No more phlebotomist in the hospital?! - page 6

1. 
   Dec 30, '13

   This is NOT&nbsp; about pitying (poor)??? RT ,EKG, or phlebotomy techs. This is about supporting nursing intervention. The RN directs the required interventions from all disciplines.<br><br>I need NO reminders to mind MY manners. I always respectfully request the support of ancillary staff that have been assigned to assist me in my nursing interventions.<br><br>Over 25 years of bedside nursing... no problems with achieving team support.<br>
2. 
   Dec 30, '13

   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
3. 
   Dec 31, '13

   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.
4. 
   Dec 31, '13

   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.
5. 
   Jan 1, '14

   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.
6. 
   Jan 1, '14

   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.
7. 
   Jan 1, '14

   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.
8. 
   Jan 1, '14

   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.
9. 
   Jan 1, '14

   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.
10. 
    Jan 1, '14

    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.
11. 
    Jan 2, '14

    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.
12. 
    Jan 2, '14

    As I've mentioned in other posts on here, where I used to work, night shift, we had 8-9 pts. No phlebotomists, our techs didn't do vitals or accuchecks. We did have RT, and we did have someone to do our EKGs though. But we made it work.
    And seriously, where I am now, I've rarely seen my stat labs actually drawn stat if the phlebotomists do them. Usually, I'll do them myself, and they show up an hour later for the 'stat'. Timed studies? Forget it. However, as others have mentioned, they are awesome at what they do. They often find something where I haven't been able to.
    OP, I do agree though that if you guys don't have techs or CNAs at all, that ratio is a bit intense.

    Last edit by uRNmyway on Jan 2, '14

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