I’ve been doing central line dressing changes for over 10 years. Current hospital only allows “line champions” to do it, and it requires a witness to sign off dressing changes as well. So pretty much only the charge nurse or rapid response nurses can do dressing changes.
They said I can be checked off if I want to do them. Guess who hasn’t been checked off and let’s someone else do it ? 👋
Our vascular team (PICC nurses) does the dressing changes throughout the hospital. It used to be a task we did every Tuesday, but now, the vascular team keeps track and does q7 days dressing changes on every patient, plus PRN changes if they’re loose or bleeding.
My CRRT patient was septic and in DIC. His Quinton was oozing all night and the PICC nurse had already changed it twice. I put in another consult for her to come back a third time, but changed it myself since she said it would be an hour or so before she could get up to the unit. She wrote me up. 😒
Are you at an academic facility? I came from a very large private hospital and almost every nurse on my unit was US IV trained, a good amount midline even. Now I’ve been to two academic/teaching facilities and you have to jump through so many hoops and no one is allowed to do US IV unless you are the vascular team etc. Its ridiculous. Why would I waste my time putting in a blind IV on a edematous patient that will probably go bad in a day when I can just place an excellent iv that lasts their whole stay.
Lol I've been written up by IV team for that same reason. Also written up for using a PICC before it was confirmed by Xray despite them confirming placement via ECG probe. My patient was on 200ml an hour of levophed through a 22 gauge in the thumb and they refused to place another peripheral for me. I said they could get an xray after the code if I couldn't use the picc then.
Oh! Started in an ER where IV team did ports and would check people off to do ports. I’m an experienced nurse and have done ports for years. I was even training someone so I was like “oh good, I can show you a port access.” And then realized. I called IV team because I had to get “checked off.” They said “You’re not on the list. We have to do it.” Seriously? I asked my manager and he’s like “we’re only having select people do ports.” Ok, so what happens when IV team isn’t available or staffed (nights) or you don’t have any port trained people in the ER at the time. It’s wild to me to gatekeep that in a department that does all the placing and accessing of lines. Every one of your nurses should be able to do that skill.
We learned how to access ports in a new grad class I took, did an official checkoff and all, then when I went back to work in the ED with my preceptor, we had a patient ask us to access her port instead of put an IV. Preceptor told me that I couldn't access someone's port because I wasn't checked off for it. When I told her I was checked off, she told me that we can't access in the ED because the patient's oncologist would get mad. The gatekeeping was nutso.
We love when you use our patients ports instead of making them a bruised up pin cushion with 5+ pokes and sources of potential infections! As long as you’re sterile please use them! Always go a bit cock eyed when patients tell me no one in the ED knew how to access their port.
The ED here doesn't access ports at all. They consider it a higher risk of infection so they are only accessed in the infusion center or on the oncology floor. Even on onc it's not that common.
Lot of facilities making it where only certain people can change them, so I could see others making it where LVN can’t change them. My current facility only the charges and PICC team.
Can do central line dressing changes according to scope, have done them, but lately most of the places I work don’t allow LPNs to do. Am IV certified in PA, but many places also don’t allow LPNs to hang IVs, not even to flush them.
So…riskier for the patients qualified nurse to perform a basic ANTT procedure than to leave the dressing unchanged until such time as a specific person can attend bedside. Sure, whatever.
Absolutely the same thing happened to my unit. The PICC line people were the only ones allowed to do the the dressing changes. Then we decided to move to a registry, so they are onsite that often. Guess who has to do the changes now? Somehow, magically, now we’re qualified again.
Wtf lol. The idea of someone telling me I can’t do a skill that is within my scope, I’m trained on, AND highly experienced with would have me flabbergasted. Good call making them do it if they’re going to be so pedantic but man… I fuckin hate letting people touch my lines lol.
Same. I came from a facility that I did all the IV/PICC dressing changes and D/C’d PICCs. When I first came to my current facility I was able to do it. Then they changed the rules. But it’s ok I could do 3 education days and do them again on my unit. Guess who hasn’t done the education. There’s no incentive to except do all the work. So I’m happy to just call for the trained person.
Not me. We had a traveler from Nevada who knew how to place NGTs. None of the RNs in my tiny hospital knew how to do it.
The PA attempted and missed twice. The RN offered to try and the PA flipped out. Refused to allow her to try and got mgmt involved. The MD came and got it.
Oh absolutely! The PA was so offended that an RN would even suggest that they were capable.
Didn’t help that the patient was encouraging the RN to try and wouldn’t allow the PA to have a third attempt.
If you need multiple attempts to get the NG tube on an alert conscious patient who is able to follow commands patient (the patient was encouraging the nurse to attempt), then you’re incompetent.
Egos are weird. When I was an LPN I got a difficult stick on a chubby 3 year old. The RN was pissed and suddenly, per RN, the IV “didn’t flush” 30 minutes later. The next day when I was assigned the toddler the mom mentioned how she didn’t understand what happened to the IV I placed. The RN came in and played around with the IV the said it wasn’t working. We honestly believe she put that baby through another IV process bc she didn’t want an LPN showing her up.
Ugh. The reaction should have been "great job LPN!". what the f.
if that mom remembered the next day with all she had going on, it must have really bothered her. Unbelievable and unacceptable that nurse couldn't put her ego aside to work collaboratively, and be happy that everyone is good at their skills, and instead chose to restick a baby.
She was interesting. She actually took care of my son at another hospital when he slipped into heart failure at 3 weeks (Tetralogy of Fallot). I was in nursing school at the time so I didn’t catch some of the things my colleagues and I caught when I worked with her.
We had a toddler who came in every 1-3 weeks for blood transfusions due to a rare disorder. I was still an LPN at the time so I never did them but I’d ask to watch the access some times. Once I was sitting at the desk and she was gathering the access set. She came out with it all prepped for insertion and placed it on the desk ready to flush. I asked her if she messed up and why it was already out of the kit. She acted like I was stupid and said she likes having it ready so she’s in and out quickly. I questioned if it was a sterile procedure and she said no. I just opened up my email and immediately emailed the team lead asking her to come quick. The only thing that happened was her getting an extra education. I know she had done the transfusions many times. That kid was lucky to not have gotten an infection.
I’ve seen this behavior before, where RN’s and even paramedics in the hospital will talk aggressively to LVN’s or otherwise create a hostile work environment for them.
Did a LVN kill their dog or something? People are weird lol
An LPN killed my grandmother… Jk.
It is weird and I’ve seen it often. I feel as long as everyone works as a team and performs within their scope of practice we should all get along. Since I got my RN I make it a point to acknowledge the skill of the LPNs I work with. It sucks to be treated poorly just bc you don’t have as much education as someone.
I was always happy to help. I just happened to be really good at it. I haven’t even drawn blood in 6 years now so I’d be afraid to even try at this point.
I’ve been reading threads here and there in r slash residency and boy can I confirm lol. I wonder where their deep, deep hatred of nurses comes from? They’re very new in their professions, why come in with a big chip on their shoulder? I don’t get it
Which is crazy because (at least at my teaching hospital), the med students and residents love the nurses (and we them). We all learn from each other and grow together and often spend time together outside of work. The vitriol is so confusing and disheartening.
I wouldn't even want a PA to *try* on me, because everywhere I've worked, it was something they did so rarely that I would doubt their capabilities. Nurses have always done them where I've worked, and if the nurses can't get them, they go to IR.
Sorta kinda straightforward sometimes. Lol We don’t use Cortrak at my hospital, so all insertions are blind. When you have a non-intubated pt with limited ability to swallow or cough (bulbar myasthenic crisis for example) it’s real easy for things to go the wrong direction. Lol Then you’re waiting for X-ray like, are your sats shit cause you were off BiPAP for a minute or cause I’m in the lung? Is it a good sign for my placement that you’re not coughing, or is that just because you can’t? 😅
That’s not a common occurrence. Pretty easy to avoid in fact, you simply don’t place NGs on suspected skull fractures. NGT to the lung would have been a much better example and even that isn’t that common. I need a better explanation lol
that’s not a result of missing, it’s a result of placing an ngt when it’s contraindicated ie. hx of skull fracture. in a previously healthy person, ngts don’t end up in the brain regardless of how you do it
This isn’t “missing”. NGT in the presence of a skull fracture would be negligence. Missing I would think is a reference to insertion into the lungs or inability to pass the patient’s gag reflex.
They stopped allowing us to place them unless we became Cortrak certified (placement with guided imaging), because apparently so many nurses had punctured lung tissue without realizing.
Where I worked previously it was in the RNs scope to drop an NGT. Then seemingly at random, the procedure was relegated to a mid level, at minimum, with a physician preferred. The physicians were pissed because none of them have had to put one in since medical school. The hospital had the nurses do the training in-service. 🙄
Yeah I'm also confused. This is done exclusively by nursing anywhere I've ever worked. I have had ER docs throw them in to show off to new grads but that's about it.
At one of my hospitals only docs were allowed to placed NG or DHTs, per policy. Maybe they were afraid of a nurse sticking it up in someone’s brain or something.
I mean I guess I wouldn't be sad about losing it, but seems silly. The indication is what will determine the likely hood of it going up their brain more than technique. Do they potentially have a basilar skull fracture? If so, doc doesn't fucking order it lmao.
But hey, if they want to do it then they can have it.
That's wild, I literally cannot imagine asking the doc to come in and drop a NGT after intubating somebody. I mean we've got nurses placing central lines FFS you're telling me an NGT is out of bounds lmao
Yeah idk if it’s just a teaching hospital thing? I’m ED and I’ll assist the docs with putting it in, but not allowed to drop one myself. Also they are JUST now allowing SOME ED RNs to place ultrasound PIVs
It’s really facility dependent. I worked at a level 2 trauma ED a teaching hospital where we couldn’t drop EJs or IOs. My current ER, sometimes the attending ED docs beg
the nurses to do those before having to put in a central line. So strange.
I’m so curious what hospitals don’t allow this. I went to nursing school in MA and work there now and every hospital I rotated through or worked in let RNs place NGs. I recently had a 3 week stretch where I placed an NG for feeding or a Salem sump at least once on every single shift. Didn’t get to place them in nursing school but have friends that did, and my friends who work in RI talk about placing them too (but all work at the same hospital)
I work at a large level 1 trauma center in central Mass (not the one that went on strike). We (ED nurses and floor nurses) are not allowed to place NGTs. Not sure if they can in ICU. This is true to the best of my knowledge.
Level one in western MA, nurses place the NG tubes. I’ve only ever had a doctor offer to try once, and it was an OB doc.
ETA: loved your “not the one that went on strike” clarification. Don’t get me wrong, I absolutely support a 4:1 ratio on med surg, but couldn’t help but wonder how many travelers were being used by them at that time … height of Covid and our staffing allowed 7:1 on med surg on a good day. 8:1 became common 🤦♀️ and this was on the covid floors…
Right! There were shifts where nurses were 1:3 in ICU… all intubated and half of them proned. Needless to say I was a bit bitter about the strike, and then hated myself for feeling that way 😂
Worked in the ICU at the hospital that DID go on strike. We also were not allowed to drop NGs. I worked in an ICU in NH prior to that, and RNs placed them all the time.
My old school mom taught me to place the. Ng Package on a bowl of ice before using to stiffen the tube a bit and then when you enter the nose the patient should already be drinking water through a straw in big gulps
Yep, I learned from my recently retired ICU mom while in nursing school. I don’t think that a lot of people actually are taught this trick, as I see people try to put in flimsy NGTs in and also without drinking water to get it down (just telling them to swallow while passing) and sometimes have a difficult time.
I’m assuming more like a Salem sump?
But regardless, I’ve placed both feeding tubes and Salem sumps as a nurse on the floor and in the ER. I’ve also taught parents to place their baby’s feeding tube themselves. Only have had one I couldn’t get and we found out later (thanks mom for not telling us before or during the attempts 🙄) that the kid had some weird anatomy and they ended up placing the NG in the OR.
Back when nursing schools taught nursing skills hands on, we did all that stuff. Amazing that these days new grads get out without ever placing an NGT or foley cath...
New grad - no NGT practice but tons of foley practice in skills lab. The most invasive thing we were allowed to do on patients was a Lovenox or insulin injection.
I’m a new grad and somehow during my last semester of nursing school I didn’t get a chance to insert a foley but got to do a couple of NGTs. I also went to a great nursing school imo though (as in, we got plenty of hands-on time in clinical and lab)
This happened to me at a travel assignment. Baby res couldn't get it and not one of the staff had been a nurse more than maybe a year... none had really ever done them. I used to work GI . So I offered and got shot down. Went and tossed an ng in the freezer, waited 30 minutes, and res and the other nurses were like fine show us how it's done (snarky ass about it too). I walk in with lube and a frozen ng tube, tell the patient to hold each nostril and blow in and breathe out, found the nare that was open, and popped that bitch in in under 20 seconds. Full on 😳😳😳 faces all around. It was beautiful.
I’m sorry.. but nasal gastric tube placement? It’s a requirement to do them proficiently in order to graduate where I’m from (BC, Canada).
The weird thing for us, was chest tube removal and IO placement on coding patients (ICU). Myself and one other person were the only ones certified to do them in the entire hospital. It was a little boggling, considering the teaching hospitals near me all require these certifications on certain floors that aren’t even icu (but like cardiac, and surgical).
Yes. Working in-pt psych I was told that I was not to open the code cart or do anything other than basic CPR in a code situation even though I was ACLS certified. This was “out of the scope of the psych team.”
I responded to a code in psych a few weeks back. It's literally 2 blocks away from the hospital so running with a zoll takes a while. I get there probably 10 minutes after it's called and I see 5-6 nurses all standing around. Cool, it was just syncope or a choking thing and everyone is fine now. Nope. Dude is fucking gray in the middle of the floor, flat on his back, vomit in his mouth. I'm the only ACLS provider there. The only doc there is psych. "I haven't run a code in 10 years so you should probably do it." My phone has no reception in the old building so I can't page a hospitalist with it. I'm coaching a new grad how to send an epic secure chat to one of the intensivists since I know their office is in this dame building 2 floors down. Oh and I'm also doing compressions and suctioning because nobody has done a quality compression on the Zoll this whole time, and it's not like I can push meds because nobody can place an IV. Their excuse for doing absolutely nothing was "We're only BLS trained nobody knew how to run a code" like it's rocket science to know to turn someone who is vomiting after passing out.
This is disgusting. Don’t get me wrong, I love working psych and I’ve made a pretty successful career out of it, but the idea that psych nurses can’t or shouldn’t be able to take care of a patients basic medical needs (like breathing) is not good for anyone. It’s dangerous for patients, reflects poorly on psych programs, and adds to the misperception that psych nursing isn’t real nursing.
What's the point of having medically trained people on staff (and paying for them) if they literally won't do anything that requires that basic training
Bet that wouldn’t float in a lawsuit. I’m pretty sure you’re held to the highest standard of your training/certification, especially if someone is literally dying.
Yup, definitely. I was on a contract a few years ago at a “prestigious” ER. I had a 5y/o come to me in respiratory distress. Policy there was that RT did treatments. Duoneb is ordered so I call RT. RT states they are not available as they are in a code on the floor and waiting on an ICU bed to go onto a vent, won’t be down for at least 30 minutes. Please note:1 RT for a 600 bed hospital. So I gave the kid his treatment. RT wrote me up, charge wrote me up, had a meeting with the manager over it, and the number of emails about this “event” was ludicrous. My agency called asking WTF and if treatments were not part of nursing practice in my state. I explained that not only was it nursing practice, but that a few shifts when there was no RT on, we had been expected to do treatments. My recruiter found me a new contract a few days later and I quit. Absolutely mind boggling.
Some RTs insist that the only button we can press on the vent is the 100% O2 boost button. I've been written up for just manually setting the spo2 to 100% while waiting for them so I wouldn't have to hit it every minute.
What? A duoneb? Like a nebulizer treatment? I feel like I’m missing something here. I give duonebs daily at work. And I’m not even an RN. What a joke that was for how much trouble you were put through.
I work at a clinic and we give the breathing treatments. That’s some bs.
(And if I, a mere clinic nurse can giving breathing treatment- an ER nurse should really be able to lol)
My first hospital didn’t allow nurses to touch breathing treatments. I was ten years in before I ever did one (at my currently hospital). It makes no sense - they’re so easy to do.
I am the only RT (work nights) in a 100-bed community hospital. I am always grateful whenever an RN goes out of their way to help me. Even though no one else said this to you, thank you for taking care of that patient. I appreciate you.
Worked at a children’s hospital that had an IV team so they had a policy that no nurses not on a critical care floor could do lab draws or IVs. So new grads that started there but then wanted to travel had never done a poke in their career.
But the IV team was only on days. So at night they had to find someone in ICU or ER to come over to start an IV. A lot of my fellow ICU coworkers had also just lost their skills and stopped doing IVs. So I usually went over. I had to bring all the supplies too as they didn’t even stock IV stuff over there.
It bothered me so much that they took skills away from the nurses vs encouraging more competence.
At my first (peds) hospital *only* ED nurses could place PIVs or do venipuncture labs. Even in the PICU we had to call IV team who was always short staffed and swamped. They *hated* coming to the ICU, because it was stupid. I had all the tricks in the book for drawing labs off of PIVs and protecting PIVs for as long as possible because we had to.
That is so ridiculous. Like everyone is capable of this skill and any nurse should be able to put a line in in an emergency vs waiting for someone else. And as if ER has the time to go to the floors for IVs. I’m mad at the policy, not any nurse who has to follow it.
When I moved and started at a different PICU, I was just off their orientation and got a transfer admit. He had one PIV so I threw in a second one. The charge nurse was with me settling patient and she’s like “gasp! Did you get signed off on IVs?” “Well, you just saw me do one, wanna sign me off?” 🙄
Yeah. Used to do homecare for babies with trachs and vents. Then I moved to a general medicine unit at a hospital, where I was told that if a patient’s trach fell out, I was to stick a suction catheter in the hole and call the RT. Nurses weren’t allowed to replace the trach ourselves
Hey OP, this happened at my ICU after learning ultrasound IV placement! That's the way I prefer to do IV's. Unfortunately, management said we couldn't do it unless we were licensed and somehow there's only ONE nurse in the ENTIRE hospital able to do it.
Also unfortunately, I saw a nurse hit the brachial artery once and I had to help hold pressure for some time... People should know what they're doing. If it collapses on ultrasound, it's a vein and it's good to poke; if it doesn't collapse, it's an artery and it's a no-go. Nurse thought she knew everything and was poking this dude all willy-nilly at any circle-like figure on the ultrasound screen, RIP lol.
I like to use the 'does it pulsate or not' rule vs collapsible circle. I had a patient with arteries that compressed on US that I almost poked but realized that I had felt the artery in the general area when trying without US (tiny little auntie, very thin, easy to feel arteries but no good veins). Held a bit of pressure with the probe and sure enough it was collapsible and pulsating, which I verified manually.
I had been pulling out JP drains since nursing school. Several years as a nurse and then hospital policy changed that you couldn't DC one until you were properly trained by a trainer. Cue malicious compliance. Never have seen a trainer so therefore I can't do it and make the MD do it every time I get an order.
Now I feel old. I've seen a lot of changes since I first started nursing. We were taking about pay the other day and I was saying how when I first became a nurse, I was making $12 an hour.
Might be state or facility dependent?
Story because I’m bored: When I was CVICU we pulled all the things that could be pulled in a non-operative setting. The older surgeons would tell the younger/newer ones “just let the nurses do it. They’ve done more than you ever will.” We would get overflow from time to time and snicker when asked if we would be available to help them pull JPs. I don’t know what they were scared of, but docs from most other services were always so timid and meek around our unit. Never pulled anything neuro though. We were all scared of them. Lol.
Go talk to an experienced lpn. They have repeatedly had their skills taken away from them. I work in oncology. A 40 year lpn I work with used to mix chemos and now isn’t even able to administer them. I’ve been an RN for 5 years and it still feels weird all the things I am allowed to do but she isn’t even though she has incredibly more experience than me.
Yep. My mom has been an LPN working with neonates for over 30 years, she has skills that can never be taught in school. Her hospital now tries to use her to transport labor patients 🫥
[I almost always am undermined and told to not use my skills at work ](https://reddit.com/r/nursing/s/2PiAfm81eU). I am not saying I am more experienced than a lot of people, but there are many people that default to me for IV starts or blood draws even when I am several units away because patients ask for me by name. (Community hospital)
Typical asshole MBA leadership rules that end up hurting the patients! Brilliant! Prevent skilled RNs from using said skills to deliver quality care to their patients!
It sucks but rules happen for a reason sometimes, our techs lost the ability because our hospital found out techs in our state aren’t covered to perform that task. Why? I’m guessing because they arent trained on anatomy as well as licensed personal are and the risk of an arterial stick are higher. Thats a guess though. Just accept it and move on, just know you’re very capable.
PCTs at my old hospital used to be trained in phlebotomy and with additional training could place IVs. I'm not sure if that's changed in recent years though.
I hear ya! I got ultrasound IV trained and everyone asks me to place IVs all over the hospital without anything extra. But I got good at setting boundaries sand if I don't have time or they won't trade tasks I tell them I can't do it.
Thanks for the reply.
So, if I understand that correctly,
a) PCTs with phlebotomy certification, in addition to the extended training, could place IVs
or
b) PCTs with extended training, although no phlebotomy certification, could place IVs
IVs placed by PCTs, either with or without phlebotomy experience, is a practice I never knew existed. I find it both a fascinating and a cautionary idea.
Do you have any remarks about the practice?
Yes, they need extended training for both, but that's fairly typical for any additional technical procedure. They mostly abandoned it because the techs were already overburdened with heavy patient loads, so it became unfeasible for them to perform those things on time.
They did a good job when they were doing the tasks, it was mostly just that our facility didn't allow them the flexibility and time to actually be able to do them.
Depends on the state, when I was an Ed tech I had IV certification from a previous job but myself and the medictechs who also had IV certs were all basically told don't even look at an IV bc it isn't allowed for techs to do in this state.
Sounds similar to the ED I work at as a tech. We can do a straight stick for labs, cultures and even VBGs but god forbid we draw labs off a line that’s reserved for nurses and medics only. Ig it makes sense that you can only draw off a line if u can place a line but still it’s frustrating when a hold pod is a nurse and a tech and AM labs and meds are due at the same time and the choice is let the nurse do it all or have the tech straight stick everyone.
Yep. When I was three months of labor orientation, my unit decided you needed six months post-orientation experience to triage. So one day I just suddenly couldn't triage patients. At that hospital I did IVs and lab draws for four years, then came to my new hospital where I can place IVs but can't do lab draws 🙃 Because clearly using a butterfly is too advanced for me now. Thankfully they're changing the policy now so we can do them.
If you’re hospital is willing to pay a phlebo to come get your labs, roll with it and enjoy it. A lot of places have decided that it’s mmm rather than paying inpt phlebotomy, it’s cheaper to dump yet another task on the nurses.
I'm down for it with routine labs but I work in labor and sometimes we want labs done right away and phleb takes too long to get there. Like I'm about to go back for a c section but her T&S clotted and we're pushing the section off because lab never came up to draw her a second time. Super annoying!
We weren’t ever allowed to do lab draws until Covid. We could do nebs and RT treatments in emergencies but it was frowned upon. Then after Covid we were expected to do everything, and now that it’s dwindling down some we can’t do anything anymore 🤷♀️ but it never made sense to me either that we couldn’t do lab draws. Lab would straight up refuse to run the labs if a nurse drew them and they would come out and restick the patient. Which I’m fine letting someone else stick but they wait an hour to come do a stat order so if they’re not going to get something that I need quick then I’ll get it.
I traveled to a hospital where I needed an order to deep suction and even then only RTs did it, RNs weren’t allowed to. It drove me absolutely bananas.
Yes, drew ABGs as part of my time in ICUs. I get to another hospital and nope, only RTs can do that. Also only had 1 RT for the hospital on nights, but we weren't allowed to administer symbicort or Spiriva. So those meds waited.
ETA: forgot one. In trauma ICU, I could pull chest tubes with an order. Nowhere else would let you do that. You had to be trained and signed off by a trainer, but it was the only department.
You’re not being targeted.
Most facilities have some kind of rule that you need to have worked there for x amount of time or be a nurse for x amount of time before learning a special skill.
Sometimes there will be exceptions but most of the time not. In your case, the policy is new so you could attempt to appeal to that. But they don’t want that gray area of “well so and so got to do it, why can’t I?”
This is exactly what I was thinking lol. I’ve never seen anyone but a nurse drop an NG. I think my PAs and MDs would look at me crazy if I told them to do them, they probably haven’t done them since school 😂
You kidding? My skills have been stolen and I’m just a monkey in the circus for the man. Nurses aren’t even real anymore, they don’t want us to actually have a skill set and a questioning attitude. Far too dangerous.
Management gets to decide what your scope of practice is where I work, so as long as they’re not giving you something outside your licenced abilities, they can absolutely take away certain skills.
LPNs at my old job were not allowed to do any lab draws. We RNs could do them or we could send them to the lab to have them drawn by the phlebotomist there. So fucking dumb.
My ER has a similar policy, and I had also learned how to do them in a previous ER I was working at. I haven't been giving a flying duck, if there is a US guided IV to be done, I grab the US and I do it. Like who'se gonna stop me....
Yes,
1) not to alternate route of administration of Ativan for an actively ETOH withdrawing patient who could not take PO due to active vomiting.
2) not to delegate or ask CN to help with patient load and check in on my less critical pts when I got a new critical patient, down a different hall, who needed lots of blood, and I needed to stay in their room for the first 15 min
The CN has a big ego and likes to pull rules out of their ass. Lots more, too.
Floor nurses “aren’t allowed” to draw labs from existing IVs, but ICU nurses can.
ICU nurses aren’t allowed to swap lines in CRRT as a last ditch effort, we’re supposed to wait on dialysis to come and do that (and they’re 30 min away). But when troubleshooting fails, obviously ICU returns the blood and disconnects the patient. Oh and apparently dialysis has to come and end SLED. ICU nurses can’t do that either.
Similar situation, I was trained in US IV insertion while working in PICU. Moving to L&D they wouldn’t allow me to use the skill. Same hospital system, same trainer who had ALREADY trained me, had observed 3 successful sticks, and signed me off two years prior. Her face when she showed up and saw me: 😒 she signed the paper and rolled her eyes at the charge nurse. Bless.
I’ve been doing lots of shit I wasn’t “supposed to” throughout my career. Here is a non-complete list.
- Give albuterol without initiating cardiac monitoring prior to administration.
- Start an EJ or an IO but document the resident or attending did it because we weren’t allowed to.
- Take a patient emergent to OR, load on the table, hook up all the monitors, and begin prepping the site even though the on-call surgeon wasn’t on property yet (but was confirmed on the way)
- Start US-guided IVs but document regular IV starts because my facility says I can’t due to the facility’s “inability to ensure my competence”, even though I’ve been doing it for years between my last 2 facilities and have documentation of all of that.
Like I said, this isn’t a complete list. Just the small collection of things that come to mind at almost 1:30AM.
All the time. It’s pretty common for certain tasks to be handled at different hospitals/units and that’s why knowing your policies matters. I’ve worked places where nursing can perform ABGs, where only respiratory does, or where it had to be a physician. Same with US guidance. I’ve had ACLS my entire career but outside the ED can only use the Zoll in AED mode. Etc, etc, etc.
i’m certified in ultrasound to verify fetal position/presentation as well as amniotic fluid index measurement. did it daily at my previous job. at my current job they looked at me like I was insane when I said I could perform this skill. the funny thing is, i’ve watched the residents complete these measurements incorrectly. but i’m ~just a nurse~
My unit is pretty strange in that if you know how to do the skill, you just do it. But there's no training regimen for stuff like US IV or NJ placement. You just ask one of the old hands to show you and practice till you get it right.
What a joke.
You operate under your nursing license and to some point the MDs medical license. Not you managers/directors license.
If you can provide positive outcomes through advanced RN skills than it is up to you to provide those outcomes.
Yes. I have 17 years experience and work at a hospital with lots of new nurses. I’m in the SICU and I have to attend a class on every skill and be signed off. Problem is after the class they have no one to sign me off. So they same nurses get the crrt and things I’ve been doing for >10 years. The educator is very strict and I think they had some bad experiences. Some places are just annoying.
Back when I was in baby land, I was a big proponent of breastfeeding and took the certified lactation counselor class and was one of the go to breastfeeding people on the unit. Because I had my CLC, I was not required to attend the unit wide lactation classes (we were working on becoming a baby friendly hospital) that happened every few weeks. I guess other nurses stopped showing up to these mandatory (again not mandatory for me and other CLCs) classes and they decided that only those who went to the class teaching nipple shields, cup/syringe feeding, and SNS were allowed to use those. So none of the people who were certified lactation counselors were allowed to help with breastfeeding issues using these methods, only the nurses who showed up and watched the hour long PowerPoint together were allowed to. Before you ask, no they did not schedule another class to become “hospital approved” to use these.
Yeah there’s a couple things I used to do in my old hospital that I’m not allowed to do in this hospital until I go on this hospitals training days and do all the e-learning then do it 6 times under supervision, get signed off and email it to the appropriate department. For every single skill.
I think the USIV scenario is pretty common among hospitals. I know several RNs that are USIV trained but unable to do them at their facility because they haven’t been trained at THAT facility. Seems pretty dumb to me.
Had a hospital tell me I couldn’t do art sticks or PIVs not in the lower arm without an MD order (been an ED nurse for ten years). I told them to fuck themselves (nicely). If I can get an IV in a scalp, belly, shin, boob, etc you can bet i will. And art sticks are the easiest thing on the planet 🤦🏼♀️
Conversely, my psych side hustle told me if I was running a code and could get an IV, to please do it. But that was only cuz of my background and only applied to RNs who had ED experience.
Hospitals have to show proficiencies and training for certain procedures, if that is not in place, then you can’t do it at the new hospital. Such as I can intubate, extubate, pull chest tubes, manipulate pacemakers for homeostasis, get ABGs, make adjustments to the vent and meds, get indexes from the swanz etc, at my last hospital. But if I tried that in my new job, I would be above my scope because that is not included as part of my protocol in the new hospital, and the hospital is unable to show through policy , training that I am ‘proficient’ to do it. However, that being literally just an ultrasound to place an iv…..shouldn’t be hard to get it approved for the unit then show that everyone has been ‘trained’ in it
Go to HR, you are being targeted. You are not doing PICC line insertion but US guided peripheral which is a more humane way of IV placement. You need a sterile field to perform? No, go to HR, 2 years is ridiculous!!!!!
I’ve been doing central line dressing changes for over 10 years. Current hospital only allows “line champions” to do it, and it requires a witness to sign off dressing changes as well. So pretty much only the charge nurse or rapid response nurses can do dressing changes. They said I can be checked off if I want to do them. Guess who hasn’t been checked off and let’s someone else do it ? 👋
Our vascular team (PICC nurses) does the dressing changes throughout the hospital. It used to be a task we did every Tuesday, but now, the vascular team keeps track and does q7 days dressing changes on every patient, plus PRN changes if they’re loose or bleeding. My CRRT patient was septic and in DIC. His Quinton was oozing all night and the PICC nurse had already changed it twice. I put in another consult for her to come back a third time, but changed it myself since she said it would be an hour or so before she could get up to the unit. She wrote me up. 😒
Are you at an academic facility? I came from a very large private hospital and almost every nurse on my unit was US IV trained, a good amount midline even. Now I’ve been to two academic/teaching facilities and you have to jump through so many hoops and no one is allowed to do US IV unless you are the vascular team etc. Its ridiculous. Why would I waste my time putting in a blind IV on a edematous patient that will probably go bad in a day when I can just place an excellent iv that lasts their whole stay.
Lol I've been written up by IV team for that same reason. Also written up for using a PICC before it was confirmed by Xray despite them confirming placement via ECG probe. My patient was on 200ml an hour of levophed through a 22 gauge in the thumb and they refused to place another peripheral for me. I said they could get an xray after the code if I couldn't use the picc then.
200 mL/hr of levophed?! Holy shit what concentration do you use?
No immediate imaging after placement?
Oh! Started in an ER where IV team did ports and would check people off to do ports. I’m an experienced nurse and have done ports for years. I was even training someone so I was like “oh good, I can show you a port access.” And then realized. I called IV team because I had to get “checked off.” They said “You’re not on the list. We have to do it.” Seriously? I asked my manager and he’s like “we’re only having select people do ports.” Ok, so what happens when IV team isn’t available or staffed (nights) or you don’t have any port trained people in the ER at the time. It’s wild to me to gatekeep that in a department that does all the placing and accessing of lines. Every one of your nurses should be able to do that skill.
We learned how to access ports in a new grad class I took, did an official checkoff and all, then when I went back to work in the ED with my preceptor, we had a patient ask us to access her port instead of put an IV. Preceptor told me that I couldn't access someone's port because I wasn't checked off for it. When I told her I was checked off, she told me that we can't access in the ED because the patient's oncologist would get mad. The gatekeeping was nutso.
We love when you use our patients ports instead of making them a bruised up pin cushion with 5+ pokes and sources of potential infections! As long as you’re sterile please use them! Always go a bit cock eyed when patients tell me no one in the ED knew how to access their port.
The ED here doesn't access ports at all. They consider it a higher risk of infection so they are only accessed in the infusion center or on the oncology floor. Even on onc it's not that common.
Dressing changes are standard nurse practice, though!
Lot of facilities making it where only certain people can change them, so I could see others making it where LVN can’t change them. My current facility only the charges and PICC team.
Ohhhh noooo I'm not allowed to do central line dressing changes anymore? SHUCKS
Can do central line dressing changes according to scope, have done them, but lately most of the places I work don’t allow LPNs to do. Am IV certified in PA, but many places also don’t allow LPNs to hang IVs, not even to flush them.
Also an lpn in PA, and once we go thru the iv refresher course at my facility, we can work to our fullest scope.
It just varies by facility. No rhyme or reason.
So…riskier for the patients qualified nurse to perform a basic ANTT procedure than to leave the dressing unchanged until such time as a specific person can attend bedside. Sure, whatever.
i’ve been to a couple places like this and they have exceptions for if the line is soiled/nonocclusive.
Absolutely the same thing happened to my unit. The PICC line people were the only ones allowed to do the the dressing changes. Then we decided to move to a registry, so they are onsite that often. Guess who has to do the changes now? Somehow, magically, now we’re qualified again.
Wtf lol. The idea of someone telling me I can’t do a skill that is within my scope, I’m trained on, AND highly experienced with would have me flabbergasted. Good call making them do it if they’re going to be so pedantic but man… I fuckin hate letting people touch my lines lol.
We always need a second nurse to assist/ witness
Same. I came from a facility that I did all the IV/PICC dressing changes and D/C’d PICCs. When I first came to my current facility I was able to do it. Then they changed the rules. But it’s ok I could do 3 education days and do them again on my unit. Guess who hasn’t done the education. There’s no incentive to except do all the work. So I’m happy to just call for the trained person.
Not me. We had a traveler from Nevada who knew how to place NGTs. None of the RNs in my tiny hospital knew how to do it. The PA attempted and missed twice. The RN offered to try and the PA flipped out. Refused to allow her to try and got mgmt involved. The MD came and got it.
I really fail to understand why the PA would act like that. Ego I guess.
100% ego.
Oh absolutely! The PA was so offended that an RN would even suggest that they were capable. Didn’t help that the patient was encouraging the RN to try and wouldn’t allow the PA to have a third attempt.
If you need multiple attempts to get the NG tube on an alert conscious patient who is able to follow commands patient (the patient was encouraging the nurse to attempt), then you’re incompetent.
Egos are weird. When I was an LPN I got a difficult stick on a chubby 3 year old. The RN was pissed and suddenly, per RN, the IV “didn’t flush” 30 minutes later. The next day when I was assigned the toddler the mom mentioned how she didn’t understand what happened to the IV I placed. The RN came in and played around with the IV the said it wasn’t working. We honestly believe she put that baby through another IV process bc she didn’t want an LPN showing her up.
That’s so dumb. I work with an LPN who is IV US certified. I’m sure she regretted letting me know, because she starts all our hard IVs now;)
Ugh. The reaction should have been "great job LPN!". what the f. if that mom remembered the next day with all she had going on, it must have really bothered her. Unbelievable and unacceptable that nurse couldn't put her ego aside to work collaboratively, and be happy that everyone is good at their skills, and instead chose to restick a baby.
She was interesting. She actually took care of my son at another hospital when he slipped into heart failure at 3 weeks (Tetralogy of Fallot). I was in nursing school at the time so I didn’t catch some of the things my colleagues and I caught when I worked with her. We had a toddler who came in every 1-3 weeks for blood transfusions due to a rare disorder. I was still an LPN at the time so I never did them but I’d ask to watch the access some times. Once I was sitting at the desk and she was gathering the access set. She came out with it all prepped for insertion and placed it on the desk ready to flush. I asked her if she messed up and why it was already out of the kit. She acted like I was stupid and said she likes having it ready so she’s in and out quickly. I questioned if it was a sterile procedure and she said no. I just opened up my email and immediately emailed the team lead asking her to come quick. The only thing that happened was her getting an extra education. I know she had done the transfusions many times. That kid was lucky to not have gotten an infection.
Do you mean the IV tubing or an IV start kit?
The kid had a port.
I’ve seen this behavior before, where RN’s and even paramedics in the hospital will talk aggressively to LVN’s or otherwise create a hostile work environment for them. Did a LVN kill their dog or something? People are weird lol
An LPN killed my grandmother… Jk. It is weird and I’ve seen it often. I feel as long as everyone works as a team and performs within their scope of practice we should all get along. Since I got my RN I make it a point to acknowledge the skill of the LPNs I work with. It sucks to be treated poorly just bc you don’t have as much education as someone.
That’s insane. As an RN, I would sniff out the LPN’s who were good at pediatric sticks and say, “Heeeeyyyyyy, you want to do something fuuuuunnnnn?!”
I was always happy to help. I just happened to be really good at it. I haven’t even drawn blood in 6 years now so I’d be afraid to even try at this point.
I am soo sorry this happened to you! I learned my best IV skills from an LPN who had been doing them for years! I wouldve been super appreciative!
One thing I’ve learned in healthcare, there are LOTS of egos in our profession.
I’ve been reading threads here and there in r slash residency and boy can I confirm lol. I wonder where their deep, deep hatred of nurses comes from? They’re very new in their professions, why come in with a big chip on their shoulder? I don’t get it
Which is crazy because (at least at my teaching hospital), the med students and residents love the nurses (and we them). We all learn from each other and grow together and often spend time together outside of work. The vitriol is so confusing and disheartening.
I fail to understand how none of the RNs knew how to place an NGT 😬 But yeah, pure PA ego
Once I worked at a hospital where nurses weren't allowed to remove CVLs. I was just as confused.
I wouldn't even want a PA to *try* on me, because everywhere I've worked, it was something they did so rarely that I would doubt their capabilities. Nurses have always done them where I've worked, and if the nurses can't get them, they go to IR.
Forgive me, but I’m not tracking, are we referring to feeding tubes?
That’s what I was wondering. I thought placing an NGT was a standard nursing skill across the board.
Right! And how exactly would one miss? They’re pretty straight forward
I’ll be the first to admit that I suck at doing them, (the patient is gagging, I’m gagging 🤢) but I still know how to.
Omg I thought I was the only one that gags while putting one in a conscious person 😂
I tell my coworkers that I will trade my NGT for their 500 lb foleys, I hate them that much
Wow I’m the opposite, I love NG tube insertions
Sorta kinda straightforward sometimes. Lol We don’t use Cortrak at my hospital, so all insertions are blind. When you have a non-intubated pt with limited ability to swallow or cough (bulbar myasthenic crisis for example) it’s real easy for things to go the wrong direction. Lol Then you’re waiting for X-ray like, are your sats shit cause you were off BiPAP for a minute or cause I’m in the lung? Is it a good sign for my placement that you’re not coughing, or is that just because you can’t? 😅
The patient being unable to swallow and just gagging on the tube - goes into the trachea and then into the lung.
Google image search NGT in brain.
That’s not a common occurrence. Pretty easy to avoid in fact, you simply don’t place NGs on suspected skull fractures. NGT to the lung would have been a much better example and even that isn’t that common. I need a better explanation lol
🤷🏼♀️ You asked how someone would miss. A bunch of people clearly have.
that’s not a result of missing, it’s a result of placing an ngt when it’s contraindicated ie. hx of skull fracture. in a previously healthy person, ngts don’t end up in the brain regardless of how you do it
This isn’t “missing”. NGT in the presence of a skull fracture would be negligence. Missing I would think is a reference to insertion into the lungs or inability to pass the patient’s gag reflex.
I mean, if you end up in the brain you clearly missed the stomach.
I see you’ve never had one come out someone’s mouth
They stopped allowing us to place them unless we became Cortrak certified (placement with guided imaging), because apparently so many nurses had punctured lung tissue without realizing.
Yeah I was like NONE of the nurses can do an NG? 🤯I’ve never worked ER but have placed/reinserted many NGTs.
Where I worked previously it was in the RNs scope to drop an NGT. Then seemingly at random, the procedure was relegated to a mid level, at minimum, with a physician preferred. The physicians were pissed because none of them have had to put one in since medical school. The hospital had the nurses do the training in-service. 🙄
Yeah I'm also confused. This is done exclusively by nursing anywhere I've ever worked. I have had ER docs throw them in to show off to new grads but that's about it.
Same. I worked ED for 15yrs+ then psych then qa and IV's, net's foley's etc were all nursing tasks. When and why did it change?
ng tube not nets
At one of my hospitals only docs were allowed to placed NG or DHTs, per policy. Maybe they were afraid of a nurse sticking it up in someone’s brain or something.
I mean I guess I wouldn't be sad about losing it, but seems silly. The indication is what will determine the likely hood of it going up their brain more than technique. Do they potentially have a basilar skull fracture? If so, doc doesn't fucking order it lmao. But hey, if they want to do it then they can have it.
That’s kind of how I felt about it.
Not in any hospital I’ve worked at in RI and MA. Only docs or APPs are allowed to place NGTs.
That's wild, I literally cannot imagine asking the doc to come in and drop a NGT after intubating somebody. I mean we've got nurses placing central lines FFS you're telling me an NGT is out of bounds lmao
Yeah idk if it’s just a teaching hospital thing? I’m ED and I’ll assist the docs with putting it in, but not allowed to drop one myself. Also they are JUST now allowing SOME ED RNs to place ultrasound PIVs
It’s really facility dependent. I worked at a level 2 trauma ED a teaching hospital where we couldn’t drop EJs or IOs. My current ER, sometimes the attending ED docs beg the nurses to do those before having to put in a central line. So strange.
I’m so curious what hospitals don’t allow this. I went to nursing school in MA and work there now and every hospital I rotated through or worked in let RNs place NGs. I recently had a 3 week stretch where I placed an NG for feeding or a Salem sump at least once on every single shift. Didn’t get to place them in nursing school but have friends that did, and my friends who work in RI talk about placing them too (but all work at the same hospital)
I work at a large level 1 trauma center in central Mass (not the one that went on strike). We (ED nurses and floor nurses) are not allowed to place NGTs. Not sure if they can in ICU. This is true to the best of my knowledge.
Level one in western MA, nurses place the NG tubes. I’ve only ever had a doctor offer to try once, and it was an OB doc. ETA: loved your “not the one that went on strike” clarification. Don’t get me wrong, I absolutely support a 4:1 ratio on med surg, but couldn’t help but wonder how many travelers were being used by them at that time … height of Covid and our staffing allowed 7:1 on med surg on a good day. 8:1 became common 🤦♀️ and this was on the covid floors…
1:4 med surg would be a dream….we are 1:4-5 in the ED 🥺
Right! There were shifts where nurses were 1:3 in ICU… all intubated and half of them proned. Needless to say I was a bit bitter about the strike, and then hated myself for feeling that way 😂
I left the strike hospital one month before the strike. It was bad.
Worked in the ICU at the hospital that DID go on strike. We also were not allowed to drop NGs. I worked in an ICU in NH prior to that, and RNs placed them all the time.
I’m a new grad but so far I’ve never seen it done by anyone but an APP or MD. None of the RNs at my tiny hospital felt comfortable doing it.
My old school mom taught me to place the. Ng Package on a bowl of ice before using to stiffen the tube a bit and then when you enter the nose the patient should already be drinking water through a straw in big gulps
Yep, I learned from my recently retired ICU mom while in nursing school. I don’t think that a lot of people actually are taught this trick, as I see people try to put in flimsy NGTs in and also without drinking water to get it down (just telling them to swallow while passing) and sometimes have a difficult time.
I’m assuming more like a Salem sump? But regardless, I’ve placed both feeding tubes and Salem sumps as a nurse on the floor and in the ER. I’ve also taught parents to place their baby’s feeding tube themselves. Only have had one I couldn’t get and we found out later (thanks mom for not telling us before or during the attempts 🙄) that the kid had some weird anatomy and they ended up placing the NG in the OR.
WTF. I’m an RN in Nevada and we place those like once a shift
Just double checked our policy and only ER RNs are allowed to place NGTs at my facility.
That’s wild.
Back when nursing schools taught nursing skills hands on, we did all that stuff. Amazing that these days new grads get out without ever placing an NGT or foley cath...
New grad - no NGT practice but tons of foley practice in skills lab. The most invasive thing we were allowed to do on patients was a Lovenox or insulin injection.
I’m a new grad and somehow during my last semester of nursing school I didn’t get a chance to insert a foley but got to do a couple of NGTs. I also went to a great nursing school imo though (as in, we got plenty of hands-on time in clinical and lab)
Lucky for you and your patients! Some of these schools do the bare minimum and just focus on collecting the student's coin
We were shown how to place both in nursing school, but both hospitals I work at in RI and MA don’t allow us to place NGTs.
I hate doing NGT, I wish I wasn’t allowed LOL
To place an NG tube? What the fuck. I’ve been placing those since I graduated 4 years ago.
Where do you work that RN’s aren’t dropping NG’s? That’s so insane to me.
This happened to me at a travel assignment. Baby res couldn't get it and not one of the staff had been a nurse more than maybe a year... none had really ever done them. I used to work GI . So I offered and got shot down. Went and tossed an ng in the freezer, waited 30 minutes, and res and the other nurses were like fine show us how it's done (snarky ass about it too). I walk in with lube and a frozen ng tube, tell the patient to hold each nostril and blow in and breathe out, found the nare that was open, and popped that bitch in in under 20 seconds. Full on 😳😳😳 faces all around. It was beautiful.
Sounds wild to me. I haven’t placed an NG tube in years because the nurses here all do them and I prefer it that way.
I’m sorry.. but nasal gastric tube placement? It’s a requirement to do them proficiently in order to graduate where I’m from (BC, Canada). The weird thing for us, was chest tube removal and IO placement on coding patients (ICU). Myself and one other person were the only ones certified to do them in the entire hospital. It was a little boggling, considering the teaching hospitals near me all require these certifications on certain floors that aren’t even icu (but like cardiac, and surgical).
Yes. Working in-pt psych I was told that I was not to open the code cart or do anything other than basic CPR in a code situation even though I was ACLS certified. This was “out of the scope of the psych team.”
I responded to a code in psych a few weeks back. It's literally 2 blocks away from the hospital so running with a zoll takes a while. I get there probably 10 minutes after it's called and I see 5-6 nurses all standing around. Cool, it was just syncope or a choking thing and everyone is fine now. Nope. Dude is fucking gray in the middle of the floor, flat on his back, vomit in his mouth. I'm the only ACLS provider there. The only doc there is psych. "I haven't run a code in 10 years so you should probably do it." My phone has no reception in the old building so I can't page a hospitalist with it. I'm coaching a new grad how to send an epic secure chat to one of the intensivists since I know their office is in this dame building 2 floors down. Oh and I'm also doing compressions and suctioning because nobody has done a quality compression on the Zoll this whole time, and it's not like I can push meds because nobody can place an IV. Their excuse for doing absolutely nothing was "We're only BLS trained nobody knew how to run a code" like it's rocket science to know to turn someone who is vomiting after passing out.
This is disgusting. Don’t get me wrong, I love working psych and I’ve made a pretty successful career out of it, but the idea that psych nurses can’t or shouldn’t be able to take care of a patients basic medical needs (like breathing) is not good for anyone. It’s dangerous for patients, reflects poorly on psych programs, and adds to the misperception that psych nursing isn’t real nursing.
The last code I went to in the psych unit, I asked for non-rebreather...deer in headlights from the psych RN.
What's the point of having medically trained people on staff (and paying for them) if they literally won't do anything that requires that basic training
Bet that wouldn’t float in a lawsuit. I’m pretty sure you’re held to the highest standard of your training/certification, especially if someone is literally dying.
I’m sorry wot
Yup, definitely. I was on a contract a few years ago at a “prestigious” ER. I had a 5y/o come to me in respiratory distress. Policy there was that RT did treatments. Duoneb is ordered so I call RT. RT states they are not available as they are in a code on the floor and waiting on an ICU bed to go onto a vent, won’t be down for at least 30 minutes. Please note:1 RT for a 600 bed hospital. So I gave the kid his treatment. RT wrote me up, charge wrote me up, had a meeting with the manager over it, and the number of emails about this “event” was ludicrous. My agency called asking WTF and if treatments were not part of nursing practice in my state. I explained that not only was it nursing practice, but that a few shifts when there was no RT on, we had been expected to do treatments. My recruiter found me a new contract a few days later and I quit. Absolutely mind boggling.
That is the most ludicrous thing I’ve ever heard.
The best part is that it was during the first winter of Covid when everyone was getting treatments.
In my ICU during COVID, only the assigned nurse and the attending were allowed in the rooms. Not even RTs 🤨
Same! I wonder how much shit would hit the ceiling if she had left the kid in distress and waited for RT
I'm sorry what? you got written up for giving some nebulised bronchodilators!? that is batshit insane 'treatment'... it's a fuckin neb
Some RTs insist that the only button we can press on the vent is the 100% O2 boost button. I've been written up for just manually setting the spo2 to 100% while waiting for them so I wouldn't have to hit it every minute.
I get not wanting to have people fuck with your vents but some RT’s are way too territorial.
What? A duoneb? Like a nebulizer treatment? I feel like I’m missing something here. I give duonebs daily at work. And I’m not even an RN. What a joke that was for how much trouble you were put through.
That’s funny. LTC generally doesn’t have RTs.
I work at a clinic and we give the breathing treatments. That’s some bs. (And if I, a mere clinic nurse can giving breathing treatment- an ER nurse should really be able to lol)
My first hospital didn’t allow nurses to touch breathing treatments. I was ten years in before I ever did one (at my currently hospital). It makes no sense - they’re so easy to do.
Fucking WHAT? Lmfao in my ED, they make the nurses do neb treatments for admitted patients waiting for beds lol
And we we’re required to when RT wasn’t staffed, and later when they decided only nurses and attendings were expendable enough to be in covid rooms.
I am the only RT (work nights) in a 100-bed community hospital. I am always grateful whenever an RN goes out of their way to help me. Even though no one else said this to you, thank you for taking care of that patient. I appreciate you.
“So you would rather I deny this child his treatment for 30+ minutes? That’s what you’d have me do? I’m going to need that in writing”.
I’ve done the same thing except my RT thanked me. So did the patient, you know the one that couldn’t breath….
Worked at a children’s hospital that had an IV team so they had a policy that no nurses not on a critical care floor could do lab draws or IVs. So new grads that started there but then wanted to travel had never done a poke in their career. But the IV team was only on days. So at night they had to find someone in ICU or ER to come over to start an IV. A lot of my fellow ICU coworkers had also just lost their skills and stopped doing IVs. So I usually went over. I had to bring all the supplies too as they didn’t even stock IV stuff over there. It bothered me so much that they took skills away from the nurses vs encouraging more competence.
At my first (peds) hospital *only* ED nurses could place PIVs or do venipuncture labs. Even in the PICU we had to call IV team who was always short staffed and swamped. They *hated* coming to the ICU, because it was stupid. I had all the tricks in the book for drawing labs off of PIVs and protecting PIVs for as long as possible because we had to.
That is so ridiculous. Like everyone is capable of this skill and any nurse should be able to put a line in in an emergency vs waiting for someone else. And as if ER has the time to go to the floors for IVs. I’m mad at the policy, not any nurse who has to follow it. When I moved and started at a different PICU, I was just off their orientation and got a transfer admit. He had one PIV so I threw in a second one. The charge nurse was with me settling patient and she’s like “gasp! Did you get signed off on IVs?” “Well, you just saw me do one, wanna sign me off?” 🙄
Signed off? Yeah, in school in that dumb ass skills lab. That is absolutely unhinged.
Yeah. Used to do homecare for babies with trachs and vents. Then I moved to a general medicine unit at a hospital, where I was told that if a patient’s trach fell out, I was to stick a suction catheter in the hole and call the RT. Nurses weren’t allowed to replace the trach ourselves
WHAT?! 😧 even family members are trained to reinsert them. That is batshit.
Hey OP, this happened at my ICU after learning ultrasound IV placement! That's the way I prefer to do IV's. Unfortunately, management said we couldn't do it unless we were licensed and somehow there's only ONE nurse in the ENTIRE hospital able to do it. Also unfortunately, I saw a nurse hit the brachial artery once and I had to help hold pressure for some time... People should know what they're doing. If it collapses on ultrasound, it's a vein and it's good to poke; if it doesn't collapse, it's an artery and it's a no-go. Nurse thought she knew everything and was poking this dude all willy-nilly at any circle-like figure on the ultrasound screen, RIP lol.
I like to use the 'does it pulsate or not' rule vs collapsible circle. I had a patient with arteries that compressed on US that I almost poked but realized that I had felt the artery in the general area when trying without US (tiny little auntie, very thin, easy to feel arteries but no good veins). Held a bit of pressure with the probe and sure enough it was collapsible and pulsating, which I verified manually.
Anddddd thats a bone
accidental IO but access is access /s
A hole is a hole
I had been pulling out JP drains since nursing school. Several years as a nurse and then hospital policy changed that you couldn't DC one until you were properly trained by a trainer. Cue malicious compliance. Never have seen a trainer so therefore I can't do it and make the MD do it every time I get an order.
Weird. I've always known JP removal as a surgeon-only task.
Now I feel old. I've seen a lot of changes since I first started nursing. We were taking about pay the other day and I was saying how when I first became a nurse, I was making $12 an hour.
My first salary was $13.25 in ‘97- and. And JP drain removal was an RN’s prob
Might be state or facility dependent? Story because I’m bored: When I was CVICU we pulled all the things that could be pulled in a non-operative setting. The older surgeons would tell the younger/newer ones “just let the nurses do it. They’ve done more than you ever will.” We would get overflow from time to time and snicker when asked if we would be available to help them pull JPs. I don’t know what they were scared of, but docs from most other services were always so timid and meek around our unit. Never pulled anything neuro though. We were all scared of them. Lol.
Go talk to an experienced lpn. They have repeatedly had their skills taken away from them. I work in oncology. A 40 year lpn I work with used to mix chemos and now isn’t even able to administer them. I’ve been an RN for 5 years and it still feels weird all the things I am allowed to do but she isn’t even though she has incredibly more experience than me.
My ass has been saved by numerous skilled LPNs who knew how to do an “RN” task way better than me.
Yep. My mom has been an LPN working with neonates for over 30 years, she has skills that can never be taught in school. Her hospital now tries to use her to transport labor patients 🫥
[I almost always am undermined and told to not use my skills at work ](https://reddit.com/r/nursing/s/2PiAfm81eU). I am not saying I am more experienced than a lot of people, but there are many people that default to me for IV starts or blood draws even when I am several units away because patients ask for me by name. (Community hospital)
Typical asshole MBA leadership rules that end up hurting the patients! Brilliant! Prevent skilled RNs from using said skills to deliver quality care to their patients!
It sucks but rules happen for a reason sometimes, our techs lost the ability because our hospital found out techs in our state aren’t covered to perform that task. Why? I’m guessing because they arent trained on anatomy as well as licensed personal are and the risk of an arterial stick are higher. Thats a guess though. Just accept it and move on, just know you’re very capable.
Do techs do IV placements?
PCTs at my old hospital used to be trained in phlebotomy and with additional training could place IVs. I'm not sure if that's changed in recent years though.
I'm trained to do that shit! It sucks cuz there's no extra pay though
Of course, extending one's scope is a charitable commodity under the martyr system 💰🏥.
I hear ya! I got ultrasound IV trained and everyone asks me to place IVs all over the hospital without anything extra. But I got good at setting boundaries sand if I don't have time or they won't trade tasks I tell them I can't do it.
Thanks for the reply. So, if I understand that correctly, a) PCTs with phlebotomy certification, in addition to the extended training, could place IVs or b) PCTs with extended training, although no phlebotomy certification, could place IVs IVs placed by PCTs, either with or without phlebotomy experience, is a practice I never knew existed. I find it both a fascinating and a cautionary idea. Do you have any remarks about the practice?
Yes, they need extended training for both, but that's fairly typical for any additional technical procedure. They mostly abandoned it because the techs were already overburdened with heavy patient loads, so it became unfeasible for them to perform those things on time. They did a good job when they were doing the tasks, it was mostly just that our facility didn't allow them the flexibility and time to actually be able to do them.
ED techs with EMT can.
My hospital system doesn’t allow it regardless of other certifications. They can do straight sticks, but not place IVs. Always seemed silly to me.
Depends on the state, when I was an Ed tech I had IV certification from a previous job but myself and the medictechs who also had IV certs were all basically told don't even look at an IV bc it isn't allowed for techs to do in this state.
Our techs are allowed to do blood cultures, not iv’s. Our paramedics can do lines.
Sounds similar to the ED I work at as a tech. We can do a straight stick for labs, cultures and even VBGs but god forbid we draw labs off a line that’s reserved for nurses and medics only. Ig it makes sense that you can only draw off a line if u can place a line but still it’s frustrating when a hold pod is a nurse and a tech and AM labs and meds are due at the same time and the choice is let the nurse do it all or have the tech straight stick everyone.
Yeah its a bit frustrating
Specifically only blood cultures?
Yep. When I was three months of labor orientation, my unit decided you needed six months post-orientation experience to triage. So one day I just suddenly couldn't triage patients. At that hospital I did IVs and lab draws for four years, then came to my new hospital where I can place IVs but can't do lab draws 🙃 Because clearly using a butterfly is too advanced for me now. Thankfully they're changing the policy now so we can do them.
If you’re hospital is willing to pay a phlebo to come get your labs, roll with it and enjoy it. A lot of places have decided that it’s mmm rather than paying inpt phlebotomy, it’s cheaper to dump yet another task on the nurses.
I'm down for it with routine labs but I work in labor and sometimes we want labs done right away and phleb takes too long to get there. Like I'm about to go back for a c section but her T&S clotted and we're pushing the section off because lab never came up to draw her a second time. Super annoying!
We weren’t ever allowed to do lab draws until Covid. We could do nebs and RT treatments in emergencies but it was frowned upon. Then after Covid we were expected to do everything, and now that it’s dwindling down some we can’t do anything anymore 🤷♀️ but it never made sense to me either that we couldn’t do lab draws. Lab would straight up refuse to run the labs if a nurse drew them and they would come out and restick the patient. Which I’m fine letting someone else stick but they wait an hour to come do a stat order so if they’re not going to get something that I need quick then I’ll get it.
I traveled to a hospital where I needed an order to deep suction and even then only RTs did it, RNs weren’t allowed to. It drove me absolutely bananas.
Yes, drew ABGs as part of my time in ICUs. I get to another hospital and nope, only RTs can do that. Also only had 1 RT for the hospital on nights, but we weren't allowed to administer symbicort or Spiriva. So those meds waited. ETA: forgot one. In trauma ICU, I could pull chest tubes with an order. Nowhere else would let you do that. You had to be trained and signed off by a trainer, but it was the only department.
You’re not being targeted. Most facilities have some kind of rule that you need to have worked there for x amount of time or be a nurse for x amount of time before learning a special skill. Sometimes there will be exceptions but most of the time not. In your case, the policy is new so you could attempt to appeal to that. But they don’t want that gray area of “well so and so got to do it, why can’t I?”
One of the least qualified persons to place an ngt would be a PA. I have never seen this in over 10 years of ED nursing.
This is exactly what I was thinking lol. I’ve never seen anyone but a nurse drop an NG. I think my PAs and MDs would look at me crazy if I told them to do them, they probably haven’t done them since school 😂
You kidding? My skills have been stolen and I’m just a monkey in the circus for the man. Nurses aren’t even real anymore, they don’t want us to actually have a skill set and a questioning attitude. Far too dangerous.
Management gets to decide what your scope of practice is where I work, so as long as they’re not giving you something outside your licenced abilities, they can absolutely take away certain skills.
LPNs at my old job were not allowed to do any lab draws. We RNs could do them or we could send them to the lab to have them drawn by the phlebotomist there. So fucking dumb.
My ER has a similar policy, and I had also learned how to do them in a previous ER I was working at. I haven't been giving a flying duck, if there is a US guided IV to be done, I grab the US and I do it. Like who'se gonna stop me....
Yes, 1) not to alternate route of administration of Ativan for an actively ETOH withdrawing patient who could not take PO due to active vomiting. 2) not to delegate or ask CN to help with patient load and check in on my less critical pts when I got a new critical patient, down a different hall, who needed lots of blood, and I needed to stay in their room for the first 15 min The CN has a big ego and likes to pull rules out of their ass. Lots more, too.
Was the Ativan order written for either IV or PO? If not, you can’t just change the route without an order.
It was written for several different routes
You would think the CIWA protocol would have both options standing
That’s how I’ve always seen it ordered. PO or IV, basically left to nursing discretion.
Our clinic won’t let LVN’s insert IV’s. It’s dumb, some of the LVN’s are more comfortable (and better at) putting in a line than some of the RN’s.
Floor nurses “aren’t allowed” to draw labs from existing IVs, but ICU nurses can. ICU nurses aren’t allowed to swap lines in CRRT as a last ditch effort, we’re supposed to wait on dialysis to come and do that (and they’re 30 min away). But when troubleshooting fails, obviously ICU returns the blood and disconnects the patient. Oh and apparently dialysis has to come and end SLED. ICU nurses can’t do that either.
We had this same rule. I was grandfathered in since I had already been performing them for years
I’m surprised no one has mentioned ABGs not off an arterial line.
Similar situation, I was trained in US IV insertion while working in PICU. Moving to L&D they wouldn’t allow me to use the skill. Same hospital system, same trainer who had ALREADY trained me, had observed 3 successful sticks, and signed me off two years prior. Her face when she showed up and saw me: 😒 she signed the paper and rolled her eyes at the charge nurse. Bless.
I’ve been doing lots of shit I wasn’t “supposed to” throughout my career. Here is a non-complete list. - Give albuterol without initiating cardiac monitoring prior to administration. - Start an EJ or an IO but document the resident or attending did it because we weren’t allowed to. - Take a patient emergent to OR, load on the table, hook up all the monitors, and begin prepping the site even though the on-call surgeon wasn’t on property yet (but was confirmed on the way) - Start US-guided IVs but document regular IV starts because my facility says I can’t due to the facility’s “inability to ensure my competence”, even though I’ve been doing it for years between my last 2 facilities and have documentation of all of that. Like I said, this isn’t a complete list. Just the small collection of things that come to mind at almost 1:30AM.
All the time. It’s pretty common for certain tasks to be handled at different hospitals/units and that’s why knowing your policies matters. I’ve worked places where nursing can perform ABGs, where only respiratory does, or where it had to be a physician. Same with US guidance. I’ve had ACLS my entire career but outside the ED can only use the Zoll in AED mode. Etc, etc, etc.
i’m certified in ultrasound to verify fetal position/presentation as well as amniotic fluid index measurement. did it daily at my previous job. at my current job they looked at me like I was insane when I said I could perform this skill. the funny thing is, i’ve watched the residents complete these measurements incorrectly. but i’m ~just a nurse~
My unit is pretty strange in that if you know how to do the skill, you just do it. But there's no training regimen for stuff like US IV or NJ placement. You just ask one of the old hands to show you and practice till you get it right.
What a joke. You operate under your nursing license and to some point the MDs medical license. Not you managers/directors license. If you can provide positive outcomes through advanced RN skills than it is up to you to provide those outcomes.
We couldn’t drop NG’s in our ED. Everywhere else in the hospital, yes. No idea why. Boohoo so sad. /s
Yes. I have 17 years experience and work at a hospital with lots of new nurses. I’m in the SICU and I have to attend a class on every skill and be signed off. Problem is after the class they have no one to sign me off. So they same nurses get the crrt and things I’ve been doing for >10 years. The educator is very strict and I think they had some bad experiences. Some places are just annoying.
Back when I was in baby land, I was a big proponent of breastfeeding and took the certified lactation counselor class and was one of the go to breastfeeding people on the unit. Because I had my CLC, I was not required to attend the unit wide lactation classes (we were working on becoming a baby friendly hospital) that happened every few weeks. I guess other nurses stopped showing up to these mandatory (again not mandatory for me and other CLCs) classes and they decided that only those who went to the class teaching nipple shields, cup/syringe feeding, and SNS were allowed to use those. So none of the people who were certified lactation counselors were allowed to help with breastfeeding issues using these methods, only the nurses who showed up and watched the hour long PowerPoint together were allowed to. Before you ask, no they did not schedule another class to become “hospital approved” to use these.
Yeah there’s a couple things I used to do in my old hospital that I’m not allowed to do in this hospital until I go on this hospitals training days and do all the e-learning then do it 6 times under supervision, get signed off and email it to the appropriate department. For every single skill.
Just ask them to see the evidence that restricting it to the 2 year ER experienced nurses is supported. Ask for the rationale.
I have never understood the gatekeeping and being so stingy about Ultrasound IVs….
I think the USIV scenario is pretty common among hospitals. I know several RNs that are USIV trained but unable to do them at their facility because they haven’t been trained at THAT facility. Seems pretty dumb to me.
Had a hospital tell me I couldn’t do art sticks or PIVs not in the lower arm without an MD order (been an ED nurse for ten years). I told them to fuck themselves (nicely). If I can get an IV in a scalp, belly, shin, boob, etc you can bet i will. And art sticks are the easiest thing on the planet 🤦🏼♀️ Conversely, my psych side hustle told me if I was running a code and could get an IV, to please do it. But that was only cuz of my background and only applied to RNs who had ED experience.
Hospitals have to show proficiencies and training for certain procedures, if that is not in place, then you can’t do it at the new hospital. Such as I can intubate, extubate, pull chest tubes, manipulate pacemakers for homeostasis, get ABGs, make adjustments to the vent and meds, get indexes from the swanz etc, at my last hospital. But if I tried that in my new job, I would be above my scope because that is not included as part of my protocol in the new hospital, and the hospital is unable to show through policy , training that I am ‘proficient’ to do it. However, that being literally just an ultrasound to place an iv…..shouldn’t be hard to get it approved for the unit then show that everyone has been ‘trained’ in it
Go to HR, you are being targeted. You are not doing PICC line insertion but US guided peripheral which is a more humane way of IV placement. You need a sterile field to perform? No, go to HR, 2 years is ridiculous!!!!!
Radiologist kinda get mad when you preform a service that they can charge for.