STARTING IVs............OMG..............

[xokelly2]

My friend from nursing school recently started her first RN job, and she had a bad third day where all the new grads were testing out on skills. The first skill of the day was starting an IV, all the other girls (ABOUT 30 OF THEM) had all had experience starting IVs from their school. My friend was the only one there who had no experience with it what so ever. They made a spectacle of her like "What school are you from? I can't believe you have never done that before." She was almost in tears. We had never even learned how to tie a turniquet!!!!!!! I must have heard about 8 times during nursing school from various instructors that we will learn from our facility where we work on how to start IVs!!! Did our school lie to us? My friend is very upset and we are feeling inferior to other newcommers. What kind of IV experience do you guys have from school?????

[RN4NICU, LPN, LVN]

One thing I did notice - ALL the ADN nurses had IV experience, hardly ANY of the BSN students did. Sometimes I wish BSN programs (like the one I attended) would get their uppity heads out of the clouds and realize that while they're teaching us more "advanced" things like management and research, maybe they should actually let us practice NURSING at some point before they hand us a diploma.

I don't necessarily agree. ANYONE can learn technical skills - you could bring in someone off the street and teach them how to start an IV. I don't think schools should skimp on actual education to put more focus on skills. Management and research are part of a baccalaureate level of education. Hands-on practicalities can be developed with time and practice and it should be up to the hiring facility to teach and hone technical skills. That is what preceptorships/internships are for and it should be what is expected when hiring a new grad. Any other professional field works the same way.

[Sheri257]

I don't necessarily agree. ANYONE can learn technical skills - you could bring in someone off the street and teach them how to start an IV. I don't think schools should skimp on actual education to put more focus on skills. Management and research are part of a baccalaureate level of education. Hands-on practicalities can be developed with time and practice and it should be up to the hiring facility to teach and hone technical skills. That is what preceptorships/internships are for and it should be what is expected when hiring a new grad. Any other professional field works the same way.

I agree that getting a BSN is a great thing to do. But I totally disagree that anyone off the street can be taught to do an IV. Well ... maybe they can be taught, but that doesn't mean they do it well. There are always patients with poor vasculature, etc. where it's incredibly difficult to get those IV's started. On the floor where I work I've seen up to four nurses try and fail. Then, they'll call in ICU nurses who often fail too. This happens with patients on a daily basis.

Thankfully, we have two RN's who are especially talented who can get those IV's in that nobody else can. I would never dismiss their skills and talent by saying anybody off the street could do what they do because ... quite frankly ... lots of RN's with years of experience can't do what they do. IV's are a special talent and skill. I can't imagine why anyone would think you don't need to learn this in school.

[elizabells, BSN, RN]

One thing I did notice - ALL the ADN nurses had IV experience, hardly ANY of the BSN students did. Sometimes I wish BSN programs (like the one I attended) would get their uppity heads out of the clouds and realize that while they're teaching us more "advanced" things like management and research, maybe they should actually let us practice NURSING at some point before they hand us a diploma. :angryfire

Gompers, I'm in a direct-entry BSN/MSN program, and they said during orientation, flat out "we are not preparing you to practice as RNs. We are preparing you to pass boards so you can be an NP." :uhoh21:

Soooooo glad for that work requirement for NNPs.

[mitchsmom]

I don't necessarily agree. ANYONE can learn technical skills - you could bring in someone off the street and teach them how to start an IV. I don't think schools should skimp on actual education to put more focus on skills. Management and research are part of a baccalaureate level of education. Hands-on practicalities can be developed with time and practice and it should be up to the hiring facility to teach and hone technical skills. That is what preceptorships/internships are for and it should be what is expected when hiring a new grad. Any other professional field works the same way.

While I do understand this rationale, I don't know if I agree that any other professional field works the same way... when I graduated with a teaching degree and got a job, I was expected to do everything everyone else did from day 1. We student teaching preceptorships but that was before graduation. When my husband got his pilot job, he was expected to perform just like everyone else. No post-graduation on-the-job training. No "I can fly, but I never got to do the landing part, so if you just show me that I'll be all set." No beginning orientation - much to the contrary, he got a 6 month probationary period & if he didn't cut it like everyone else, he was let go. We didn't get anything beyond the normal continuing ed that everyone does.

And not to dispute that baccalaureate programs have it, but personally neither of us remembers getting much 'management & research' to speak of in our college programs either (he has a geography degree; my previous degree is education). I know that BSN programs have to differentiate themselves but they do seem to be in an awkward spot sometimes. Sometimes it seems like it would be better just to say "it's the same damn thing as an ADN but they have to take the 2 years of general ed first" for a more 'well-rounded education' and quit trying to carve a niche. Or, going along with the current differentiation & having a different focus than ADN programs... IV's, foleys, etc. are still pretty basic duties of a nurse. If the BSN argument is that they are such quick & easy skills to pick up, that a monkey can learn them, then why don't we just do it?

[RN4NICU, LPN, LVN]

Thankfully, we have two RN's who are especially talented who can get those IV's in that nobody else can. I would never dismiss their skills and talent by saying anybody off the street could do what they do because ... quite frankly ... lots of RN's with years of experience can't do what they do. IV's are a special talent and skill. I can't imagine why anyone would think you don't need to learn this in school.

That is exactly the point I was aiming to make - being an RN (and therefore, nursing education) has little, if anything, to do with how good a stick you are. It's not like you have to understand patho, A&P, chem, or statistics to start an IV. Someone can be trained to do it (and become very proficient at it) whether or not they have ever spent one day in a nursing program. I stand by my original statement.

[Sheri257]

That is exactly the point I was aiming to make - being an RN (and therefore, nursing education) has little, if anything, to do with how good a stick you are. It's not like you have to understand patho, A&P, chem, or statistics to start an IV. Someone can be trained to do it (and become very proficient at it) whether or not they have ever spent one day in a nursing program. I stand by my original statement.

Ok ... I see your point there. But I was talking about difficult cases. RN's still have to do their own sticks every day. Why on earth would you want to wait and rely on the hospital to train you? Especially when virtually every patient in the hospital gets an IV and new grad orientation programs can be as little as six weeks. Wouldn't you want at least some experience beforehand?

Besides, not all hospitals want to train you with the basics, and a lot of them do expect a certain level of competency with skills, as evidenced by the original post that started this thread. Whether it be basic clinicals, preceptorship or new grad orientation, a lot of RN's simply don't have much time to train you as it is, because they also have their own patients to worry about. I certainly wouldn't want to bother them with beginner basics.

One of the reasons California got rid of the Excelsior program was because some of their grads weren't proficient in basic skills. The hospitals complained about it and the state got rid of the program, despite the shortage. I sure wouldn't want the hospitals complaining about my school not teaching IV's. Quite frankly, it would be embarrassing.

Employers don't care so much about how many management and statistics courses you took as much as they care about whether you can do the job as a new grad, and IV's are a big part of that.

[xokelly2]

Besides, not all hospitals want to train you with the basics, and a lot of them do expect a certain level of competency with skills, as evidenced by the original post that started this thread. Whether it be basic clinicals, preceptorship or new grad orientation, a lot of RN's simply don't have much time to train you as it is, because they also have their own patients to worry about. I certainly wouldn't want to bother them with beginner basics.

One of the reasons California got rid of the Excelsior program was because some of their grads weren't proficient in basic skills. The hospitals complained about it and the state got rid of the program, despite the shortage. I sure wouldn't want the hospitals complaining about my school not teaching IV's. Quite frankly, it would be embarrassing.

Employers don't care so much about how many management and statistics courses you took as much as they care about whether you can do the job as a new grad, and IV's are a big part of that.

Your post reminds me of the whole interviewing process I recently went through, not one recruiter or unit manager asked me any questions about my skills or abilities but there were plenty questions about the courses I took and my grades thorugh out college. Its because of comments like yours where you say you would be embarassed and the hospitals are too busy to train that led to me begining this post in the first place!!!! I understand a lot can get lost in message board translation. That the other new gards and preceptors starting with my friend were being rude and far from understanding. So you're sounding as if one is not "proficient" in a skill, youre not worthy of an entry level RN position? Or if you do not feel proficient/confident performing a skill (no matter how "basic") then you should be embarassed to ask for help because the staff is too busy????????? What?????

[RN4NICU, LPN, LVN]

While I do understand this rationale, I don't know if I agree that any other professional field works the same way... when I graduated with a teaching degree and got a job, I was expected to do everything everyone else did from day 1. We student teaching preceptorships but that was before graduation. When my husband got his pilot job, he was expected to perform just like everyone else. No post-graduation on-the-job training. No "I can fly, but I never got to do the landing part, so if you just show me that I'll be all set." No beginning orientation - much to the contrary, he got a 6 month probationary period & if he didn't cut it like everyone else, he was let go. We didn't get anything beyond the normal continuing ed that everyone does.

And not to dispute that baccalaureate programs have it, but personally neither of us remembers getting much 'management & research' to speak of in our college programs either (he has a geography degree; my previous degree is education). I know that BSN programs have to differentiate themselves but they do seem to be in an awkward spot sometimes. Sometimes it seems like it would be better just to say "it's the same damn thing as an ADN but they have to take the 2 years of general ed first" for a more 'well-rounded education' and quit trying to carve a niche. Or, going along with the current differentiation & having a different focus than ADN programs... IV's, foleys, etc. are still pretty basic duties of a nurse. If the BSN argument is that they are such quick & easy skills to pick up, that a monkey can learn them, then why don't we just do it?

I don't see where it matters whether the preceptorship/internship occurs before or after graduation. It is totally non-issue because the point is that the more practical hands-on learning occurs aside from the school's formal curriculum. And other professions DO work the same way:

pharmacists have internships

MDs/DOs have internships and residencies

engineers have internships

lawyers have clerkships

Nursing internships/externships are available. One may choose to participate or not. Those who participate will have an edge over those who do not. That is as it should be.

The BSN argument, by the way, is that one should have at least a bachelor's degree if they want to call themselves a professional. A 2-year degree is more of a trade degree, while the 4-year degree is traditionally recognized as a professional degree. It is not the "same damn thing as an ADN" and it DOES have a different focus. The focus is toward non-bedside nursing positions - management, research, etc. Those are not courses typically found in an ADN program. Yes, one must have experience to get those positions, but a BSN is usually required as well.

[mitchsmom]

I don't see where it matters whether the preceptorship/internship occurs before or after graduation. It is totally non-issue because the point is that the more practical hands-on learning occurs aside from the school's formal curriculum. And other professions DO work the same way:

pharmacists have internships

MDs/DOs have internships and residencies

engineers have internships

lawyers have clerkships

Nursing internships/externships are available. One may choose to participate or not. Those who participate will have an edge over those who do not. That is as it should be.

The BSN argument, by the way, is that one should have at least a bachelor's degree if they want to call themselves a professional. A 2-year degree is more of a trade degree, while the 4-year degree is traditionally recognized as a professional degree. It is not the "same damn thing as an ADN" and it DOES have a different focus. The focus is toward non-bedside nursing positions - management, research, etc. Those are not courses typically found in an ADN program. Yes, one must have experience to get those positions, but a BSN is usually required as well.

I didn't mean to relay that no professional fields had further training after graduation, but that all pro fields don't (i.e. it's not requisite to be a profession). My end point being, I think we should be more proficient coming out of school in the way of basic skills. If they are so easy to pick up as administrators argue, then even more reason we should be able to do them on graduating. I don't feel secure thinking that I may graduate and go to my job and then do my first IV. Just my personal feeling.

Internships and externships are there, but they are limited (I think my program offers 12 for our class of 80 students), not everyone can do them, and they are not included in our formal educational program.

I know that BSN and ADN aren't the same thing... I guess I didn't say that part very well either. I guess I wonder if BSN programs overemphasize the "research and management" part relative to other 4 year degree programs since they have to differentiate themselves from ADN's... that they need to use that to carve a stronger niche for BSN programs... is that making sense? Sorry if I'm not communicating well. Don't get me wrong, I'm in a BSN program... I just think it's an interesting thing the BSN niche...

I guess I just feel like BSN should be ADN plus the research and management, rather than research and management in place of clinical skills. Do you agree?

The funny thing is, I think we do about the same amount of clinical hours as the local ADN programs but with the BSN/ different emphasis.

I have been told that BSN grads who are weaker in skills tend to make up for it after a few months or a year, but no patient on earth is going to appreciate that I took a research class when I am inadequate at her bedside. To me, 'critical thinking' & sound judgement come first, procedures are up there somewhere high on the list... research and management are somewhere further down on mine & Maslow's lists. My measly opinion

[Sheri257]

Its because of comments like yours where you say you would be embarassed and the hospitals are too busy to train that led to me begining this post in the first place!!!! I understand a lot can get lost in message board translation. That the other new gards and preceptors starting with my friend were being rude and far from understanding. So you're sounding as if one is not "proficient" in a skill, youre not worthy of an entry level RN position? Or if you do not feel proficient/confident performing a skill (no matter how "basic") then you should be embarassed to ask for help because the staff is too busy????????? What?????

No ... I'm not saying these people aren't worthy of being RN's. Not at all. And I don't think anyone should be ridiculed. I blame the schools that aren't teaching IV's. No student or new grad should be put in that position. Of course we all have to ask for help. But certainly we've all seen how busy RN's are. I just think it's better if the school does provide some basic training so that once you are working with RN's, you're using that valuable, limited clinical time more for practice, rather than having to start at the very beginning. Otherwise, you're stumbling around trying to learn the skill when it's much better to be practicing and improving your skills in the hospital. Especially when RN's have limited time to help you. Being a new grad is tough as it is ... the schools should do a better job and prepare you with critical skills like IV's. That's all I'm saying.

[lunakat]

At the beginning of our second semester we had to come in on Fridays (usually our off day) and get IV training. There was lecture on the setup, various fluids and how the pumps worked, and practice Iv problems. Then at the end we had to set up the whole thing on another student (liability waivers were signed first). We did this for 3 Fridays. Then about a month later we had to bring in 4 friends to stick. Then we were sent to a local hospital for about 4 hours do nothing but IV sticks on pts. Nothing else, just shuttling from room to room. That was cool. Before we went out on the floor with the nurse we spent some time practicing with their needles and setup on a foam arm. When we were sticking a pt if we didn't get it the first time, the nurse took over and did it, less traumatic for pt this way. If there were hardly any sticks to be done then the staff volunteered to let us stick them. I had to do a couple of nurses and they were really cool about it. Told me to relax, and tried to guide us. It was a really great experience. However I wish I had more time on setting up the pump but that's what the lab is for.

My friend went through her LVN program and had to attend a separate class after graduating to get IV training. So I guess for some programs it's a little different.

[Luv2BAnurse]

My school didn't teach IV starts. The instructors told us if we needed to do any, the facility would teach us. I was the only one in my orientation class (10 new graduates) that wasn't taught that in school. They were very nice, and enjoyed showing me how to set up, start, and tape down, on a fake arm. Once I got out of orientation and on the floor, my preceptor had me to start an IV, and I got it on the first try. Wish it was that easy every time.