Nurses vs Phlebotomist

Specialties Emergency

Published

Why do ER, ICU, && Med Surg nurses always get into it with lab techs. I notice a lot of nurses and lab techs always have issues with each other.

Being a former phlebotomist and now a RN I have seen both sides of frustration. As a phleb we had more than just 1 patient. We usually had a whole floor to draw sometimes two or three. We were on a tight schedule to get labs done and resulted before rounds or in a emergent case. We got yelled at by nurses all the time for not getting to the unit right away. Sometimes nurses would get mad if we asked then to turn off the IV pump to draw there patient. We weren't allowed to touch the IVs. Or if they were a difficult stick and we couldn't get the blood RNs would get mad. The biggest insult was "really this is your job it's the only thing you do" which isn't true, phlebs have to do more than just draw blood. Or if the RN didn't get the minimum amount and the patient had to be redrawn the nurses would get upset,especially if it was a nurse draw patient. As a RN now I try to keep in mind the things that I went through. I try to help other nurses understand why it's done a certain way. I also know that some phlebs will say they couldn't get a patients blood after being in the room 2 minutes, especially an isolation room because they don't know how to feel veins with gloves on. Or they can't tear the tip of the glove off, or they see a central line and automatically assume it's a nurse draw. I know because I have assumed this when I went into a room and seen a central line,art line or PICC. Having worked as a CNA,PCT, unit clerk and phlebotomist has really opened my eyes and has showed me how much everyone has to work together as a team. So when the phlebotomist tells me I couldn't get the vein, I ask if the have time to go in with me and we can try and find a vein together. Most times they say yes and we work together, they appreciate the fact that I am not upset and want there input of where they tried and I'm including them. I've had them hold the arm a certain way or help me with a positional vein. If they say no they can't help then I say ok thank you for trying. All anyone in any profession is looking for respect and appreciation. Sorry for the long drawn out response...

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Specializes in ED Clinical and Documentation.

When i first started working in my ER a few years ago. It was the techs or nurse that drew the blood. Then they discovered too many contaminated specimens and trailed having a phlebotomist in the er until we now have one 24/7. The only blood draws that the nurse or techs do is for stemi and stoke alert patients. For the most part we value our phlebotomist!

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Specializes in Emergency, Telemetry, Transplant.
I also know how easy it is for someone to send an ABG to the wrong lab via transporter or a tube system. It is not always the lab who initiates a lost sample. I doubt if they are hiding samples and would rather result them instead of getting into ***** fits with RNs.

I realize that there are computer system issues...but, we only have one lab. In another situation, we had an ABG that they would not run because the order did indicate how the ABG was drawn (line draw vs. "fresh" stick). The ABG had the correct sticker on it. The pt was circling the drain hard. I did not have time for a long discussion about this ABG, but the tech seemed to have a really bad attitude and wanted to get into a peeing contest about it. I realize they are protocols and procedures in place, but she wanted to put up every roadblock possible. Perhaps she was having a bad day, that happens. Maybe she did not recognize the urgency of the situation. Perhaps she did not realize that I had to go into the room rather than "hang out" on the phone while she talked me through the situation.

I can see how the stat issue can be quite annoying though...

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I realize that there are computer system issues...but, we only have one lab. In another situation, we had an ABG that they would not run because the order did indicate how the ABG was drawn (line draw vs. "fresh" stick). The ABG had the correct sticker on it. The pt was circling the drain hard. I did not have time for a long discussion about this ABG, but the tech seemed to have a really bad attitude and wanted to get into a peeing contest about it. I realize they are protocols and procedures in place, but she wanted to put up every roadblock possible. Perhaps she was having a bad day, that happens. Maybe she did not recognize the urgency of the situation. Perhaps she did not realize that I had to go into the room rather than "hang out" on the phone while she talked me through the situation.

I can see how the stat issue can be quite annoying though...

Assumptions can do harm to a patient. Careless or inaccurate reporting does no one any good. Don't expect someone else to jeopardize their license because you can not fill out the required data. I would have a bad attitude also if you wanted me to put my license on the job for your lack of proper documentation and attention to detail.

Would you view and treat the results of a VBG differently than an ABG? Line draw vs stick can make a difference by line contamination and acid base results which can skew the ABG results. If it was a stick and the results looked more "venous", that is a clue about the validity of "ABG" reporting. Yeah it is a big deal for treatment.

This is not the "tech's" regulations but CLIA and JCAHO's for patient safety. They have a responsibility that the proper data is reported for the proper intervention. No one should ever ASSUME and do "assumption" data reporting.

Get over the attitude that these techs have nothing better to do than give you attitude. Trying to fault others when the deficiency began at your end is never the correct answer.Learn what is required for a lab sample and try to do it correctly. If not, listen to how it can be easily corrected instead of trying to **** away their license and get the hospital a huge fine with a lab restriction. Having an outside agency take over the lab because people (RNs and lab technologists) failed to follow the guidelines won't make your life any easier.

This might sound harsh but everyone has a job to do and should be held accountable for accuracy.

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Specializes in Family practice, emergency.

If I see phlebotomists, I'm happy. They're there to help. Sometimes, if I have labs stacked up, I'll draw their labs, too, on the admitted pts. However, calling the lab is a different story. I have to do deep, cleansing breaths everytime I call, anticipating my "I never received that sample, and no, I won't look again, you didn't send enough in the pedi tube (with a three day old...)" There was one lab tech that worked at my first job who could do CBC's and BMP's with drops, I just had to call and say "Mr. Fabulous, this was a really tough stick..." And he'd cheerfully reply "Say no more!," put on his cape and make magic happen.

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Specializes in Emergency, Telemetry, Transplant.
Get over the attitude that these techs have nothing better to do than give you attitude. Trying to fault others when the deficiency began at your end is never the correct answer.

I never said nor implied that this tech was giving attitude just for the sake of giving attitude. All the tech are trying to do the job, and the vast majority of interactions between the lab and the ER are pleasant and professional. Given the dire situation described above, I may have been short, but that does not excuse her snotty attitude. FWIW, the order was complete in the computer...she chose to not look it up and instead demanded a new stick rather than trusting the ER nurse and the ER doc (who was actually the one who stuck the pt) that it was indeed from a stick. If the policy of the lab (or JCAHO, etc) is not to take information over the phone, so be it...just publish said policy and have every lab tech follow it.

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Given the dire situation described above, I may have been short, but that does not excuse her snotty attitude. FWIW, the order was complete in the computer...she chose to not look it up and instead demanded a new stick rather than trusting the ER nurse and the ER doc (who was actually the one who stuck the pt) that it was indeed from a stick. If the policy of the lab (or JCAHO, etc) is not to take information over the phone, so be it...just publish said policy and have every lab tech follow it.

In your other post you indicated the info was not complete and the source or method was missing.

I would also be reluctant to cover the charting for someone who is demanding on the phone also. Do you routinely fill in the blanks for other RNs for data they might have missed especially in today's digital age where the electronic footprint is left?

ABGs also have a time limit. If it is 20 - 30 minutes beyond the time of draw, even if iced, the sample might be considered no longer suitable for running. This is sometimes an issue when RNs click collected which puts a time stamp on the ABG before they pull the blood off the line. This might mean a redraw if you get side tracked regardless of how much you argue you just drew the sample. The time stamp for "time drawn" is already there.

I think you will find this in the P&P where it explains all the data which MUST be completed when the sample is sent. There might be 400 RNs in this hospital and a hundred more doctors. Not all will have good intentions. Taking the word of someone you don't know for legal patient chart documentation is not something one should take lightly. You never know which chart will be audited or pulled for an investigation for whatever reason.

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Nurses have academic degrees, techs do not. As a critical care nurse, who is Not really good at IV sticks (I always have CLs)

I am better than most at ABGs because I have done so many and this is why I applaud all my lab tachs who can hit a vein I cant

see or find because I dont do it even on a regular basis. I let them know how much I value their skill because I do. it allows me to do

what I do best.

Put your self in their place. They know you know so much more for them and they know how much more we make. But the reality is their skill is so important in helping me have the time to my job.

We are a team; let them know how you value them.... you will be surprised at your new relationship!

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Specializes in Emergency, Telemetry, Transplant.
In your other post you indicated the info was not complete and the source or method was missing.

Since you weren't there and you don't know how the system is supposed to work at my facility (just as I don't know how it works at yours) it doesn't make much sense to continue a tit for tat discussion on it.

The one take home point that I see from this--if there is a policy, I want all lab techs to follow it. Some are letter of the law types. Others seem to be more lax about certain things. I wish they would have a policy and have everyone follow it.

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Nurses have academic degrees, techs do not.

This is definitely one reason for friction. Many RNs assume the "techs" have no education and are merely skilled at one job. For MLTs this is much like nurses who get frustrated because people do not know the difference between an MA, CNA, LVN/LPN, RN or NP.

MLT (tech) must have at minimum of an Associates degree and many hours intern in a lab. They can be limited in the tests they can do and positions they can hold depending on their state. In labs today you will find many with at minimum a Bachelors degree. Masters or Doctorate may also be required depending upon the testing your hospital performs. Those in smaller hospitals might be familiar with the "send out" labs meaning they must be ran on the appropriate equipment by the appropriately educated and licensed staff.

Phlebotomists also now have different levels of training and some states are requiring certification. This starts with about 80 hours and can go up to 1500 hours (similar to LVN/LPN). Their specialty is drawing blood and may not be qualified to do any diagnostic testing.

However, it depends on the staffing as to who might actually be drawing blood. In smaller hospitals it is not uncommon to see someone with a Masters degree doing phlebotomy. They essentially wear many hats. In some larger hospitals the MLTs with Bachelors or higher might rotate doing the phlebotomy so they can maintain skill level or just help out. Some phlebotomists might be Bachelors or Masters degreed awaiting a position or getting more floor time in their internships.

Sources:

California (look at the FAQs)

https://secure.cpshr.us/cltreg/

http://iccweb.ucdavis.edu/HBS/pdf/Medical_Technology_Preparation_at_UC_Davis.pdf

Washington

http://www.doh.wa.gov/portals/1/Documents/Pubs/681019.pdf

New York

NYS Clinical Laboratory Technology:Laws, Rules & Regulations:Article 165

New Jersey

New Jersey State License Requirements for Lab Techs | Lab Tech Career | A Complete Guide

Massachusetts

http://www.mass.gov/eohhs/docs/dph/clinical-lab/clia-lab-qualifications.pdf

CLIA and CMS laboratory personnel requirements.

https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/apcsubm.pdf

I think you can see the education requirements are similar with these examples.

I ask questions and actually talk to people in other professions. This is how I know why some can run a micro (small) sample in their lab and others can not depending on the machine and policy. I know their frustrations when their technology is not the best or the hospital changed computer systems and did not take lab into consideration for the transition. Besides the differences in technology capabilities, some specimens might require a second machine's opinion and enough blood for both will be needed.

When you stay in a bubble and feel your profession is the only one which matters or you might be too busy arguing the ADN vs BSN mess, you fail to notice what others do know. If you look at the CMS and CLIA requirements as well as all of the regulatory standards, I think you can see why accuracy is a mandate and not something to be taken lightly. MLTs are trained by these regulations.

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The one take home point that I see from this--if there is a policy, I want all lab techs to follow it. Some are letter of the law types..

That means RNs should also follow the policies and provide the information required.

See the CLIA/CMS link I posted earlier. There are many regulatory mandates for lab reporting. This is not something they just make up. These policies exist in all parts of the United States for every clinical lab.

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Thank you TramaSurfer for pointing out the education of people in the laboratory. I believe there is a lack of education about our qualifications is simply that patients just don't see us. With the exception of Phlebotom In addition to our degree we also have to take a board of registry exam. There are a few credentialing organizations however the gold standard seems to be the American Society for Clinical Pathology (ASCP) certification. In addition to CLIA and CMS, we also have to follow regulations set forth by the College of American Pathologists (CAP). They are very stringent to say the least.

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