Hi all. At my facility, we've been having an issue with our School of Nursing. My supervisor and the Telemetry Unit supervisor are behind me 100%. So here's the issue:
At our hospital, we have put a great deal of time and energy into educating our floor nurses on care of central lines, including drawing blood. We have gone for almost 2 years without a central line associated bloodstream infection, so I'd say we're doing pretty well. It's set up now that RNs must be signed off on a competency in order to be able to draw blood from a central line. All new hires are getting the education in orientation and we are, at least a few times a year, rounding and educating again and again.
Also, floor nurses are not permitted to insert IVs unless they have spent a day (at least) with the IV Team and have been authorized, that is, had 8 successful sticks. This authorization is usually for critical care and night shift nurses, but available for anyone interested. Otherwise, our IV Team is available 16 hours a day for all starts/restarts and any vascular access issues.
The problem is that our school of nursing is encouraging their instructors to do and/or supervise the SNs doing central line blood draws and IV insertions. This is of great concern as the instructors themselves do not have the education that we give everyone else in the house, and accordingly, the students do not either. We feel that this is something that they should not be doing, as we all know there is plenty else to learn and some of the tasks would be better left to when they've graduated and are on the floors. Last semester, after attempting to reconcile this issue many other ways, I emailed the director of the school to see if there was some way we could work it out. My email went unanswered.
Now, a new class of SNs is starting and the issue has again come up. My supervisor asked me to do a little research and find out what the other hospitals in our system are doing. I'm taking it one step further (because the other IV Teams aren't quite as involved in policy and procedure as we are) and asking all of you - the experts.
Are your SNs allowed to do central line blood draws or IV insertions on a regular/telemetry unit?
Thanks! Kelly
I have only worked where any student was only able to do anything with the IV therapy while working directly under the supervision of a member of the IV team. They could not do anything else without the IV nurse being with them. I would say at a minimum their instructors must go through your competencies and meet your internal standard. This is now a matter of the amount of revenue that will be reimbursed the hospital. Hospital acquired CRBSI will not be paid by Medicare after 10-1-08 and other insurance companies have annouced they will be going the same way. You may have to kick this up to your CNO, or CFO or CEO to communicate with the school administrator. I am sure there is some type of agreement that allows students to work in your hospital and this should be included. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Hi Kelly, you are doing a great pursuing this issue. Our hospital has not allowed SN's to start an IV nor do anything with central lines since we don't have an IV team, but last year the pressure from the schools has come back to haunt us! So what we have done is to collaborate with them to re-create a community standard where in all school and all students will go thru the same training. It is a lot of work but at least we know what the students are learning. THis is only allowing them to perform PIV on adult patients. Our facility will not allow any care or mangement for any central lines and with the new regulations coming up with CRBSI I don't think the SN's will get the chance to do it on the real patients. Once they get hired by our facility then they get the hands-on training & experience they need.
In your case, I think the instructors should do the same competency as your staff.....I hope this helps
goodluck
elvie
In our hospital all RN and LPN orientees must attend a class taught by our department. We get new nurses in that class who have been taught incorrectly in nursing school, and we have to unteach them right off the bat. They are stunned to find that their instructors were teaching them inaccurate "facts" based upon decades of misunderstanding. I would suggest that you forbid them touching your CVCs, inserting PIVS or performing any task related to vascular access or infusion therapy until they have attended a class that you teach, and have been competency validated by you.
Leigh Ann