BSN with 2 IV starts??

[ZootownMedic]

So last month I was at Denver Children's hospital finishing up my last 8 hour rotation for Paramedic school. There was a nursing student there who I got to chatting with and she told me that she was about to graduate the same week as me with her BSN. A little boy came in with possible menigitis and I volunteered us to start the IV, mainly because I wanted to beat the 4 year medical student in there to do the assessment.....anyways as we go in there and I start to assess the little guy I hand her a IV start kit and a 20 gauge and she turns BRIGHT red. I asked her what was wrong and she quietly told me that she had only started 2 IV's before. I don't know how many PVC's a minute I started to have but it was probably at least trigeminy.

So....has anyone else ran into this? How can someone be about to graduate with a BACHELOR'S degree in nursing and have started 2 IV's. Whats the catch here? I haven't heard any horror stories about nurses coming out of her school and in fact I know some ER nurses that went there that are great RN's.....It just blows my mind.

 

[Tigger]

I don't know how BSN programs work, but there are some healthcare programs where the clinical component comes after the awarding of a degree...

 

[ZootownMedic]

I don't know how BSN programs work, but there are some healthcare programs where the clinical component comes after the awarding of a degree...

She was on a clinical at Denver Children's when I saw her........plus, how can you have a bachelors in nursing with NO clinical experience? I mean that is just crazy. I don't know what all they learn in nursing school but I don't think it is 4 years of bookwork.

 

[Medic Tim]

The nursing program I was in before switching to EMS was more job/unit/role focused. It wasn't a minimum number of skills then.... next. Some got to do a lot of skills in certain areas, while others did not. To only have 2 sticks though she must have been avoiding it or was very unlucky in her rotations.

 

[abckidsmom]

I only got an associate's degree in nursing, but I had one IV start during all of my clinical time, and that was only because they knew I was a medic, I was bailing out a nurse on the floor who couldn't get the stick.

IVs are not usually a high priority item in nursing school. More attention is given to nursing care than skills.

 

[Handsome Robb]

I don't know how BSN programs work, but there are some healthcare programs where the clinical component comes after the awarding of a degree...

The clinical component is included in a BSN.

That's nuts that she had only gotten two though...

I wont lie when a patient doubts me about an IV I'm guilty of telling them myself or my partner are better* since we start them all the time while some nurses in the slower ERs might go a couple days without one.

*there are plenty of nurses out there that are far better than I am at starting IVs. I do feel pretty confident in my start skills though.

 

[usalsfyre]

(insert discussion about critical thinking and decision making vs monkey skills here)

There's a reason physicians and increasingly new grad nurses have residencies. Education is designed to lay the ground work for critical thinking. Training in job skills is where you learn to start IVs, ect. Unfortunately too often EMS imposes far too short of an orientation on new medics.

 

[ZootownMedic]

The clinical component is included in a BSN.

That's nuts that she had only gotten two though...

I wont lie when a patient doubts me about an IV I'm guilty of telling them myself or my partner are better* since we start them all the time while some nurses in the slower ERs might go a couple days without one.

*there are plenty of nurses out there that are far better than I am at starting IVs. I do feel pretty confident in my start skills though.

I was with a awesome ER doc one time who was evaluating a older lady in the ER. I was about to start an IV on her when she saw my Paramedic student shirt and kinda freaked out a little. The Doc actually laughed at her and told her that if she didn't want me to start the IV he would do it. Then he told her that I had started 15 that day and he hadn't started one in 8 months. That shut her up. :rofl:

 

[medichopeful]

In many BSN programs (mine included) you DO NOT start IVs. Rather, a licensed RN or equivalent has to start them, then you can give meds through them, etc. I think it has something to do with liability, but I wouldn't quote me on that! For us, we will learn to start IVs after we get a job, but not before we graduate. I know a lot of places do it that way, for better or worse.

Sorry if this double or triple posts, there were some internet issues! :glare:

 

[JakeEMTP]

With Paramedic school, the total focus is on the skills. You walk in to the ER and start looking for sticks and tubes. Nothing else really matters.

Nursing school isn't set up like that. They get exposure to as many areas as possible without focus on any one specific skill. Their skills will be tailored to their job.

 

[Akulahawk]

Starting an IV line is considered basically a task that an RN can learn on the job from his or her employer. As such, I can see that educational programs would not spend a whole lot time emphasizing that particular skill. It is very possible for an RN to go his or her entire career without ever starting an IV. The program that I am in focuses more on what to do procedurally with an IV line than actually starting at. So far I have not learned anything new in that regard as I already knew how to institute a primary line, do a piggyback, administer meds IVP, and so on. The only new thing I learned so far this past Semester was how to work with pumps. That's something I could have been in-serviced on as a Paramedic... What I did learn that was new was more of the why the IV would be in place and what to do with them once they're in place.

I am just not at all surprised about this. Not one bit. I've started more than a few IV's, but I've certainly met Paramedics and RN's that were far better than I, and I have learned some of their tricks of the trade that only made me better at doing that. I have no doubt that Paramedics are probably better as a group at starting peripheral IV's, however, some types of Nurses are far better than most Paramedics at this.

Really, the program that I'm in (and I'm sure most RN programs) are more concerned with the why behind the IV rather than the actual skill because it's just a task... and sometimes starting an IV is as simple as calling the IV RN to come do the start.

 

[the_negro_puppy]

Here in Aussie land RNs generally dont do any IVs during their training. They have to do a separate competency/assessement on the job.

 

[DrParasite]

In many BSN programs (mine included) you DO NOT start IVs.

yeah, exactly what he said.

 

[systemet]

She was on a clinical at Denver Children's when I saw her........plus, how can you have a bachelors in nursing with NO clinical experience?

I doubt that she's got no "clinical experience". My guess is that in a four-year BScN program, she's probably done more practicum hours that your average paramedic student.

I don't know about you, but I spent 1100 hours in the ambulance, and 400 or so hours in the hospital. I'm betting she's probably got those numbers beat. She's just not got a lot of practice at IVs, because it's not that important that a new grad BScN knows how to start an IV.

At my old job, the BLS guys had IV therapy in their scope, so to me starting IVs has always been a BLS skill. When someone came out of a six month EMT progam, I'd expect that they'd started maybe 30 IVs, perhaps more, perhaps less. My expectation for their skill level with IVs was about zero. But they'd be starting almost every IV on the truck for the next x months, until I felt confident that they'd "got" it.

It was nice for me when an EMT partner could start a line, because it meant I could do something more useful, but not critical. However, even when I was a brand new paramedic, it was extremely important that I was reasonably competent with IV initiation, because there was a good chance I'd have an inexperienced EMT partner, that I couldn't rely on.

Paramedicine is much more technically focused than most nursing specialties. And a new grad nurse isn't a specialist yet. That's what they have post-grad training for. Plenty of RNs don't work in roles where they need to be that competent with IV initiation.

 

[mycrofft]

I had ONE IV attempt offered to me, handed an 18 ga to start a dorsal hand line on a dehydrated sick little girl. After my one stick, the nurse on duty started what I now recognize as a butterfly needle in an antecubital vein and run in a liter of saline. Looking back, someone was zooming me.

 

[ZootownMedic]

Interesting on all sides. I have never been to nursing school so I guess I have no clue it is just surprising to me on all sides. That said however, the average nurse's bread and butter is medication administration. I am sorry to say it that way but that is one of the biggest things that separates them from lower levels of care in the hospital setting. So she is pushing medications but cant even obtain intravenous access? Do they learn how to give IM medications in nursing school? SQ? It seems to me that they are putting the cart before the horse. I understand that their schooling is totally different than ours but I find it hard to believe that someone could have FOUR years of schooling and not be schooled in the methods of medication administration when that is going to be one of their primary jobs in the field.

 

[ExpatMedic0]

I have been to a number of hospitals that on the med surge floors RN's are not allowed to start IV's. They have to call a special "IV team" or designated IV person from another area.

 

[Shishkabob]

I understand a floor nurse not starting an IV for quite some time, but I know all RN schools around here do ER time. No rhyme or reason why they can't event attempt an IV at some point during their few shifts in the ER in the local level 1 and 2 trauma centers that allow the students.


Heck, I had an attending physician (who I later learned was the medical director of what is now my agency) have me, as an EMT student doing my first ever ER rotation, get taught how to do an IV and then proceed to do one on a patient. He knew I wouldn't be doing it as an EMT, but he still wanted me to know how to and showed me how.

I've never had to do a foley in the field, but I did work at an agency that had foleys on the trucks... and guess what I was taught to do in the ER in medic school?



An IV takes a couple of minutes for a new person to attempt... the average ASN RN student around here spends ~48 hours in the ER (same as EMT students, and much less than medic students). Can't tell me they can't at some point go for an IV, even if it is "just a skill", it's a skill that, if they are working in the place they are currently training it, will get to know quite well.

 

[JakeEMTP]

I don't think that it is that they are not allowed since it is in their scope of practice. It probably is because they have 8 - 12 patients and are getting admits and doing discharges which is time consuming along with all of the medications they must give.

 

[Shishkabob]

It probably is because they have 8 - 12 patients

Doesn't happen, even at the busiest ERs here in DFW. In my years going to different hospital, the most I've ever seen a single RN get for any real length of time was 4, and ICUs never exceed 2. Really acute patient? 1.



I've had more doing first aid rooms at 'legal' raves and college football standbys.