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Coming Soon? Will Nurses be Taking Over the Lab?

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The Center for Medicare and Medicaid Services recently ruled that a BSN is equal to a bachelor’s degree in a biological science for high complexity testing personnel. What does this mean for nurses and for lab scientist?

Specializes in CVICU/ICU. Has 24 years experience.

Coming Soon? Will Nurses be Taking Over the Lab?

It sounds crazy but a vague ruling but the Center for Medicare and Medicaid Services could be interpreted that way.

I have been discussing, with Clinical Laboratory Scientist's, what current communication between nursing and the lab is like and how we can improve this relationship. I have been working on trying to standardize blood collection across the continuum. During my research I found out that the Center for Medicare and Medicaid Services (CMS) recently ruled that a Bachelor of Science in Nursing is the equivalent to a Bachelor of Science in Biological Science.

Here is an excerpt from that ruling:

Quote
"Bachelor Degree in Nursing: A bachelor's degree in nursing meets the requirement of having earned a bachelor's degree in a biological science for high complexity testing personnel. The laboratory may show a PSV report verifying that a bachelor's degree in nursing was earned, a diploma with the type of degree earned, or transcripts as evidence of meeting the education personnel requirement. An associate's degree in nursing meets the requirement of having earned an associate's degree in a biological science for moderate complexity testing personnel. The laboratory may show a PSV report verifying that an associate's degree in nursing was earned, a diploma with the type of degree earned, or transcripts as evidence of meeting the education personnel requirement. "

I don't understand why this was done and would like to learn more. Where better to gather information than here on allnurses? Therefore, I am asking for you to help me in identifying what this all means. Can we wear any more hats? Is this going to put more stress on a career that is already overloaded with responsibility? Does this mean a BSN can be a lab director? Does this mean that a BS in Biological Science can be a CNO, or ICU director? Is this another way of dealing with shortages by trying to combine resources? Doing more with less? Both nursing and the laboratory science field are experiencing shortages. This is a very confusing ruling. (view attached pdf)

I can tell you that the Clinical Laboratory Scientist community is not happy and would like our support. The American Society for Clinical Pathology (ASCP) is encouraging everyone that has an interest to sign a petition to get the CMS to reconsider its decision. For starters the ASCP says a biological science degree requires three to four times more academic science than does nursing. This CMS ruling seems to be a very broad ruling and deserves to be scrutinized. This can cause a rift between nursing and the lab if the reasons for the ruling are not spelled out.

The ASCP Board of Certification (BOC) has been talking with staff from the Centers for Medicare and Medicaid Services (CMS) about this decision. The CMS memo does not provide a rationale or justification regarding this decision. The BOC communications are on behalf of the Board of Governors (BOG), whose member institutions include:

  • ASCP (American Society for Clinical Pathology)
  • American Association for Clinical Chemistry (AACC)
  • American Association of Pathologists' Assistants (AAPA)
  • Association of Genetic Technologists (AGT)
  • American Society for Clinical Laboratory Science (ASCLS)
  • American Society of Cytopathology (ASC)
  • American Society of Hematology (ASH)
  • American Society for Microbiology (ASM)
  • AABB
  • Clinical Laboratory Management Association (CLMA)
  • National Society for Histotechnology (NSH)

They are taking this very serious so it makes me think it deserves a good looking at. I wonder what the impact will be for nurses. With your help we can formulate what this ruling may mean to nursing and what potential impact this will have. In my limited research I can't find where the American Nurses Association, Nursing Boards, Nursing Unions etc. have weighed in on this subject. I don't think this subject matter has been exposed enough and may not be on their radar yet.

Have you heard about this? Has this affected your job? What do you think?

Survey-and-Cert-Letter-16-18.pdf

I am an RN inventor making and improving products and processes that will improve our quality of life. 24 year(s) of experience in CVICU/ICU.

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37 Comment(s)

i am thinking this is to cover NURSES for bed side testing, ie FSBS, guaiacing stool. Not to take over in the lab.

As one who holds both a BS in Biology and a BSN I can state, unequivocally, that the two degrees are not equivalent. Not even close. In my Biology program, I had to take 8 credit hours of REAL chemistry, with lab, 8 credit hours of REAL organic chemistry, with lab, 10 credit hours of REAL physics, with lab plus physiology, microbiology, genetics, bio statistics and a whole host of other REAL science courses. The BSN students at that university had watered down versions of a fraction of those classes. Most BSN nurses I currently work with can barely calculate IV infusion rates. Put them in a lab with real chemical calculations and they would be lost. Centrifuges, micropipettes, mass spectrometers??? There would be blood on the walls,.....literally!!!

WKShadowNP, DNP, APRN

Specializes in Hospital medicine; NP precepting; staff education. Has 20 years experience.

Absolutely not. My medical technologist mother-in-law already has a struggle with high-school educated and grandfathered in MLTs trying to tell her how to do her job. (Then there are the legitimate MLTs who have their undergraduate training but it's still not the same.) Not only does my MIL have her BS with a major in chemistry, minor in microbiology, she went for additional training to medical technology school and is certified by the ASCP. This requirement, unfortunately, is not universal in the states as licensing is for nursing.

Yes, what Harveyslake said. The science courses for nursing are not the equivalent of "for majors" science courses. I've taken both and they are night and day. I thinks it is very unlikely BSNs will ever take over the lab.

In California, regardless of your actual degree, you can be a CLS so long as you meet all the requirements. The allied health science courses that nurses take do not count. However, BSNs that did take the "real" classes would be in a position to meet requirements although given the number of units for all those classes the time to complete the necessary education would be extended considerably.

Academic requirements

  • Bachelor's degree (baccalaureate) with specific course requirements:

  • 16 semester or equivalent quarter units of chemistry, which must include clinical chemistry OR analytical and biochemistry.

  • 18 semester or equivalent quarter units of biology, which must include hematology, immunology, and medical microbiology.

  • 3 semester or equivalent quarter units of physics (light and electricity


  • Training or experience


    • Minimum one year of post-baccalaureate training

      OR

      Minimum one year of work experience.

    • Training or work experience must be comprehensive to cover all areas of the clinical laboratory.

    • Training or work experience must be in a clinical laboratory.

Examinations
The following certifying organizations are approved by the Department for the CLS generalist licensure examination:

  • ASCP
    certification

  • ASCPi
    (international) certification

  • AAB
    certification

  • AMT
    certification

There are also specialties within medical lab science:

https://www.cdph.ca.gov/programs/lfs/Pages/ClinicalLaboratoryScientist.aspx

Also, CLS/MLS and MLT are not equivalent. Medical Laboratory Scientists have a bachelor's degree. Medical Laboratory Technicians have an associate's degree or technical certificate. Some institutions and/or states limit the type of testing MLTs can perform. Generally, an MLS performs more highly complex testing requiring interpretations and correlation of data, as well as more intense trouble-shooting processes. (
http://thepathologycenter.org/MLS-Program/faq/
)

WKShadowNP, DNP, APRN

Specializes in Hospital medicine; NP precepting; staff education. Has 20 years experience.

Wintersoldier, thank you for that. My mother in law is an MT, not MLT, which sounds like the MLS you describe as she has the specific education you shared that is required.

adventure_rn, BSN

Specializes in NICU, PICU.

I wonder if they'd be advocating for more POC testing. In some ICUs, nurses use iSTAT machines to run a ton of POC labs, kind of like a glucometer that can also read blood gases, electrolytes, creat/BUN, crit/hgb, lactate, and cardiac markers. They're supposedly as accurate as standard lab tests (vs. glucometers, which are just screening tools), they're ridiculously easy to use, and they spit out results in 2 minutes.

There are tons of labs that nurses definitely aren't qualified to run or interpret (i.e. a CBC with diff), but if all units adopted iSTATs nurses would take over a much greater responsibility in running and interpreting basic, frequently ordered labs. I'm sure the machines and cartridges are expensive, but they can't be more expensive than staffing the lab. It would also require nurses to take a greater responsibility for interpreting lab values (since there isn't a lab tech to call and tell you, 'BTW, that pt had a critical result').

So no, nurses definitely wouldn't be qualified to 'take over' lab, but I wouldn't be surprised if over time nurses took a greater responsibility for running and interpreting POC tests as the technology develops.

Well - ok here is the thing:

People do not read the stuff thoroughly and to make it more dramatic say something like "CMS says the BSN is equivalent to the BS biology or Chemistry" and try to make it even more dramatic by suggesting the nurses will be flocking to the labs - take them over - and what not.

I wish people would reflect on the issue before getting all upset.

CMS does not really say that the BSN and the BS Bio or so are equivalent meaning they are the same. Of course they are not. Though there is the word "science" in BSN .... CMS put out that they view the BSN as a science for the purpose of lab testing , which would mean that nurses are technically allowed to perform certain tests in certain categories that were limited to staff the has studied a science science and have the lab experience.

The detail is important though - it could open up the possibility for nurses to also supervisory for labs especially if they are advanced practice nurses.

Does that make much sense? It depends. If you ask the laboratory personnel lobby - they are highly upset because they feel that nurses are moving into their arena and probably feel de-valued by this move from CMS. They are lobbying hard against this - there are some links below. But is it like many other things in healthcare - things change over time. Look for example at the "medication aids" in some states and facilities. Nurses were upset about it because they go to school and now a medication aid with minimal training can pass out certain medication (not they are really doing the same as nurses but for arguments sake). So for the purpose of passing out medication that is established and routine without high risk the CNA medication aid education is equivalent to the nursing education for this specific population and case. It does not mean that they are really "the same" So both are able and allowed to pass out let's say a cholesterol pill. But of course we know that the "education" is not really the same.

Is it a safety risk to allow nurses technical and theoretical to qualify per their BSN to perform moderate testing? That probably needs to be determined and looked it. I guess it also depends on the test. If you are a BSN and perform the moderate testing but have actually not passed the competency you are not qualified - with or without BSN.

I can not really see nurses running with wide open arms to the labs and perform moderate testing. It is probably less $$ and why would you go to nursing school if you wanted to do lab work???

I feel it is mostly about protecting their jobs and and attempt to draw some more boundaries around their profession. But again - nobody really said the the BSN and the BS Bio are the same meaning you have the total same knowledge. I honestly do not know a single nurse who would want to sit in a lab and waste their education on performing moderate testing or supervising a lab....

Internal Warning

"The American Society for Clinical Pathology (ASCP) is urging laboratory professionals and other interested individuals to sign a petition urging Centers for Medicare & Medicaid Services (CMS) to reconsider its position that nursing is a biological science for purposes of performing laboratory testing."

Press Start: Lead an Empowered Life as a Clinical Laboratorian : CMS Says Nurses Can Perform High Complexity Tests

https://www.aacc.org/~/media/files/legislative-issues/2016/061716_nurses_letter.pdf?la=en

Clinical Laboratory Management Association : Blogs : Tell CMS Nursing is NOT a Biological Science

"It also appears that CMS's position could allow individuals with as little as a bachelor's degree in nursing to direct a CLIA moderate complexity laboratory and/or serve in senior supervisory roles within a CLIA high complexity laboratory. Since the Clinical Laboratory Improvement Amendments (CLIA) of 1988 doesn't specifically require clinical training of individuals with a degree in biological sciences, CMS's new policy exempts individuals with a bachelor's degree in nursing from any specific training requirement prior to performing high complexity testing for diagnostic purposes."

Nerd eNurse, ADN

Specializes in CVICU/ICU. Has 24 years experience.

i am thinking this is to cover NURSES for bed side testing, ie FSBS, guaiacing stool. Not to take over in the lab.
The ruling states,"high complexity testing". My understanding is that for highest levels of test that are actually done in the lab. I will try to clarify that point. If it was that simple I wish they would have set parameters on the ruling. Thankk you for the comment!

Nerd eNurse, ADN

Specializes in CVICU/ICU. Has 24 years experience.

As one who holds both a BS in Biology and a BSN I can state, unequivocally, that the two degrees are not equivalent. Not even close. !
Thank you for the insight. Regardless of the impact on the ruling it would be good for nurses to know what really goes on in the lab.I had no idea how complicated blood analyzing was. I thought they put the tube into a machine and it spit out results. Wow was I wrong. Nurses have been doing POC testing for many years... why the need for a change now? Thanks again for the comment.

Nerd eNurse, ADN

Specializes in CVICU/ICU. Has 24 years experience.

This requirement, unfortunately, is not universal in the states as licensing is for nursing.
The clinical laboratory is one of the fasted growing departments in healthcare. Technology is constantly changing at rapid pace. That is why it does not make sense to water down the requirements... they need to define the requirements and make them national certification. Thank you for the comment.

Nerd eNurse, ADN

Specializes in CVICU/ICU. Has 24 years experience.

In California, regardless of your actual degree, you can be a CLS so long as you meet all the requirements. The allied health science courses that nurses take do not count. However, BSNs that did take the "real" classes would be in a position to meet requirements although given the number of units for all those classes the time to complete the necessary education would be extended considerably.

You are wealth of information... thank you. I think this comment kind of explains the problem. There are requirements and a BSN did not meet those requirements until this recent CMS ruling.

Edited by Nerd eNurse
spelling

Nerd eNurse, ADN

Specializes in CVICU/ICU. Has 24 years experience.

CMS does not really say that the BSN and the BS Bio or so are equivalent meaning they are the same. Of course they are not. Though there is the word "science" in BSN .... CMS put out that they view the BSN as a science for the purpose of lab testing , which would mean that nurses are technically allowed to perform certain tests in certain categories that were limited to staff the has studied a science science and have the lab experience.

Thank you for all of the information. I don't know who is upset but I am not. Yes, I did make a couple of provocative comments but that was to get attention for a subject that on the surface is not of great interest to nurses. As far as the impact of the CMS ruling goes.... what lab testing is a BSN not allowed to do? I am probably wrong but it looks like a BSN can do any testing a lab scientist is certified to do. I don't see why the ruling had to be so broad. I would like to know the intent of the ruling. I don't think nurses are going to flock to the lab but I wonder if nurses are going to be expected to take on more responsibility.

catsmeow1972, BSN, RN

Specializes in OR. Has 15 years experience.

Hmmm...I have done trauma, transplant, big arse complicated surgeries, etc. as an OR nurse. I've also dabbled in critical care (just not my cup of tea). I can draw out of a central line, I can run an arterial blood gases given to me by anesthesia. I can do I-stats. Great. I can look at the results and make a quickie assessment on it. FINAL decision on it comes from the surgeon/doctor OR the lab. I've taken a bunch of classes for my BSN. They were not so much watered-down as they were focused on NURSING, not LAB.

I love and appreciate my lab folks from the phlebotomist (some of those folks can draw from a rock and still get 4 tubes of blood) all the way to those running and managing the equipment and the seemingly infinite number of various specialties. No way in h*** could I do that.

No folks, Laboratory management cannot be filled by a BSN regardless of what asinine ruling has come from CMS. Just like another blooming discussion here on AllNurses, a BSW in Social Work does not qualify a person to do physical assessments, as a BSN does not qualify a person to do therapy for behavioral issues (just an example). A BSN qualifies me to be a nurse and take care of my patients. Also to know when to utilize my colleagues. Just because we all have a BS-something, in no way makes us interchangeable.

Nerd eNurse, ADN

Specializes in CVICU/ICU. Has 24 years experience.

Hmmm...I have done trauma, transplant, big arse complicated surgeries, etc. as an OR nurse. I've also dabbled in critical care (just not my cup of tea). I can draw out of a central line, I can run an arterial blood gases given to me by anesthesia. I can do I-stats. Great. I can look at the results and make a quickie assessment on it. Just because we all have a BS-something, in no way makes us interchangeable.

Great comments. The more responsibility we have the less we can spend thinking about giving the best care we can too our patients. If there is a need to have nurses do specific lab testing then CMS should spell it out or identify a BSN with what other requirements(science classes etc.) are needed. I think we need to keep these fields separate. If we don't pay attention to this ruling we may find that down the road they will rule that phlebotomist will be allowed to draw blood off of central lines.

Julius Seizure

Specializes in Pediatric Critical Care.

if all units adopted iSTATs nurses would take over a much greater responsibility in running and interpreting basic, frequently ordered labs. I'm sure the machines and cartridges are expensive, but they can't be more expensive than staffing the lab.

So, in my ICU, we aren't allowed to use the iSTAT for labs without a specific order from the physician that it is warranted.

The reason isnt because it costs more exactly....but the cost isn't billable to insurance in the same way. It is still about money, however you look at it.

Now, seeing as this memorandum came from CMS, perhaps it is aims at allowing bedside POC testing like the iSTAT to be billed equivalently. That wouldnt mean that nurses were taking over the lab, but would potentially expand the use of iSTAT testing which, especially in ICUs, could be a very helpful thing.

adventure_rn, BSN

Specializes in NICU, PICU.

So, in my ICU, we aren't allowed to use the iSTAT for labs without a specific order from the physician that it is warranted.

The reason isnt because it costs more exactly....but the cost isn't billable to insurance in the same way. It is still about money, however you look at it.

Now, seeing as this memorandum came from CMS, perhaps it is aims at allowing bedside POC testing like the iSTAT to be billed equivalently. That wouldnt mean that nurses were taking over the lab, but would potentially expand the use of iSTAT testing which, especially in ICUs, could be a very helpful thing.

Very interesting insight! I read a couple of cost analysis articles which found that iStat labs cost less than standard labs to run, but I hadn't considered the billing issue. I'm sure that hospitals don't give jack squat about the cost effectiveness of iStat testing if they aren't getting reimbursed for it at an equivalent rate. I definitely agree that patient care could benefit from increased POC testing utilization. Perhaps this new policy will help make that possible.

Nerd eNurse, ADN

Specializes in CVICU/ICU. Has 24 years experience.

The reason isnt because it costs more exactly....but the cost isn't billable to insurance in the same way. It is still about money, however you look at it.

Now, seeing as this memorandum came from CMS, perhaps it is aims at allowing bedside POC testing like the iSTAT to be billed equivalently. That wouldnt mean that nurses were taking over the lab, but would potentially expand the use of iSTAT testing which, especially in ICUs, could be a very helpful thing.

Good point but why don't they just say that in the ruling?I don't know if the ruling is good or bad but it definitely is broad. Thanks for the comment.