No more phlebotomist in the hospital?! - page 5

by squatmunkie_RN

5,581 Views | 50 Comments

The place I work for wants to get rid of all phlebotomist and make nurses do lab draws. I work on a telly floor. This means many lab draws that get ordered all ..day.. long.... K+, Mg+, Troponin, PT. Not to mention nearly... Read More


  1. 0
    Quote from psu_213
    Its not about practicing, it's about becoming proficient. If you draw blood from 25 people, there might be no one that is a hard stick. Well, suppose the person that is coding is a hard stick...even the nurse who is drawn those 25 "easy" sticks is a lot more likely to get the blood from the hard stick than a nurse who has never stuck someone.
    I suppose I made a poor choice in words. I'm not saying nurses shouldn't do blood draws ever. (In my mind, the addition of "maintain" after "practice" implied a level of achieved proficiency to be maintained.) I agree that nurses should be proficient at blood draws and that having all patients be nurse draws makes this more likely to be the case.

    On floors where patients tend to code or deteriorate quickly/higher acuity floors like ICUs/IMCs, I've noticed that the nurses are very good at their own blood work (because they don't even bother with waiting for phlebotomy or IV access). But again, these are all floors with lower patient ratios. That's not to say a patient won't suddenly code on a busy and understaffed lower-acuity floor, because obviously, that happens and the nurses are out of luck if no one is a proficient stick (but hopefully if the nurses aren't running around with too high of a task load, their patients stay safe, promptly- and well-attended, and don't get to that point!)

    In OP's case and with the way I've seen many hospitals structured, I still support the use of phlebotomists, at least for AM labs. I would hope hospitals where nurses are not proficient at blood work due to phlebotomy/IV teams make sure their patients always have an extra IV access/hep-lock for emergencies and quick RRT/code teams. In my experiences, this was always standard protocol and has been the case anyway, but perhaps others are not so lucky.

    IMO, if less phlebotomists, more nurses please (though it seems the latter is asked for super often anyway...)
    Last edit by renardeau on Dec 30, '13
  2. 0
    Quote from dorénavant

    IMO, if less phlebotomists, more nurses please (though it seems the latter is asked for super often anyway...)
    If less phlebotomy, they certainly aren't going to pay for me which is 3 times their average wage where i work.
  3. 3
    I work in ICU and we do not have a unit clerk, nor do we have nursing assistants. When we get an admission, we are putting orders in the computer, doing the entire admission process ourselves, all of it~ including hygiene. The nurse has to do everything from start to finish. We do have the lab techs for blood draws, thank goodness, and our resp. techs do the EKG's. I am already the RN, the unit clerk, the bodily function clean-up person. I don't need any additional duties.
    teresaakin, RunBabyRN, and morte like this.
  4. 2
    My previous hospital we had pretty much no PCAs, no phlebotomy, no clinical support, no clerks. It was awful. Especially on an Onc floor where almost everyone is a difficult stick. Now that I've worked in a hospital that actually has support services, I wouldn't go back to the first unless there was no other alternative.
    RunBabyRN and RNperdiem like this.
  5. 3
    I don't understand how you don't do your own EKGs. What do you do if your patient complains of chest pain? Page the doc, wait for EKG order, page someone to do said EKG? Seriously it takes less then 3 minutes to do an EKG -- in that time you could have had it complete.

    I work in the ED and anyone with chest pain must get line/labs/EKG within 10 minutes of arriving into the department. The patient must also get triaged appropriately. We're busy but it gets done. If we can do this on top of all our other patients (4:1) then I'm sure with prioritization others can make it work.
    nrsang97, TraumaSurfer, and KelRN215 like this.
  6. 1
    Quote from lindsayalyssa
    I don't understand how you don't do your own EKGs. What do you do if your patient complains of chest pain? Page the doc, wait for EKG order, page someone to do said EKG? Seriously it takes less then 3 minutes to do an EKG -- in that time you could have had it complete.
    I've worked cardiac and ED, and I've never done my own EKGs. We page EKG when a patient presents with chest pain at triage. Our hospital is so small, it only takes a minute or two for the EKG tech to get there. In the meantime, I'm gowning the person, putting them on the monitor, getting a full set of vitals, asking them about their chest pain (PQRST, etc), starting an IV, and letting the doc know we have a chest pain patient.
    RunBabyRN likes this.
  7. 3
    Quote from KelRN215
    I'd much rather do everything for my patients and have fewer of them than have to rely on a bunch of unreliable people.
    True, but OP's work is not giving them fewer pt's from the sound of it.
    RNperdiem, RunBabyRN, and ~*Stargazer*~ like this.
  8. 4
    Quote from Been there,done that
    You are missing the point. Phlebotomy is NOT a simple/basic task. It is an ADDITIONAL task on an already overworked nurse.
    I know, right? One stick *can* be a simple task if it's a 25 y/o athlete whose veins you could hit w/ a dart. But what about the edematous ones? (None of those in tele...) The CRF pt w/ no veins? Multiply that by SIX pt's on top of everything else that tele nurses do?

    Another point that I haven't seen brought up is that phlebotomists do phlebotomy all day, every day. They are very good at what they do. Personally I'd rather my pt. be stuck by the expert and not feel like a pin cushion than pat myself on the back for giving "total care." I know if it were me in the hospital bed, for routine daily labs, I'd rather be drawn by the one who does nothing but phlebotomy all day, every day.
    teresaakin, morte, RNperdiem, and 1 other like this.
  9. 1
    Quote from lindsayalyssa
    If we can do this on top of all our other patients (4:1) then I'm sure with prioritization others can make it work.
    That's the key: 4:1. Try 6-8 to one and report back how easy all these additional tasks are when added to your already busy day or night. Unless the number of patients per nurse decreases to compensate for the extra work, this is just wrong.
    RunBabyRN likes this.
  10. 1
    I'm still in nursing school, but I'm a former phlebotomist. I'm SHOCKED that my program hasn't taught us phlebotomy (and I'm entering my final semester). I'm grateful that I know how to perform it, but only a few of us do! I hope to see the use of phlebs in hospitals in the future, so that RNs can focus on all of the other care that needs to be done, though it IS good for RNs to know how to perform phlebotomy, come a code/stat situation. However, if an RN doesn't perform it often enough, they likely CAN'T perform it in such a stressful situation, where someone likely has awful veins, and an IV would be a higher priority (at least you can generally draw labs from an IV start).
    It's sad how many more tasks continue to be added to what nurses are expected to do, without better patient ratios.
    Here.I.Stand likes this.


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