No More Fingersticks for Techs!!

Nurses General Nursing

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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.

Specializes in Community Health, Med-Surg, Home Health.

What 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.

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Specializes in Psychiatric Nursing.

In 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.

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medical 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.

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Specializes in Critical care, tele, Medical-Surgical.
What 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.

We've found that so long as they don't get caught hospitals don't mind breaking the law.

Just like people speed and run red lights.

Only nurses have to be the police. We first inform them of the law and then, when necessary, report them.

No RN should be assigned to eight patients in acute care.

Why not an LVN to help do glucose monitoring, foley catheters, NG feeds and such?

Not an unlicensed person.

Violating the law places everyone at risk.

I don't trust a bar code to assess a patient.

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Specializes in LTC, assisted living, med-surg, psych.
We've found that so long as they don't get caught hospitals don't mind breaking the law.

Just like people speed and run red lights.

Only nurses have to be the police. We first inform them of the law and then, when necessary, report them.

No RN should be assigned to eight patients in acute care.

Why not an LVN to help do glucose monitoring, foley catheters, NG feeds and such?

Not an unlicensed person.

Violating the law places everyone at risk.

I don't trust a bar code to assess a patient.

You said it, Herring!!:yeah:

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Specializes in CVICU.

I never realized that techs doing finger sticks was such a controversial subject. Are the same people who are upset over this upset when an UAP also known as a phlebotomist comes in and draws their patient's blood?

I work on one of only 2 floors in my hospital where RNs are the ones who do peripheral sticks when needed, for lab draws. The other floor is the burn unit, which is understandable. However, I can call lab if I don't have time, or if the patient is a very difficult stick.

It's weird because all of the other ICUs and floors in my hospital have phlebotomists come stick their patients, but ours doesn't. I guess what I'm asking, is what's the difference between someone coming to draw your patient's blood, and someone doing a bedside finger stick? We're ultimately responsible for the results of both...it just saves the RN time if it can be delegated to someone else when necessary.

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I am very torn about all of this. I don't wish to diminish CNAs and say they aren't capable of doing this. Equally, this reduction of nursing to "tasks" clearly has become the thin end of a bloody big wedge.

As for inserting a foley no frigging way.

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Specializes in MS, ED.

Jersey here...

I am a third semester student working as a nursing assistant. On the floor where I work, techs regularly do all chemsticks; while we're obviously advised to be mindful of any stick outside the usual 'normal' values, we are also notified by a trending screen when the result is charted which will indicate an unusual number for that particular patient. Any value out of range is advised, immediately rechecked, and advised again.

On this particular floor, I may have 3-8 patients with chemsticks ac/hs on that shift. As much as I see our nurses run by with the med cart and for treatments, I'm not sure how sticks would get done if not able to be delegated.

Take my observation with a grain of sand, but I'm not sure nurses can reclaim 'nursing duties' as indicated by some in this thread, (through legislative means or otherwise), without addressing the larger issue: inadequate staffing and crippling ratios.

JMO.

Best,

Southern

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Specializes in Community Health, Med-Surg, Home Health.

Personally, I have no issues with assistive personnel doing fingersticks due to the swamped situation we have at this time. As long as they report promptly, that is all I would ask as a nurse. But, as mentioned, what I was seeing/hearing was contradictory to what the BON informed me of, personally. And, seeing some hospitals blatently ignoring this in my state is scary, because this may mean that we take more legal slack if something happens.

As an LPN, we are not supposed to assess, but we are also legally responsible for the outcome because we are the medication nurses. If I administer insulin, I am doing it based on the reading reported by the UAP. Now, I see that I have to be more careful, do a secondary stick myself to be sure and make sure that I report it to the physician or the RN I am working with so that we are all on the same page. Apparently, something deep and funky must have happened for them to make a rule on that all of a sudden, and I was curious to what other states may be doing the same thing.

What happens is that we are told to follow the policy and procedures of the hospital. But, if the facility itself is in violation, where does that leave the nurse?

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Specializes in CCU & CTICU.

I'm also from NYC and our techs still do our q2h sticks. (yes, that's all pts in the unit, q2h) They tell us the value when it pops up on the screen.

That's about all our night one seems to do, but that's another issue. :banghead:

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Specializes in Community Health, Med-Surg, Home Health.
We've found that so long as they don't get caught hospitals don't mind breaking the law.

Just like people speed and run red lights.

Only nurses have to be the police. We first inform them of the law and then, when necessary, report them.

No RN should be assigned to eight patients in acute care.

Why not an LVN to help do glucose monitoring, foley catheters, NG feeds and such?

Not an unlicensed person.

Violating the law places everyone at risk.

I don't trust a bar code to assess a patient.

I'm also from NYC and our techs still do our q2h sticks. (yes, that's all pts in the unit, q2h) They tell us the value when it pops up on the screen.

That's about all our night one seems to do, but that's another issue. :banghead:

This is the very thing I am speaking of...the BON of NY states that this is now not allowed, but I am finding that many of the major hospitals with big reputations are still doing it. I told my friend about it who works for a very influential facility that cares for many celebrities. First thing she said was "I'm not telling the PCAs this, nor administration. We have to do fingersticks for patients q2h. We'd be swamped!!". If my hospital is aware, then, the others MUST be. What happens if push comes to shove and the entire facility is wrong?!

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
It has not been OK in my state for a decade.

I was one of thousands who worked for this law.

Once before rations I had eight patients on telemetry. Six were diabetic. The CNA gave me a list of room numbers and accucheck numbers.

One was listed as 47 so per parameters he told me.

I went into the room with D 50, a standard protocol on that unit unless the MD orders otherwise.

The room mate of the patient who supposedly had the low BS was seizing.

I called the resident, did another accucheck, and when it was 39 gave the dextrose to the patient with the actual low glucose.

Nursing is a process, not just a series of tasks. The licensed person who does the fingerstick (or any bedside lab testing) must be the person to respond to the result.

I think you need more nurses.

Good for the BON!

This is the main danger, imo. I had a mix up once years ago with roommates.

We have techs do our blood sugars where I work. Because there are so many diabetics on telemetry units, there is always the chance of a mixup, but we're so busy! Our blood sugars, however, do show up on the patient's lab profile, since their wristband is scanned before their blood sugar is obtained. However, everyone usually goes by what is written on the sheet.

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