being an RN. But WHERE they are essential, refusing to do so is a reasonable grounds for termination.

It's not about the task. It's about the UNPROFESSIONAL conduct. Treating your co-workers professionally and with respect is something I know you DID teach your students.

~faith

Timothy.

Retired R.N. · May 26, 2006

What a load of crap! Most nursing schools teach the basic theory behind IV therapy. And, even if they don't, which I highly doubt, hospital nursing educators give RNs and IV certified LPNs inservicing on it during their orientation as new employees. Every single hospital I've worked in over the years did this. Learning to put an IV in someone is no different a skill than inserting a foley catheter or N/G tube. We all had to do them multiple times before we finally got good at it. You become well trained and well practiced at any skill or procedure by seeking out opportunities to do them. You'll never learn by taking on a "hide and hope the problem goes away" mentality. Remember how your clinical instructors in nursing school used to search out opportunities for you to do procedures? Once you're out of school you have to be autonomous and find those opportunities on your own. Duh!

Perhaps you haven't worked in enough hospitals to know that many of them do not have inservice departments, and do not provide any orientation over and above showing you where the utility rooms and the clean linen can be found.

If you are so convinced that the inexperienced nurse just needs a little practice in learning how to start IVs, perhaps you would like to volunteer to be a combined educator and "patient" for him or her to practice on. With your excellent coaching, this skill could be be practiced daily on you for about a week or so until it was completely learned. As you say, "Duh!"

sanctuary, BSN, MSN, RN · May 26, 2006

Perhaps you haven't worked in enough hospitals to know that many of them do not have inservice departments, and do not provide any orientation over and above showing you where the utility rooms and the clean linen can be found.
If you are so convinced that the inexperienced nurse just needs a little practice in learning how to start IVs, perhaps you would like to volunteer to be a combined educator and "patient" for him or her to practice on. With your excellent coaching, this skill could be be practiced daily on you for about a week or so until it was completely learned. As you say, "Duh!"

:yeahthat: :yeahthat: :yeahthat: :w00t:

barbyann · May 26, 2006

What a load of crap! Most nursing schools teach the basic theory behind IV therapy. And, even if they don't, which I highly doubt, hospital nursing educators give RNs and IV certified LPNs inservicing on it during their orientation as new employees. Every single hospital I've worked in over the years did this. Learning to put an IV in someone is no different a skill than inserting a foley catheter or N/G tube. We all had to do them multiple times before we finally got good at it. You become well trained and well practiced at any skill or procedure by seeking out opportunities to do them. You'll never learn by taking on a "hide and hope the problem goes away" mentality. Remember how your clinical instructors in nursing school used to search out opportunities for you to do procedures? Once you're out of school you have to be autonomous and find those opportunities on your own. Duh!

Not crap......I was being sincere and truthful. I would like to think that I am a kind and empathetic nurse who puts her patients needs ahead of her own. I want to get good at IV starts. I want to master this skill. I try and try and try......and still have less than 40% success rate after five years. If the hospital fires me because I can't master this skill and cause the patients undo pain/stress then so be it. I will know I have tried my best. Your words were very harsh.

clemmm78, RN · May 26, 2006

I learned IVs on the job when nurses here were only starting to get the right to start them on the floors (early 1980s). I had incredible sympathy for nurses who just couldn't do it. Starting an IV is a skill, some people are better at it than others. For those nurses who had a hard time with them, I absolutely didn't mind starting one. Took five minutes of my time usually.

However, if a nurse refused to start them (which happened), then I had a problem with it. If you're hired to do a job, and IV starting is part of that job, then you have to at least try. If it is vital that you start them and you're not good at it despite trying, then you should approach admin for extra training. Or find a job that doesn't call for IVs.

CHATSDALE · May 26, 2006

when you apply for a job you can outline the things that you will or will not do and this gives the employer the option to hire or not depending on the needs that that particular opening

if a 'plum' job comes open and a nurse who has worked diligentily is passed over for a nurse who says 'ohh i just can't do that' then there will be anger and hurt feelings

Lurksalot, BSN, RN · May 26, 2006

I've read this whole thread, and I'm still not too sure why it's gotten a wee bit testy. :confused:

Pretty clear cut to me, if you refuse to perform part of your job, an employer has a right to fire you. The OP was talking about a nurse who refused to start IVs. The nurse had a fear because of an experience she had, and refused to do it anymore.

If a nurse refused to do CPR, give pills, or do assessments, he/she would be refusing to to the job the same way.

If the same nurse had sought help for her fear of IVs (whatever happened obviously upset her) and worked with her employer to find a solution, rather than simply refusing to do IVs, there probably would have been a different outcome.

But I still don't see anything wrong with any employee being fired for refusing to perform a basic part of the job.

I'm not saying there's anything wrong with having difficulty with starting IVs, or that a nurse who isn't great at it is a poor nurse. There are plenty of great nurses who have a tough time with IVs or just don't do it enough. That's a horse of a different color.

For example, this post interested me because one night I went in to work a tech shift, and when it came time for my 15 clients to need accuchecks done, the nurse from the other side came over and handed me her list and asked me to do 15 more. (All of them needed to be done before 6 am, and it was now 5:15.) I told her I would be happy to help out, but I wasn't sure I could get them all done fast enough, was the other tech on break? Well, I was informed the other tech does not DO sugars. I asked her to repeat it, she rolled her eyes, shrugged her shoulders, and repeated that the other teach simply does not do sugars! Now, this is a tech who has been there ten years and has always done her job, and suddenly she no longer does sugars, and the other techs are just supposed to pick up the slack? If I was working on that floor after I graduate I would have looked into the situation, but I'm not so I just did it and was way behind with my duties. But bottom line is, how can people refuse to perform their job duties and still have a job?!

maidy · May 26, 2006

Well, I really feel sorry for my co-worker because she is a such a sweet thing on the floor and also to the patients. She will always try to help us co-workers in our NGT, Foley cath and dressing if she can because not all of us are also proficient in that aspect. We always have 13-15 patients on the med surg floor and it really helped a lot. We are just dismayed that management chose the opportunity to fire her because she said she will not insert iv's anymore after a nasty incident when she was slapped by a patient. probabaly hurt her ego and unnerved her. we had tried to help her with her iv's in exchange that she will do other procedures. it worked well until someone told management about it and decided that she will be place in day surgery just so she will have that training again. But she refused and that is how they fired her. Was that really fair? I mean it could not have been a big issue but they thought otherwise.

elthia · May 26, 2006

I've read this whole thread, and I'm still not too sure why it's gotten a wee bit testy.
Pretty clear cut to me, if you refuse to perform part of your job, an employer has a right to fire you. The OP was talking about a nurse who refused to start IVs. The nurse had a fear because of an experience she had, and refused to do it anymore.
If a nurse refused to do CPR, give pills, or do assessments, he/she would be refusing to to the job the same way.

I totally agree.

Being even adequate at starting IV's does not mean someone is a good or bad RN. However if you work in an area that has pt's recieving IV therapy, then you can't just flat out refuse to even try to start IV's, in my opinion.

Myself, I was once attacked by a pt in his room, he was choking me. For a long time I was super paranoid anytime I was alone with a pt, no matter who the pt was. But working in a hospital, I cannot refuse to go into a pt's room just because of something that happened to me once. Part of being a professional in healthcare is being able to control a panic reaction for the sake of the pt. I'm not ashamed to say I took advantage of an employee assistance program after this situation. If you want to be an RN that does not have to do IV's, then get a job that does not do IV therapy. There are other areas for RN's to work than in hospitals. I chose to stay in acute care...but I go into male pt's rooms, and I don't refuse pt's just because they have the same pysch dx as the one who attacked me did.