Backwards in the backwoods

  1. I have worked for many years in a large metropolitan hospital. I am now working in a small community hospital that is about 45 miles from any major city. I am puzzled at the attitudes of the nurses. I feel as if I were back in the stone ages. They are afraid to ask the docs anything. I am used to working with the docs and residents (most times).

    The question I have for everyone is this: For the am insulin coverages they draw a fasting Blood glucose on each patient. By the time we receive the value it is after 8:30 or 9:00am!! (coverage is schedule for 7:00am--they wait to see what level is and then give coverage.) I feel this is very dangerous, but since I am not technically a staff member (I teach and have 10 students I am responsible for) I have no input. Has anyone else heard of this??? It seems so backwards to me.

    Frustrated in the backwoods of western ny.
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  2. 6 Comments

  3. by   NicuGal
    After working in a large hospital, I would have a terrible time going back to a quiet little suburban hospital where I don't have the autonomy that I have now! Maybe you can make suggestions...like a glucose monitoring machine for one! Little baby steps can lead to big leaping bounds!
  4. by   donmurray
    Working in the National Health Service, I am surprised that you don't have glucose monitoring machine, my ward has one, and we are supposed to be a "second-rate" service, if you believe the media.
  5. by   P_RN
    Until about 4 -5 years ago that's the way we did it too. Shortly thereafter the lab went to the glucose meters and the phlebotomists would come to the floor and then post the results on a white china board.....(later stopped because of patient confidentiality).

    Then they decided that the nurses didn't have *enough to do* so they did away with the labs phleb.s and we had to draw and do all labs. Whoopee......the patients weren't consulted and for many it was a *learning experience* to say the least.

    Then FINALLY someone got the floors a handheld glucose interfacing meter and we actually had immediate results. True point of care testing (POCT).

    TPTB also relented and each floor had a phleb. for the 6am routine labs so the nurses could be spared. STATs were still the nurses tasks.

    THEN....get this.....Medicare ruled that the hospital couldn't charge a phlebotomy fee for nurses drawing blood! (Nurses are part of the room and board.) So all their brilliant plotting actually LOST money!


    POCT of blood sugars is surely within the budget of even a small place. A little inservice and off you go.


    http://www.pointofcare.net/clinical/...betesIndex.htm
  6. by   traumaRUs
    You need accu-check machines now. How do you monitor diabetics that might develop low blood sugar during the day? Do you always draw blood and send it off?
  7. by   peggysilva
    Originally posted by zumalong
    I have worked for many years in a large metropolitan hospital. I am now working in a small community hospital that is about 45 miles from any major city. I am puzzled at the attitudes of the nurses. I feel as if I were back in the stone ages. They are afraid to ask the docs anything. I am used to working with the docs and residents (most times).

    The question I have for everyone is this: For the am insulin coverages they draw a fasting Blood glucose on each patient. By the time we receive the value it is after 8:30 or 9:00am!! (coverage is schedule for 7:00am--they wait to see what level is and then give coverage.) I feel this is very dangerous, but since I am not technically a staff member (I teach and have 10 students I am responsible for) I have no input. Has anyone else heard of this??? It seems so backwards to me.

    Frustrated in the backwoods of western ny.
  8. by   peggysilva
    It was 35 years ago when I worked where FBS was ordered in the AM. The insulin was given after the report was received and before breakfast was served. The scheduled time was also 0700 with everyone knowing that the insulin was not given at 0700. The patients did very well. Good Luck in getting this changed.

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Backwards in the backwoods