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

[maidy]

Hello! just wanna know if it is mandatory for all RN's to insert IV's? Because a fellow nurse who is more than well experienced and very skillful in other procedures and previously IV certified too who refused to do IV's was terminated. Nurse claims she developed phobia to it after a very bad experience with a patient. 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? Thanks!

[justmanda]

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.

I love starting IVs, especially on hard sticks. When I started at a new hospital though, they used different catheters and I was couldn't get even the largest veins without blowing them. So, I told all the nurses that I was the IV nurse for the night....any IVs they needed to be started, I was their gal. By the end of the night, I was a pro. You just have to get in there and do it. Don't stick more than two times per person (don't want to torture the patient) but try on every person you can. The more independent you are as a nurse, the better you can manage your time. Before long, other nurses will be coming to you to ask you to get a hard stick for them.

[justmanda]

How is dumping an essential element of your job on your peers TEAMWORK?

I'm a 'team' player and I lend my expertise when needed to others and have them lend their expertise to me.

But that is not the same thing as demanding that my peers do some distasteful part of my job for me. No, THAT is where the 'teamwork' broke down; not in the responses on this thread.

Your co-worker, if she absolutely refused to do a legitimate part of her job description, EVEN AFTER HER EMPLOYER offered remedial experiences: she should have been fired.

It simply doesn't matter how 'nice' a person or nurse she is/was. Refusing to do part of your job is destabilizing to the work environment. It's an unprofessional 'poison' and I'm not surprised your employer would eliminate that attitude lest it become contagious.

I'll tell you frankly: if I knew management was aware of such behavior and allowed it to foster - my thoughts would be, what can I REFUSE TO DO and get away with it? Because, I have a list of things I'd rather not do as a nurse . . .

~faith,

Timothy.

How about this one. There is a nurse on my floor who is a great stick but won't start IVs on HIV/Hepatitis patients. The worst part is, she will ask another nurse to try her "hard stick" patient and FAIL to tell them it is an HIV patient. So, now we know that when she asks another nurse to start an IV for her...they probably have a bloodborne disease.

[caroladybelle, BSN, RN]

How about this one. There is a nurse on my floor who is a great stick but won't start IVs on HIV/Hepatitis patients.

The worst part is, she will ask another nurse to try her "hard stick" patient and FAIL to tell them it is an HIV patient. So, now we know that when she asks another nurse to start an IV for her...they probably have a bloodborne disease.

The worst part is that she fails to tell them it is an HIV patient?!?!?!

UUUhhhhh what difference should knowing the patient's status be as to how bad the nurse's behavior is???

When you imply that she should tell the other nurse the patient's status, you imply that there is a difference in how one cares for the patient....otherwise there is no reason to relate the info. That is not much difference in that attitude than her neglecting to start the IV herself.

The only reason for knowing the status would come if there was a contaminated stick. The patient's status does not change how an IV should be started, only what would happen if there was an accident.

[Ann RN]

I've been in hospital supervision and nursing management in several different facilities where there were and weren't IV teams and I know IV therapy was a subject that was given to RNs during orientations because they needed to know the hospital policies connected with them. I worked on IV Teams for 6 years and not one of them EVER discouraged any staff nurse from starting or learning to start their own IVs if they so desired. In fact, we offered staff nurses the opportunity to make rounds with our IV teams and get experience starting IVs. Wanna know how many RNs were beating down our door asking to do this? Zero! We had more student doctors rounding with us than staff RNs. And this was after we did inservices on IV care at unit staff meetings and made personal invitations! Hospital staff nurses are technical nurses and as such need to hone their skills in a vast variety of procedures. IV skills are just one one of them. If todays RNs don't want to do it, there's plenty of LPNs ready to step up and take the reins of opportunity to do your job--and probably do a better job of it without all the whining.

"Technical"?? "LPN's do a better job"?? "whining"??

Do NOT group a few nurses into all. And maybe they did not ask to round with you because of a multitude of reasons: They may have had to do it on their own time, which is precious to a busy nurse. They may have been too busy making sure orders are correct, making sure doctors are not hurting patients (we all know July is coming WAY too fast), titrating vasopressors, consoling a family, taking care of THEIR pts. etc.

NO LPN will ever come close to an RN's knowledge of vascular anatomy. There is no "rein of opportunity" here. It's a patient safety issue.

Whining? I won't even go there.

[ZASHAGALKA, RN]

The worst part is that she fails to tell them it is an HIV patient?!?!?!

UUUhhhhh what difference should knowing the patient's status be as to how bad the nurse's behavior is???

When you imply that she should tell the other nurse the patient's status, you imply that there is a difference in how one cares for the patient....otherwise there is no reason to relate the info. That is not much difference in that attitude than her neglecting to start the IV herself.

The only reason for knowing the status would come if there was a contaminated stick. The patient's status does not change how an IV should be started, only what would happen if there was an accident.

You should always be a cautious driver. But, when the gov't knows a particular stretch of road is hazardous, they go OUT OF THEIR way to post additional caution signs.

None of us need lecture about standard precautions.

But, it is still highly dangerous and rude to not inform a co-worker of relevant issues relating to nursing care: and knowing that a pt has a bloodborne dx is absolutely relevant to a request to work w/ that pt's blood.

I would consider that if a nurse asked me to start an IV and purposely failed to reveal their HIV status to me: that is an act of treachery.

Platitudes are one thing. Standard precautions yada yada. But EVERYONE knows that actual hazards, as opposed to pontential ones, receive more caution. That is simply human nature.

~faith,

Timothy.

[TazziRN, RN]

I value LVN's and think they are a very important part of the nursing team, but I have yet to see an LVN who can just step into an RN's shoes, just like a CNA cannot step into an LVN's shoes. I can think of several reasons why RN's did not accept the invitation to round with the IV team, and none of them come close to whining.

[PANurseRN1]

You should always be a cautious driver. But, when the gov't knows a particular stretch of road is hazardous, they go OUT OF THEIR way to post additional caution signs.

None of us need lecture about standard precautions.

But, it is still highly dangerous and rude to not inform a co-worker of relevant issues relating to nursing care: and knowing that a pt has a bloodborne dx is absolutely relevant to a request to work w/ that pt's blood.

I would consider that if a nurse asked me to start an IV and purposely failed to reveal their HIV status to me: that is an act of treachery.

Platitudes are one thing. Standard precautions yada yada. But EVERYONE knows that actual hazards, as opposed to pontential ones, receive more caution. That is simply human nature.

~faith,

Timothy.

I agree with carolina. HIV status is absolutely immaterial. There is absolutely no reason to disclose that info.; it's not pertinent to getting an IV started.

I know there are still some nurses out there who are foolish enough to refuse to wear gloves to start IVs. If they want to play Russian roulette, fine. That's their choice. But it still doesn't mean they need to know HIV status.

[caroladybelle, BSN, RN]

You should always be a cautious driver. But, when the gov't knows a particular stretch of road is hazardous, they go OUT OF THEIR way to post additional caution signs.

None of us need lecture about standard precautions.

But, it is still highly dangerous and rude to not inform a co-worker of relevant issues relating to nursing care: and knowing that a pt has a bloodborne dx is absolutely relevant to a request to work w/ that pt's blood.

I would consider that if a nurse asked me to start an IV and purposely failed to reveal their HIV status to me: that is an act of treachery.

Platitudes are one thing. Standard precautions yada yada. But EVERYONE knows that actual hazards, as opposed to pontential ones, receive more caution. That is simply human nature.

And human nature is extremely faulty.

Your analogy for one has been demonstrated to be problematic. The vast majority of auto accidents occur relatively close to home in familiar surroundings. Those very familiar circumstances and feeling of nonchalance lead to careless behaviors: not locking car doors or wearing seat belts on the short ride home, not being as careful with signs or signals, zipping around corners. The mother that doesn't think that she needs to put the baby in the back, "because that it is just a short ride".

A huge percentage of those with HIV, Hepatitis in our care are not currently identified as having those disorders. As a hemo/onco nurse, I have had a large number of patients diagnosed with Burkitt's lymphoma or other onco/hemo disorders, who received an positive HIV test AFTER being diagnosed. Many of these patients are being cared for in the TOP HOSPITALS in this country, have been through numerous medical tests/facilities, and despite all, never had an HIV test. And quite frankly, if they have been HIV for the period that it takes to develop lymphoma, they have been HIV for long time that no one knew.

As one of the few people that starts IVs on the difficult to start patients, I don't need to know whether they have HIV or not as it will not change my care of them. As an onco/hemo nurse, I accept that many of my patients may be infected without my or their knowledge of that condition and frame my behavior accordingly. If I am dealing with immunosuppression issues, maybe I need to know. But not for starting an IV.

[justmanda]

You should always be a cautious driver. But, when the gov't knows a particular stretch of road is hazardous, they go OUT OF THEIR way to post additional caution signs.

None of us need lecture about standard precautions.

But, it is still highly dangerous and rude to not inform a co-worker of relevant issues relating to nursing care: and knowing that a pt has a bloodborne dx is absolutely relevant to a request to work w/ that pt's blood.

I would consider that if a nurse asked me to start an IV and purposely failed to reveal their HIV status to me: that is an act of treachery.

Platitudes are one thing. Standard precautions yada yada. But EVERYONE knows that actual hazards, as opposed to pontential ones, receive more caution. That is simply human nature.

~faith,

Timothy.

Thank you! I agree with you 100%. One can be politically correct and say "If you use universal precautions then it shouldn't matter" Well, it does. If you are PRIVY to this information and you are sending your co-worker TO DO A FAVOR FOR YOU and you fail to tell her that the patient is a KNOWN risk to her life, you are selfish and heartless.

[justmanda]

The worst part is that she fails to tell them it is an HIV patient?!?!?!

UUUhhhhh what difference should knowing the patient's status be as to how bad the nurse's behavior is???

When you imply that she should tell the other nurse the patient's status, you imply that there is a difference in how one cares for the patient....otherwise there is no reason to relate the info. That is not much difference in that attitude than her neglecting to start the IV herself.

The only reason for knowing the status would come if there was a contaminated stick. The patient's status does not change how an IV should be started, only what would happen if there was an accident.

Yes there is a difference in the attitude in that I am willing to start the IV and she is not. So, you could comfortably send a coworker in to start an IV for you and NOT tell her the patient has HIV? OH GEE, and thanks for telling me she is HIV postive AFTER I get stuck. And anyway, why would you knowingly keep it mum? For what reason?

[caroladybelle, BSN, RN]

This also begs the question: Does every phlebotomist that comes to the floor get notified that the patient has HIV/Hepatitis? Does every housekeeper that may dispose of red bagged garbage (might have a sharp edge that got trashed in the wrong place), cleans the bathroom, washes out the sink (that could have saliva) get notified so that they can be "extra careful". After all, they should have the same rights as we do to "safety".

We won't even go into HIPAA issues.

[caroladybelle, BSN, RN]

Yes there is a difference in the attitude in that I am willing to start the IV and she is not. So, you could comfortably send a coworker in to start an IV for you and NOT tell her the patient has HIV? OH GEE, and thanks for telling me she is HIV postive AFTER I get stuck. And anyway, why would you knowingly keep it mum? For what reason?

Please read my posts. I have already stated that I have no need to know a patient's status to start an IV. It is not a matter of "knowingly" keeping anything. It is a matter that there is no inherent need to know that information to do my job, in starting an IV. Just as phlebotomy may be expected to do their job without knowing the HIV/Hep status of the patient.

I frequently start hard to start IVs and knowing the HIV/Hepatitis status is not needed for that procedure. I will following the same guidelines as with any other patient.

It is regretable that your coworker has a rude bias about starting IVs on some patients. That is HER problem and she should be required to account for it to management.