A little while ago I was seconded to do some administrative-type work, and one of the things I was asked to do was certify ED nurses in central venous catheter access. CVADs — central venous access devices — include such things as Hickman catheters, implanted ports and PICCs (peripherally inserted central catheters). They are typically seen in chemotherapy patients or dialysis patients, or people who require very long-term antibiotic therepy, or frequent venous access.
CVADs are fussy and fastidious, rather than difficult; they are somewhat time-consuming and they demand good preparation and strict aseptic technique. In the emergency department, we use them principally to obtain blood draws and to start IV therapy. They are certainly becoming more common, even as the population ages and community care options become more feasible. The case for ED nurses acquiring this skill ought to be a no-brainer: decreased patient discomfort, no new invasive procedures for blood draws and IVs — not insignificant considerations for patients who might be immunocompromised. Unlike many hospitals we have no vascular access team; getting bloods or starting IV therapy was left to the two or three of us who were certified in CVAD access. My job was to get a critical mass of nurses certified so there would be at least a few competent available on every shift. A pretty straight-forward task, or so you would think.
I was frankly taken aback at the vehemence of the resistance to to this initiative. “It’s the worst decision this department has ever made!” one nurse told me in tones which suggested I had asked her to kill puppies with me in the soiled utility room. One interesting thing I noted was there seemed to be a distinct demographic divide. New(ish) nurses I approached for the inservice and certification seemed to be much more receptive* than the old birds (like myself) who were, um, more vocal in their objections. I get/don’t get the objection. I know nurses worry about increased workloads affecting their practice and patient care, I understand the difference between acuity and complexity — and CVADs do add a layer of complexity to patient care. But ultimately it’s about improving patient care — as using CVADs ultimately does. So what’s the problem?
I’m at a bit of a loss to explain this dichotomy. My hunch is that hospital administrators have manipulated and lied to nurses over the past — what? two decades? — about how this or that new initiative or increase in workload will “improve” patient care, even when patently false, so often that older nurses have given up trying to figure out the the spin from the evidence. My other hunch is that newer nurses are more interested in evidence-based practice than us old dinosaurs — maybe. What I’m also not clear about is how this resistance can be changed into something positive. My sense is that it’s probably not worth the effort, and leadership is not enough. Am I wrong?
*Or fearful of me.