As RN's on Picc Teams most of us start piv's ,access/deaccess port-a-caths, declott central lines and troubleshoot.
If we are going toward being Vascular Access Specialists I don't think we need to be worried about radiologly techs or
respiratory therapists taking over our jobs. So my question is , Is it in their scope of practice[rad. techs and resp. therapists]
to start piv's or access/deacces port-a-caths etc, etc.? Also,any ideas on the "future" of Picc Teams?
You need to attend the INS Fall Studies Preconference where the whole day will be devoted to the concept of Infusion Alliances. I am now and have always been an infusion nurse specialist. Although I began placing PICCs in 1981, I have never considered myself to be a "PICC nurse". Frankly I think the term is degraded to nurses. I also think that we can not abandon the whole of infusion therapy for the task of inserting vascular access devices. Please do not misunderstand me - I think that nurses should be the ones inserting **all** catheters, and yes I am talking about surgically inserted ones too. However, I also firmly believe that insertion is only the first 30 to 60 minutes of that catheter's life. Yes, insertion is important, but the remaining days, weeks, months or even years of that catheter life can not be abandoned by infusion nurse specialist. There is a dramatic need for this group of dedicated specialist and I also firmly believe that what is happening now in all of healthcare will drive the need for full service 24/7 infusion therapy teams. If you cannot come to Jacksonville in November, I hope you can get the supplement to the JIN when it comes out. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
that Infusion Therapy/Vascular Access Specialist jobs are 'safe'. For professional development reasons, for all of the reasons Lynn discusses, and because the health care system is undergoing rapid change - you/we should be extremely proactive about defining and steering our profession, within the industry itself and at the state and federal levels.
If there is no legislation or board governance at the state level, it IS possible that hospitals, or individual groups within hospitals, may figure out a way to fill the regulatory vacuum with what they believe to be cost effective, less demanding employees. (Demanding = assertive professionals with high standards of practice.) There appears to be uncoordinated movement in this direction at our hospital, and there are definitely loopholes that could allow it.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
the future is 24/7 but the future of nursing is multi-tiered skill levels. Meaning that RN's will not be needed to do it all in the future. RN's will be managers and will be high tech providers of care. Do not be surprised if the future of healthcare involves pharmacy techicians hanging meds and doing PIV's, RT's accessing ports etc. The rules are changing due to economics and there is not enough money to pay for a RN that cost anywhere from $65,000 and up to $130,000 a year with benefits. The nursing shortage is over right now and may never re-appear. My suggestion for the future to stay in the folds of healthcare is to re-engineer yourselves. If you are not servicing the ICU you need to. If you are not doing 24.7 PICC line placement you need to. If you are not on the rapid response team you need to get on it (this is not a crash team by the way). Start applying to your state boards to do IJ and subclavian lines. Get out of the PIV's or bring on technicians to do them regardless of what Lynn might think. I as a CEO have no desire to pay you $85,000 a year to place PIV's when I can have staff RN's do it. Your hospitals have no money and money is not coming into your systems for at least 18 months or longer. Go back to school and get a bachelors if you have none and a pursue a Master's. I have an MBA. A two year level degree is not managerial focused and the future is managerial in nurisng. Team nursing is coming back. The healthcare system is broke. Look around you. By the way it is within the scope of practice for any RT to start PIV's, access ports, and de-access ports if the state has no rules against it. They have NO STATE BOARDS. They work under an MD unlike RN's.
Kathy Kokotis RN BS MBA
As much as we would like to believe that we are important in the eyes of hospital management, the truth of the matter is we are a luxury that most hospitals can't afford. We are the easiest item to delete from a budget. They disbanded our I.V. therapy team strictly as a matter of cost. Immediate savings! We "save" money, but do not really "make" money. Now IR does the PICCs and midlines using "leftover" time from other procedures to pay for the suite. My suggestion is (as had appeared before on these pages) is to NOT give up inserting PICC lines, get an ultrasound machine, do your best to put a hard $ figure on the benefits of having an I.V. therapy team, and scream long and loud extolling those virtues to management!! Good Luck!
IV GUY
As much as everyone hates the thought of a "Stick and Run" PICC team, I think we need to make our PICC nurses valuable for many reasons, not just PICC insertions. The PICC nurses here are "Resource Nurses". They are on 24/7/365 and not only perform PICC insertions, but also do difficult IVs, round on all diabetics and do diabetic ed., help out throughout the organization as an extra pair of hands, attend and record for Codes, and perform delegated tasks on the nursing units to help out. They are never given a load of patients. We have 2 on most day shifts - one is diabetic ed and one is Resource/PICC. They work 12 hour shifts. One is on from 6p to 6a. They are absolutely phenomenal at PICC insertions! They are considered the "go to" people for all types of vascular access.
Prior to starting the Resource Nurse program, I coordinated the service and when I would lose a PICC nurse, I had to scramble to find a non-direct patient care RN who had the time and interest. It was so stressful!! Now any new resource nurse knows that part of her/his job description is to insert PICCs. I couldn't be prouder of them! No crystal ball here, but I cannot envision the loss of this service at our hospital. If it happens, hopefully it will be after I retire! :)
Wendy Erickson RN
Eau Claire WI
It is my understanding that the IV Team that has been in existence since the 1970's in Hawaii is eliminating their very large IV Team to the tune of 15 FTE's. That saves the hospital $1.5 million dollars a year in labor and benfits
It is very public knowledge that the entire IV Team in Melbourne at Holmes Regional Medical Center is not gone. 2 million dollars saved in labor. I think they kept two RN's to do PICC lines
Barnes Jewish also lost their long standing IV Team but have a very high functioning PICC Team at the top of their game
The point is can a CEO afford to pay an RN to do dressing changes, peripheral IV's, declot, access hubers $85,000 a year (that is with benefits) to do a function that any staff RN can add to their job now that their patient loads are down. No one has insurance. There is a 10% un-employment rate. They must cut labor. Uniion or no union
What job can a staff RN not do PICC lines with ultrasound.
The new scare is in Florida where PICC Teams are being replaced by very low cost outside contractors. At least five are gone now due to $300 all labor and materials included. The main selling point get rid of your labor cost and we provide the materials and do 24/7. If you re not looking at how your team functions now you will not have a team.
Kathy Kokotis RN BS MBA
PICC Business Analsyst
Bard Access Systems