No More Fingersticks for Techs!!

[pagandeva2000]

Is this happening where you all are? I live/work in New York City and work in a city hospital, and in the past few months, the BON sent a mandate stating that techs, CNAs, PCAs, etc...can no longer do fingersticks...this is designated only to licensed personnel; LPNs and RNs. Now, I am hearing from other RNs working in private industry that they are still allowing their techs to do this. Last year, they just upgraded many of our CNAs to Patient Care Associates, which was supposed to include this skill, but, now, they are not allowed to.

In addition, it causes more stress to the nurses, especially in our prenatal diabetic clinic, diabetes, endocrine and medical clinics because there are more PCAs than there are nurses. Now, I can be backed up with 8 charts, trying to push them out, and then, here comes the page: "Fingerstick in room 10" and this can go on for awhile! I emailed the BON and straight from the horse's mouth, it was told that we can no longer allow them to do so. I suspect that a mistake was made, or something was probably not reported to the nurses which had determental affects on the continuity of care. I was just curious to know if any of you are confronted with this as well.

[Effie, RN]

i have never thought this was a good idea. in missouri we have certified medication technicians who can also get insulin certified so they not only do the fingersticks but give the insulin too, all with training that is measured in hours not months or years. in the same vein, i am totally opposed to "patient care techs" removing indwelling urinary catheters and iv lines. who in the world came up with these moronic ideas???

[pagandeva2000, LPN]

i have never thought this was a good idea. in missouri we have certified medication technicians who can also get insulin certified so they not only do the fingersticks but give the insulin too, all with training that is measured in hours not months or years. in the same vein, i am totally opposed to "patient care techs" removing indwelling urinary catheters and iv lines. who in the world came up with these moronic ideas???

it is so interesting that you bring this up. my beautician works in a group home for the mentally disabled and is currently taking a certification course to become a medication technician, a requirement for her job. she happened to have had her booklet with her and when i read it, it did have a nice summary of the meds that i usually give with the basic details, so, i decided to order a similar book on line. found one that was used for about $2.00 and when i got it, i was totally shocked. the book begins with saying that it was published to assist medication techs, home health aides and cnas to administer medications, and that the book 'has no assessments' in it. it actually did, but without using the word. i was absolutely floored! the book also says that because there is a lack of licensed staff to give medications, some of this role was transferred to the medication aide. just like you said, it had insulin injections, even administering the epi-pen; discussing the symptoms of anaphylatic shock (and they're not assessing?? are you kidding me??). telling them when to call the doctor or the rn...seems like an assessment to me... i mean, they broke down the catagories of medications, common side effects, most of what we learned in nursing school.

i worked in a psych hospital years ago, and i was also certified to administer meds (oral, only). even ordered stock meds from the pharmacy. i was only 20 years old at the time and had no idea of how serious this is. all of the mistakes that i made that 'didn't seem like a big thing'. they eventually took that task from us, but still! basically, the going message is that anyone can give meds. even back then, our literature was not even close to this book i received, and no way, no how did we ever learn about insulin injections! heck, i could have used it for my lpn program!

this does not mean that all medication aides are stupid in the least. but it seems that the line between being licensed or not is getting thinner and thinner.

[johnsboo]

I've been doing it for years as an aide in the hospital here in missouri. The nurses never had any problem with it, it is standard practice. It frees up the nurses to do their jobs.

[dblpn]

i'm not surprised this is happening. our instructor the other day told us that UAP's (unlicensed assistive personel [cna's, techs etc..]) could no longer do insertion of foley catheters b/c of the increase of infections among patients. so no surprise here.

[dblpn]

I've been doing it for years as an aide in the hospital here in missouri. The nurses never had any problem with it, it is standard practice. It frees up the nurses to do their jobs.

hey john, i'm in missouri as well. i've been doing fingersticks for years too and never had any problem. i dunno, probably some aide screwed up somewhere and now a chain reaction has started where all of us have been deemed incompetent to perform this simple task.

[Eaglelady]

I work per diem on med surg floors and each unit has different rules, so to speak. Some require the CNAs to go directly to the medication nurse to inform them of the fingersticks immediately, no matter what it is, others don't come at all. Some do it even if it was requested that the nurse do it. I'd rather do a second stick under confusing circumstances if I had to administer insulin. Now, it is a mute issue since they are not allowed in my hospital any longer.

Well here in Florida techs still do them including all vs as well as insert foleys (not mine b/c I do them myself)

[herring_RN, ASN, BSN]

Honestly, I think this is just another example of something that some RN's don't want to give up/are "possessive" about, in thinking that only they can do. We have seen a lot of this on the council that I'm on, as we review the LPN/CNA task lists. Several RN's have a hard time delegating ANYTHING. We have gone to using automatic blood pressure cuffs quite a bit more than we used to, and I'm OK with getting VS from my CNA's (and I would also be OK with it if they were doing them manually, I TRUST them, and it's within their scope of practice).

If you have a patient on routine blood pressure meds, do you always do your own VS? If a CNA tells you a patient's temp is elevated, do you recheck it before giving them Tylenol, or whatever? I don't, necessarily. They know how to take a temperature.

I guess you could use the argument then, that the RN should always do peri-care, too, since the CNA can't *assess* skin and therefore might miss signs of breakdown....one more thing you'd better do. Especially if they need Sensicare or some other skin barrier cream put on, right? If it has to be put on, you'd better be the one doing it, and looking at why, every time.

I agree with the comparison to lab results. I don't have to go down to the lab and run my own CBC to believe that the Hgb is low, and that those 2 units of PRBC's need to be administered.

A FSBG is not an invasive procedure.....

I work in critical care. We have one CNA/secretary for 21 patients so of course I do my own VS, baths, and cleaning. We help each other for lifting that cannot be done by one person.

Our CNAs are invaluable but no way can one person do it all.

When I float to telemetry or med/surg I don't always know the competency of the unlicensed caregivers. I do know that to be certified a CNA must have their competency for vital signs, I&O, and ADLs validated by observation.

But when we lobbied for the law the houskeepers and dietary staff were only given 16 hours of orientation, including BLS, before replacing a aid off RN. Often the same RN who 'trained" them. I think they were taking advantage of them because they had them replacing registered nurses for very low pay.

They were neither educated nor experienced for the responsibility placed on them. I know for sure that one patient died due to this.

I floated and arrived early. An aide had written over and over on the med cart, "C/O pain." The patient was having an MI. I went in and got the patient transferred to CCU but the patient coded a couple hours later on route to cath lab.

An experienced CNA would know to report chest pain STAT. This person just knew it wasn't yet time for pain medication. This was NOT a certified CNA. Not someone who had chosen patient care. just didn't want to lose a job.

Now it is not legal. But we had to make our hospital follow the law:

http://www.rn.ca.gov/pdfs/regulations/npr-b-29.pdf

We have worked to keep our LVNs and experienced CNAs. LVNs are assigned to work with the high acuity patients.

Our younger LVNs have earned their RN. Older experienced LVNs are as competent as any RN but don't have the same legal authority. SO we work as a team.

[Effie, RN]

...we have worked to keep our lvns and experienced cnas. lvns are assigned to work with the high acuity patients. our younger lvns have earned their rn. older experienced lvns are as competent as any rn but don't have the same legal authority. so we work as a team.

the key here is knowing the knowledge level of the practitioners and everyone working as a team! it's not supposed to be about egos or letters after your name, it's about using everything you know and everything everyone else knows to make sure the patient gets the appropriate level of care.

[jackiesue94]

This past week at work I had a graduate nurse helping with tasks before she takes her boards. What I didn't like is my own 'disconnect' with the glucose readings she reported to me. I guess I actually do quite a bit of assessing while going through the task of checking the patients glucose. I have 28 residents to care for so I m super busy with 8 of them ac and hs checks...and yes I had more time to chart but I also learned that by doing them myself I really take better care of them.

[matt59]

Where I did my clinicals, CTs did the sticks but could not take pusle-ox. I was told that the rationale behind this was that O2 is considered a med....

In the 2 jobs I've had since as an RN, it was only nurses that took the sticks, but the aides did take pulse ox.

Matt

[island40]

I've had units where the CNA did glucose monitoring and units where the LPN & RN only did them. It really depends on the staffing mix that you have which is going to work better for the client. Having a nurse so overloaded with work that the clients are at risk for hypoglycemic shock is a situation that would probably not be helped much safety-wise by having the ancillary staff do the glucose checks.

[maagsix]

I work on a critical care step down unit and our Techs do our chemsticks. We are on a computer system so when the chemsticks are taken they go into the computer system where they pop up under lab results. If the chemstick is below 60 or greater than 150 our techs come and report the results to the nurse.