Our hosiptal is struggling with the decsion to conitnue to allow our non licensed personal to start PIV's. We a pediatric hospital. Any thoughts, are there any other hospitals out there that allow them start PIV's. I am aware of the "Scope of Practice" standard.
This would be considered a delegated act. I would recommend you check with your state board of nursing to learn there position on what tasks can be delegated and the criteria for that delegation. It is always important to remember that the RN will retain all responsibility for the outcome of any tasks delegated to an LPN or unlicensed person. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
It is not always the RN that delegates. I have seen as a travel nurse at a hospital in New Mexico that allow's CNA'S to start EJ's. The CNA's thought on this is that they will look for a peripheral line first and if they can't find one, then they go to the EJ. The hopsital policy allows that. So if hte CNA gos ahead and does this then the RN is not held responsible since she knew nothing about it and did NOT give anyone permission.
Sorry, but IMHO, you are not correct on this. The RN or whomever gave the work assignment for the day to the CNA is the responsible party to supervise, oversee, and monitor outcomes of what the CNA does. This supervisory person will be held accountable for what the unlicensed person is doing, regardless of whether the supervisory person knows or does not know what that unlicensed person is doing. This is why there must be clearly written polcies, procedures and practice guidelines including scope of practice. There also must be clear, open, and effective lines of communication. In the case you described, I do believe that RN will be held liable for any negative outcomes. I also believe the hospital will be held liable and their written polices will be closely examined if this were to ever end up in a court of law. See INS SOP 35 Scope of Practice, and SOP #6 Competence and Competency Validation. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I am strongly opposed to unlicensed personnel starting PIVs. It is more than a "task" to be checked off our list of things to do for the day. I want to see the vein, feel the vein, choose the site and size, talk to my patient, make sure I know sterile technique is used, the site is scrubbed, no one draped the tape over the siderail, there was a good blood return, feel the initial flush. I realize nurses are busy but do not feel this is something we should hand off to an unlicensed person.
IMHO.
INS (2011) Standard 5.5 states: "The role of nursing assistive personnel (NAP) involved with infusion therapy shall be limited to non-invasive and administrative tasks." Further guidelines are given pg S9.
I think that is your answer to the hospital struggling to make a decision.
Lynn is correct. State boards may allow non liscensed personnel to place PIV's. In fact many states will and can the INS which is a professional organizatin dictate to the state board. State and federal laws will likely supersede professional organizatoins. Un-liscensed personnel have successfully for the last 10 years at least that I know of placed PIV's in the state of Minnesota for years. It really depends on the training, accountability, supervison and outcome management. Phlebotomists last I heard are not liscensed as well. Most IV starts are not done unfortunately in a sterile procedure as there is no sterile field set up. I would love to see that change. I believe that we are overlooking the bacterial that is introduced when performing phlebotomy and placement of a PIV and focusing on central lines only. That however is off topic. I suggest contacting Mayo who has one of the largest teams in Minnesota that uses technicians very successfully to place PIV's.
Kathy Kokotis
This is a matter for a lot of hospitals today. I'm a travel nurse and worked at a hospital in New Mexico that allowed their CNA'S to start EJ'S! Now you talk about risk!