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.

[blondy2061h, MSN, RN]

Yeah, I've never seen a safe set used. We have special positive pressure caps that have an antimicrobial layer or some sales pitch to that effect in them. Just draw flush, draw back 10 cc waste, draw out 2ml blood, flush again. Safe set sounds like interesting idea to prevent blood waste. I think for our patients the advantage of not sticking them with such low platelet counts outways the risk. Plus, many of our patients have 5 lumen central lines so we can often avoid disconnecting a line to draw a glucose.

[Hygiene Queen]

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.

[blondy2061h, MSN, RN]

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.

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 then we have the aids who can't seem to hear the call light and could really care less if the O2 sat was 75%, they'll report it when they're done with vitals. Yet they've gone through the same training. One just cares about the patients while the other about the paycheck. The same goes for nurses, though the effort taken to get there tends to sway the nursing side of things a bit more.

[Spidey's mom, ADN, BSN, RN]

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.

cheers,

Before 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).

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.

steph

[pagandeva2000, LPN]

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?

Not 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).

[Reno1978, BSN, RN]

A "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.

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/pressuremonitoring/vampplus.htm

[herring_RN, ASN, BSN]

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.

We found it disturbing that licensed nurses were being replaced with unlicensed assistive personnel.

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.

[blondy2061h, MSN, RN]

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/pressuremonitoring/vampplus.htm

That looks awesome.

[Multicollinearity, BSN, RN]

Granted 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.

[86toronado, BSN, RN]

My techs have never done this and I'm in NYS. Only nurses.

I've worked at three hospitals in NYS (as a tech)

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.

[VivaLasViejas, ASN, RN]

I 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!

[truern]

NC 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.