Every Patient Needs an IV, or Do They?

(This post is by an author of AJN‘s January CE feature, “Evidence-Based Practice for Peripheral Intravenous Catheter Management.”)

Questioning the status quo.

As a former critical care nurse and now a vascular access nurse researcher, I’ve had the good fortune to travel widely and work with nurses from around the globe on multiple projects. As a researcher, part of my role is to question clinical practices we often take for granted and to ask, “Is this the best way? Could there be a better way?” Identifying practice that may not always be evidence-based is how research often begins.

Prior to the Covid-19 pandemic, I undertook a two-month fellowship in the US and visited several hospitals where, time and again, I noticed the majority of hospital patients had a peripheral intravenous catheter (PIVC) in place, but many were not in use. When I asked the nursing and medical staff why patients had a PIVC that was not in use, I was repeatedly told, “Every patient needs an IV, just in case.” When I pointed out that some patients had two or three PIVCs not in use, or a central venous access device as well, it became obvious that this is a common problem.

An ‘idle’ catheter is a PIVC that has […]

2023-01-11T11:41:34-05:00January 11th, 2023|Nursing, patient safety|0 Comments
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ER Nurse Who Called 911 for Backup: ‘What Are We Afraid Of?’

Making the call.

As I got home this morning after a hectic 12-hour shift as charge RN in a 50-bed ER, I sat in my silent car for a moment to ponder how much has changed in the last three weeks.

Three weeks ago, overwhelmed by walk-in patients and ambulance traffic and severely short-staffed, I called the emergency services non-emergent line and asked for help in our crowded lobby. I wasn’t thinking about the repercussions, about the uproar or the giant target I sometimes feel I’ve installed on my back with my outspokenness. I was thinking about my coworkers, spread too thin, exhausted and afraid for their licenses, and the patients that I knew had been sitting in the lobby for hours, sick and in pain and mostly unmonitored. I had no idea of the attention that call would receive.

Did speaking out change anything?

Someone recently asked, “What changes have you seen in the month since you made that call?”

For myself, I’ve been learning to navigate in a more public arena, […]

2022-12-01T09:51:43-05:00December 1st, 2022|Ethics, Nursing, nursing perspective, patient safety, safe staffing|5 Comments
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Improving the Discovery and Care of Pressure Injuries in the Emergency Department

Jonathan Nover, MBA, RN

The problem.

Hospital-acquired conditions, particularly pressure injuries (PIs), increased at alarming rates during the COVID-19 pandemic. Hospital isolation precautions and infection prevention practices limited clinician time at the bedside. How does a nurse regularly turn and position a patient if they are unable to enter the room as often as they did prior to the pandemic? In addition, hospitals often operated with high percentages of their workforce out sick.

While Covid may be less of a threat by now, the number of patients admitted to EDs continues to increase while nurse staffing shortages intensify the pressure on nurses to maintain patient safety standards. With patient boarding in EDs becoming more common, the risk of hospital-acquired PIs grows as well, even in the ED. Traditional ED care focuses on rapid screening, assessment, and stabilization, followed by discharge or admission. But the reality is that medical–surgical inpatient care has become more necessary in the ED.

A central element of nursing care is the identification of PIs upon entry to the hospital, PI prevention, and care of existing PIs. Patients who are boarded in the ED, particularly older patient populations with underlying diseases and long length of stays, are at especially high risk for pressure ulcers […]

2022-10-27T11:03:41-04:00October 27th, 2022|Nursing, patient safety|0 Comments
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Getting Nurses with Substance Use Disorders the Help They Need

“Nurses have distinctive risk factors associated with the work environment that may increase the probability of developing an SUD.”

In my previous roles as the director of the emergency department and pediatric intensive care unit, I worked with nurses who were enrolled in the Intervention Project for Nurses (IPN), which is a substance use disorder (SUD) assistance program.

My colleagues would often ask me why I’d hire anyone who was enrolled in this program. My response was that these are the ones who are getting help and trying to recover. I feel safe with these nurses because I know they are being monitored and receiving treatment—it’s the other nurses that I worry about. […]

2022-10-12T09:33:38-04:00October 12th, 2022|career, Ethics, Nursing, patient safety|0 Comments
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Are Fall Prevention Precautions Missing the Mark?

Happy first day of autumn! Let’s have some fall talk.

If you spend any time in the acute care setting, you’ll be inundated with signs of fall precautions: yellow alert armbands, yellow nonslip socks, yellow signs on patient room doors, and of course the constant ringing of bed alarms.

It appears that hospitals put a lot of effort into fall prevention, and understandably so—falls cost hospitals money. These costs include tests and procedures that aren’t covered by insurance, increased length of stay while the patient recovers, and lawsuits from injured patients or from their families.

Checking boxes vs. individual patient needs.

However, the current approach of applying all precautions to all patients at risk for falling isn’t supported by research, and may decrease patient satisfaction. Sometimes it seems more focus is put on checking boxes about having prevention strategies in place than on the actual patient’s preferences or needs. For example, a former patient told me about a time she was in the bathroom of her hospital room and felt lightheaded. Rather than risk falling, she eased herself to the floor and hit the call bell for assistance to get back to bed. Upon finding her on the floor, the staff were so focused on filling out an incident report and assessing her for injury that they ignored her attempts to explain what actually happened.

The ‘next era’ in fall reduction.

2021-09-22T09:47:00-04:00September 22nd, 2021|Nursing, patient safety, Patients|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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