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

ZASHAGALKA, RN · Jun 1, 2006

We won't even go into HIPAA issues.

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".

Your previous reference to my analogy, about accidents happening in familiar territory, is insightful, but not relevant, and certainly not mutually exclusive, to what I was saying.

This co-worker isn't hiding the status of her pts because IT DOESN'T MATTER. Indeed, it does matter to her, and she is hiding relevant information in attempt to ensure that it wouldn't matter to others. I'm sorry, I don't subscribe to notion that 'ignorance is bliss', especially when that ignorance is purposefully perpetrated to engage others to do jobs that that person considers too dangerous to do. That's treacherous.

Regarding HIPAA - there is no clash with HIPAA on this issue. HIPAA ensures that medical information is protected on a 'need to know' basis. Starting an IV is an act of primary care and relevant dangers regarding that act are surely 'need to know'.

The principle of 'standard precautions' is sound and its judicious use will INDEED cut down on accidents 'close to home'. But, that in no way diminishes the value of the knowledge of the specific precautions related to a specific patient with known risk.

In tandem, both types of precautions, general AND specific, are aids to reduce accidents.

Why? Because, as you say, human nature is indeed faulty. You even describe this particular fault in your example: complacency. KNOWING that people can become complacent and therefore lax in precaution, how could you justify holding out on the added warning that could shake that complacency and provide additional precaution?

~faith,

Timothy.

Roy Fokker, BSN, RN · Jun 1, 2006

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.

I can understand the point of the argument -- that all our patients deserve the same standards of professionalism and care. Nobody ought to get "special" treatment simply because they might be carrying an exotic disease.

But on the other hand - since your colleague is doing you a favour, what is the harm in letting him/her know?

For example - even though 'allergies' are listed on the patients record, most places I know will also tape a small sign at the room enterance or above the patients bed - "Caution: Latex allergy" or some such.

PS: That's not 'begging the question'. Begging the question is a logical falacy: when one assumes the truth of what one is attempting to prove in an argument.

Sorry, didn't mean to be picky or anything :)

sanctuary, BSN, MSN, RN · Jun 1, 2006

:flowersfo :yeahthat: :kiss

CseMgr1, ASN, RN · Jun 1, 2006

The only IV training I ever received was during the seven years I worked as an LPN at a small community hospital, where we were all certified in IVT. Thank God, for I received 0 days of IVT training during nursing school, because I was out with a sick child on the only day my clinical group was scheduled to work with the IV Team. When I returned and asked my instructor about making it up, she replied casually: "Oh, don't worry about it. You're already an LPN and don't need to". It wasn't until a year later during my Senior rotation in SICU that I was given the opportunity to start an IV, and it was on a 400-pound man whose only IV access for receiving blood products had blown. No one, including the Resident could get it restarted. They were talking about doing a cutdown on this poor man, when I asked my instructor if I could try. She said OK, and here I go with a 16-gauge Jelco, praying that I don't screw up and make a fool of myself in front of her and everybody else. This guy's arm was as big as a woman's thigh, and even though I couldn't visualize the vein, I could palpate it. I took a breath, and by sheer luck got it in on the first stick as my instructor looked on, her eyes almost popping out of her head. "Mrs. ------!", she gasped, "HOW did you do that?" Weak with relief, I replied: "Just lucky, I guess". It was at that moment I realized my years of on-the-job training had paid off, as I would have never acquired this skill otherwise. Even though Nursing School tries to teach us what we need to know in order to be competent practioners, it can't teach us everything. The rest is up to us.

twinmommy+2, ADN, BSN, MSN · Jun 1, 2006

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.

That was exactly what I was going to say. Knowing someones status should not change how you do a procedure that includes contact with body fluids because everyone is treated as if they have HIV. If you do standard precautions correctly there should be minimal risk of infection no matter what the status.

NRSNFL · Jun 1, 2006

Wow, Firing The Employee Is Still More Unproductive. Most Hospitals Have Nurse Education. They Could Put Her In Another Iv Class Just To Decrease Her Fear And Brush Up On Her Skills. It Doesn't Sound Like A Case Of Not Being Able To Do The Job. What Happened To Good Old Fashion Work Ethics And Teaming? A Nurse I Used To Work With Absolutley Hated Iv's And Blood Draws And I Loved It. So We Would Trade Tasks. I Would Start Her Iv And Document While She Did One Of My Treatments On A Patient I Had Lost Patience With. We Worked Really Well Together And Would Report To Each Other On The Tasks We Traded. I Wanted To Help Her. Now, I Did Work With Another Nurse Who Was The Laziest Person I Had Ever Met. She Would Convince You That She Was So Busy She Needed Your Help, So You Help Her Out By Doing Some Of Her Treatments. Then You Can't Find Her Anywhere, You Search And Search Because Now You Are Behind In Your Own Tasks, And Where Do You See Her When You Look Out The Window, Sitting In A Chair Smoking. And If All Her Stuff Wasn't Done, She Would Go Straight To The Don And Tell On You. You'd Just Be Burning Over It. It Took Our Don 3 Months To Figure Out The Truth And She Fired That Girl. You Do Have To Be Carefull About Who You Help.

Off the topic...how the heck did you manage to type that whole thing capitalizing every first letter. Wow.

caroladybelle, BSN, RN · Jun 2, 2006

This co-worker isn't hiding the status of her pts because IT DOESN'T MATTER. Indeed, it does matter to her, and she is hiding relevant information in attempt to ensure that it wouldn't matter to others. I'm sorry, I don't subscribe to notion that 'ignorance is bliss', especially when that ignorance is purposefully perpetrated to engage others to do jobs that that person considers too dangerous to do. That's treacherous.
Regarding HIPAA - there is no clash with HIPAA on this issue. HIPAA ensures that medical information is protected on a 'need to know' basis. Starting an IV is an act of primary care and relevant dangers regarding that act are surely 'need to know'.
Why? Because, as you say, human nature is indeed faulty. You even describe this particular fault in your example: complacency. KNOWING that people can become complacent and therefore lax in precaution, how could you justify holding out on the added warning that could shake that complacency and provide additional precaution?
~faith,
Timothy.

First, HIPAA adresses "need to know". And there is no need to know that status to merely start an IV. As we should be that cautious with virtually everyone under our care.

If the staff has a problem with someone not doing their job because of a bias, then that needs to be addressed with management, where they can address that nurse's issues. Or her collegues can refuse to start her IVs/obtain a detailed history. Yes, she is rude, but that has to do w/her attitude.

You also have not addressed whether you notify all other providers of care. In most facilities (not mine) , Phlebotomy draws labs and are at much higher risk from blood bourne illness, as they draw and often help process the blood. The same for the lab techs. And from what I understand, that notification rarely if ever happens. Outpatient labs that are drawn, are all the lab techs/OP nurse notified of bloodbourne status...No.

And they are all at greater risk of a stick/contamination than we on the floor are.

The issue is that ALL patients are a risk and we should treat them as such.

wjf00 · Jun 2, 2006

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!

Not being very skilled at starting IV's should not be a problem. But flat out refusing to start IV's, is insubordination, definitly cause for being fired. But both parties in this dispute could be short-sighted. There are many nursing jobs that do not require starting IV's. The better approach for this nurse would be to seek another position where starting IV's is not part of the job. The better approach for the employer might be to offer such an option.

1dz_rn · Jun 2, 2006

Not being very skilled at starting IV's should not be a problem. But flat out refusing to start IV's, is insubordination, definitly cause for being fired. But both parties in this dispute could be short-sighted. There are many nursing jobs that do not require starting IV's. The better approach for this nurse would be to seek another position where starting IV's is not part of the job. The better approach for the employer might be to offer such an option.

amen, wjf. although i'm no expert, i've started a few i.v.'s in my day. but it amuses me how being a good phlebotomist is being equated to being a good nurse. i know a lot of less-than-great nurses who think their behinds smell like roses just because they can stick people. that's like saying that a secretary is a good businessman because s/he types faster. nursing is not just about phlebotomy. any nurse who thinks otherwise is underselling him/herself or just doesn't get it.

banditrn · Jun 2, 2006

amen, wjf. although i'm no expert, i've started a few i.v.'s in my day. but it amuses me how being a good phlebotomist is being equated to being a good nurse. i know a lot of less-than-great nurses who think their behinds smell like roses just because they can stick people. that's like saying that a secretary is a good businessman because s/he types faster. nursing is not just about phlebotomy. any nurse who thinks otherwise is underselling him/herself or just doesn't get it.

:lol2: Ahhh - someone who 'gets it'!!

ZASHAGALKA, RN · Jun 2, 2006

amen, wjf. although i'm no expert, i've started a few i.v.'s in my day. but it amuses me how being a good phlebotomist is being equated to being a good nurse. i know a lot of less-than-great nurses who think their behinds smell like roses just because they can stick people. that's like saying that a secretary is a good businessman because s/he types faster. nursing is not just about phlebotomy. any nurse who thinks otherwise is underselling him/herself or just doesn't get it.

NOBODY here, I believe, made the equation that being a good phleb is equal to being a good nurse. If starting IVs were as easy as drawing blood, this probably wouldn't be an issue at all.

There are all sorts of nursing 'tasks' that can be delegated. Delegation is one thing, refusal is another. And this particular task isn't a task that normally can be delegated to unlicensed personnel. (Sometimes in the ED, but not normally on nursing units.)

So, refusal to do such a task serves the effect of dumping that task on your co-workers.

I have participated in this thread from the beginning. I don't believe that you can find a post in this ENTIRE thread where someone made the claim that how well you can start IVs is a determinant in how good a nurse somebody is.

Many posts suggest that it's not how good you are, but whether you are willing to attempt to improve a needed skill, WHEN IT'S NEEDED for your job.

You will find SEVERAL posts, including mine, that suggest that REFUSAL to do something that is part of your job description is grounds for dismissal. If you can't, or more to the point, won't perform your job description, then you can't complain if your employer wishes to replace you for someone that can.

It's anti-teamwork to just decide one day that all your co-workers must carry your load in some unpleasurable aspect of your job. That's a poison that is too dangerous to entertain. If SHE can dump parts of HER job that she merely dislikes, why can't I? That 'tude, if allowed to grow, will destroy the morale of any unit.

If you decide that IVs are something that you just can't do anymore, does that make you a 'bad' nurse? NO. But, it makes you a nurse that needs to find a job that doesn't require IV starts as part of its job description.

I've said this before: it's not like such jobs aren't out there.

~faith,

Timothy.

chadash · Jun 2, 2006

I can understand that a nurse might be weaker in one skill than another, and that nursing is based on sound judgement more than manual dexterity, but what suprises me is a lack of desire to develop this skill (in this case, there may be a phobia, and she needs counseling with this: I am OK with that...) but, if you want to go into nursing, wouldn't you also want to do all of the above so to speak?

Honestly, just a question.