I am aware that there are places allowing techs to start IVs. The 2 hospitals that I work at allow ED techs who are EMTs/PMs to be trained. A couple of ICUs have 1 or 2 paramedics that we have trained.
Now there is a request to move into the step down units. I am not liking this trend. I see how busy the nurses are and my IV staff are being whittled down, too. I hate to think that allowing techs that I know are not being supervised and have little training and no theory is the answer.
Anybody able to share thoughts or suggest action? I still have some hope that the CNOs will not allow this to go further based on safety and quality.
I know there are places that have given this responsibility to techs or unlicensed assistive personnel, however there are numerous aspects that must be considered. First, I can understand the thoughts behind this move. The decision-makers see starting a peripheral IV catheter as a "commodity" service - something that anyone can be taught to do. In some respects, that may be true, but not when the entire task is considered. Before I give any further comments, let me say that I have worked on an IV team in the past that employed techs. We hired EMTs, nursing students and phlebotomists to work directly under the supervision of an infusion nurse. I place a great deal of advantage on this structure rather than having these techs report to an overly burdened primary care staff nurse who does not have the same level of knowledge that an infusion nurse has. The INS has a position paper on their website stating that these techs can fill administrative roles such as supply management, statistics gathering and assisting with procedures, but they should not be given the responsibility to perform any invasive procedure. The EMT's are in a little different situation as this task is incluced in their regular practice. I believe that these EMT's do not have an individual state license, but please correct me if I am wrong on that, or if it is different between states. You must assess the information from your state board of nursing about delegation. These recommendations are coming from the National Council of State Boards of Nursing and the INS paper is written in conjunction with those statements. Most states have some guidelines on this. This would be a delegated act coming under these guidelines. Generally if a task requires making patient-specific decisions during the procedure (choice of gauge size, choice of site, assessing allergies, etc) that task can not be delegated. One more important criteria is that the nurse would always retain the accountability for the outcome. So those nurses may see this as another body that can relieve some of their workload, but they must also understand that if anything goes wrong with what that unlicensed person is doing, the nurse is held responsible legally. 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
We investigated this issue a long time ago. In the ER, the unlicensed personnel work under the license of the doctor and are "delegated" the ability to start IVs by the doctor. In other areas of the hospital, they cannot do the same, because the RNs cannot delegate this task in Texas and there is not a doctor on the unit.
I would think that you need to check with your BON. If the techs report to a nurse, what does the BON say?
Gwen
Austin, Texas
I would refer to the state of Minnesota as being the expert opinion at this time on technicians placing PIV's as mayo has been doing it for at least five or more years. In Minnesota there are quite a few hospitals employing this practice and the union lost the argument that Lynn so eloquently laid out on assessment decision making. It is the hospital that has the legal liability of the technician they employ. If that technician works under an RN than both have that legal liability. The best way is to have a IV Team Medical director and than the technician is working under the same umbrella as the RN is. The Medical Director is the expert opionion on practice in that facility. Healthcare changes in the next five years will involve considerable change on all our parts. Cost, productivity, and response time will all be the goal.
The hospital design of the future will resemble more of the manufacturing process of Deminig and others on thruput. I suggest reading up on six sigma. Keep an open mind to change. Look for solutions even if they involve un-liscensed personnel and look to improvements in patient flow. Sell the financial savings you create and make sure they are real dollars and not monopoly money dollars. We are in for a new healthcare system regardles of the politics. It is being driven by an un-employment rate of 10% and a lack of insurance. Should the employment rate even change for the better you will still have the issue of whether the employer can even afford to offer their employees insurance. We are seeing more companies dropping their plans, offering plans to employee only, or asking for very high co-contributions. This means the insured populatin will continue to decline.
Kathy Kokotis
Bard Access