No More Fingersticks for Techs!! - page 4
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... Read More
May 26, '09Joined: Dec '02; Posts: 41,761; Likes: 48,078Quote from Roy FokkerBefore I became a nurse, years ago, CNA's did foleys and accuchecks and other duties I learned were nurses responsibilities. (This must be the time herring is talking about).My old hospital, techs were permitted to insert foleys and do accu-checks.
Now in my ED (different state), techs can do accuchecks - no foleys.
I was shocked when I first came on allnurses and learned other states allowed CNA's to do things I thought were only nurses responsibilities.
I've never had a CNA do a blood sugar or insert foleys. I agree with that.
May 26, '09Occupation: Licensed Practical Nurse Specialty: Community Health, Med-Surg, Home Health ; From: US ; Joined: Sep '05; Posts: 9,297; Likes: 8,221Quote from morteNot sure just yet what basis influenced this decision, but I'll ask...it seems that I am asking them a great deal of questions lately. This time, I sent an email on their stance on medication aides in New York...if they make an error, who is ultimately responsible? The tech or the nurse? I know that is another issue that is beat to death on this forum, but I want to know what position the BON of my state has on this. Recently, a friend of mine who works for the handicapped told me she is being certified to give meds, and when I asked her who had the ultimate responsibility, she told me that the tech responsible for giving that med is. I told her I would email the BON for myself, because it could be that this facility is scaring the techs into thinking that they are responsible (hopefully scaring them to death to keep them from messing up).it is entirely dependent on the "quality" of your tech.......the computor linked glucometer is also a good thing...makes it harder to lie. I think most of us can remember a tech or two, lying about VS or something else...if not personally, it has been mentioned here at AN more than once......the last two hospitals that i worked at (none particularly recent) the techs did routine blood sugars.....but they were long term, well trained, ACCOUNTABLE sorts of persons......Out of curiosity, on what basis did the NY bon decree this?
May 26, '09Joined: Sep '07; Posts: 2,475; Likes: 8,793"I doubt it's the CNAs aren't being taught it, but more that for some of them it's not "sticking." I have one aid I work with who's just awesome. She understands the importance of reporting vital signs, even down to interpreting it past just a raw number (BP of 95/50 in someone who's sleeping soundly and has been 100/60 all week versus in someone who previously had HTN and is also febrile and tachy)."
And that's what drives me nuts when I hear people say CNA's don't use/need critical thinking.
And even if they report low vitals on a sleeping pt who normally runs low... well, at least they're showing sense to report what MIGHT be wrong. Then when they report it and the pt is assessed, the nurse can at least use that as a teaching opportunity for the tech and encourage the tech to keep up the good effort and keep reporting!!
May 26, '09Joined: May '06; Posts: 1,288; Likes: 940Quote from c0ntagionI love these! Where I work, they call this the VAMP system. There's a good picture of one here: http://www.edwards.com/products/pres...g/vampplus.htmA "safe set" is an extension which connects to the pressure tubing. 10 ml of blood is drawn back into a syringe device and then locked off - that's the "waste." There are ports distal to this which blood can be obtained from with a syringe. The 10 ml of blood is then unlocked and flushed back into the patient, and then the fast flush is utilized to flush through the extension tubing. We don't access the central lines for glucoses unless it's at a longer time interval (like 4-6 hours) just because we'd be wasting 240 ml of blood a day on some of our poor patients... heh.
May 26, '09Joined: Mar '04; Posts: 17,903; Likes: 37,167Quote from Hygiene QueenWe found it disturbing that licensed nurses were being replaced with unlicensed assistive personnel.As long as the tech understands the WHY of reporting abnormals, why shouldn't they do fingersticks? It's like vitals. Understanding WHY should behoove the tech to report their findings with integrity.
I find it disturbing that a lot CNA's are not being taught this.
Whenever you give away part of your practice you are going to have less time for your patients.
At too many hospitals the RN is always at the computer while an unlicensed person is providing the care.
Only a NURSE can perform the entire nursing process.
Safe staffing by acuity with ratios are the solution to many unsafe situations, including "Failure to Rescue".
I've attached the law we worked for 12 years to get passed.Last edit by herring_RN on Jun 13, '09
May 26, '09Joined: Jul '08; Posts: 4,274; Likes: 12,969Quote from Reno1978That looks awesome.I love these! Where I work, they call this the VAMP system. There's a good picture of one here: http://www.edwards.com/products/pres...g/vampplus.htm
May 26, '09Joined: Dec '05; Posts: 4,143; Likes: 4,405Granted I'm still just a nursing student with limited experience. However, I do not think techs should be able to insert foleys. From my limited experience in clinicals, with what I've seen, some of the techs just can't be trusted to use aseptic technique.
May 26, '09Occupation: RN-emergency Specialty: 5 year(s) of experience in neurology, cardiology, ED ; From: US ; Joined: May '07; Posts: 525; Likes: 658Quote from SuesquatchRNI've worked at three hospitals in NYS (as a tech)My techs have never done this and I'm in NYS. Only nurses.
at two of them I did (do) blood sugars and draw labs except off of a central line
at the other, the RN did all.
May 26, '09Occupation: RN and blogger extraordinaire Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psych ; From: OR, US ; Joined: Sep '02; Posts: 26,953; Likes: 44,668I work in LTC, where the med aides are trained to do FSBS and the CNAs are allowed to check SaO2s. I'm one of the only nurses who will actually allow the aides to check sats, mainly because it's non-invasive; and as long as they remember that it's MY job to interpret the readings, I see no problem with it. Most of the other nurses are really anal-retentive about it; I'm not sure if it's a power trip or what, but I've never had a problem with results not being charted. There are a couple of aides who used to not report skin problems or a slow heart rate in a resident with a history of A-fib because "the other nurses who work on this unit won't even come and look at the resident," but that's been corrected..........they know that I want to know EVERYTHING, and it's up to me figure out what to do with the information.
However, I don't let the CMAs do fingersticks unless I've got some sort of emergent situation going on......I'm so used to my routine of running around with my diabetic supply basket, checking the AC & HS blood sugars and then drawing up and administering the insulin (or the Glucagon, in some cases!). It's much more efficient than having the med aide interrupt her med pass to do the fingersticks (we currently have ten of them at dinnertime) while I wait to do insulins. Besides, this takes me into rooms I don't usually have much reason to be in otherwise because the roommate needs few or no nursing interventions, and I catch things sometimes before they get out of control, so everybody benefits when the nurse does the fingersticks!
May 26, '09Occupation: Obs Unit Specialty: Telemetry & Obs ; From: US ; Joined: Oct '03; Posts: 2,412; Likes: 1,820NC here....and CNAs do the fingersticks. Of course I follow up any highs or lows and so far haven't had any problems with it.
May 26, '09Occupation: Licensed Practical Nurse Specialty: Community Health, Med-Surg, Home Health ; From: US ; Joined: Sep '05; Posts: 9,297; Likes: 8,221What I find interesting is that while the BON of NY does in fact state that UAPs are not to do fingersticks and my hospital is complying, there are other facilities right here in NY that are still allowing their unlicensed personnel to perform these tasks. I don't know if it is because they do not know, or that they have a special reason why they are allowed to (it seems to be so much of that theses days). That is why I started this thread...and it appears that there are a few New Yorkers responding that they they are still doing them. Perplexed...I'd think that hospitals would be more vigilant about these things.
May 26, '09Occupation: Psych Nurse Specialty: 1 year(s) of experience in Psychiatric Nursing ; Joined: Jul '08; Posts: 217; Likes: 169In my area the local hospitals are able to delage fingersticks over to the CNA/PCT and often times do. Within my specific hospital the RNs must do it. I work in an acute care psych hospital and do not come across very many medical procedures and really dont mind doing the fingersticks myself I just was supprised that we do not have the ability to delagate if we need to.
May 26, '09Occupation: Certified Medical Assistant Occupational Medicine Specialty: 13 year(s) of experience ; From: US ; Joined: May '09; Posts: 7; Likes: 4medical assistant's can do them.....but then again, m.a's are not subject to the findings of the bon. if the term tech serves as any clinical technician, then wouldn't that be the decision of the medical director? as for all clinical procedures, m.a.'s have standing orders from our physician so we can perform procedures when the physician's are not on site. there are some benifets to being an m.a.