New-to-practice nurses are expected to be proficient in the skill of initiating IV fluid therapy when they graduate. This is a task that nurses may perform daily, but nursing students do not routinely perform the skill. Initiating IV fluid therapy involves reading the order, selecting the appropriate fluid, volume, and the tubing, assessing the IV site, then spiking fluids, priming tubing, connecting the tubing to the patient and setting the pump.
In clinical rotations, students may not have the opportunity to initiate IV fluid therapy. They may replace a bag, but they are not going through the full process of decision-making, assessment and skill practice.
In skills labs, supply costs and conservation limit the amount of practice students can have with the technical skill. Students may watch a demonstration and perform the skill once, but due to financial and supply constrictions, it is not feasible to have students perform repetitive practice of the skill.
The Observation
As simulation faculty, I observed simulations daily and noticed that there was a missed opportunity to practice the full range of technical and decision-making skills associated with initiating IV fluid therapy. The initiation of IV fluid is written into many simulations, but due to the prohibitive cost of spiking a new bag with every simulation, perhaps only the first group of the day fully practices the skill. The subsequent groups would be provided with the previously spiked and primed fluids and tubing wrapped in a tangled mess.
This demonstrates an inequitable learning experience between groups. The first group had to choose the correct fluids, bag volume, tubing type, assess and perform the skill. While the groups that followed would be asked to use the ‘used’ bag, ‘used’ tubing and their imagination.
