No More Fingersticks for Techs!! - page 5

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

  1. by   herring_RN
    Quote from pagandeva2000
    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.
  2. by   VivaLasViejas
    Quote from herring_RN
    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!!
  3. by   WalkieTalkie
    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.
  4. by   2BSure
    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.
  5. by   amarilla
    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
  6. by   pagandeva2000
    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?
  7. by   Cindy-san
    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.
  8. by   pagandeva2000
    Quote from herring_RN
    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.
    Quote from Cindy-san
    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.
    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?!
  9. by   FireStarterRN
    Quote from herring_RN
    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.
  10. by   Tait
    You know the more I think about this thread, the more it irks me.

    I have noticed, when we have float techs and RN's from the same floor, and specifically from the floors where the techs do the lab draws, they are much more respectful of each other. The RN's trust them, the techs feel respected and like they have a place on the floor.

    I understand we all have the responsibility to maintain nursing process, however we were also trained in school to delegate, communicate and be responsible.

    I feel the more we take away from our techs the more disgruntled and dissatisfied they will become. Just because they haven't gone and gotten the degree, does not mean they haven't taken this role as the Queen Cleaner Upper of sick and sometimes angry, heavy, back breaking patients, because they want to make a difference.

    Now imagine you had a simple, but valuable role. To take vital signs, and sugars to help in the protection, care and safety of your team. Now imagine someone came along and told you you were no longer trustworthy of that, because apparently to be "smart" enough to recognize 30 is a "bad" number, you have to have 2-4 years of schooling?

    I am sorry but if you are going to take away this simple, delegated task, then you might as well take away vital signs as well and tell your techs the only things they are good enough for, is taking so and so to the bathroom and cleaning up the vomit from room 543.

    Then lets see what kind of people you have left in the underrated profession of tech/CNA/PCA.

    I am sorry, but I don't agree with 90% of the posters in this thread. Either let them do their job, or get rid of them entirely.

    Tait
  11. by   Aneroo
    Techs are allowed to do them here. Yes, it is up to the nurse to make sure that the skill delegated was performed correctly. It is up to the nurse to make sure that an abnormal value has an appropriate follow up- Just like vital signs. It's equally dangerous for a tech to fail to report a blood glucose of 49 as it would be for them to fail to report a blood pressure of 70/30.
  12. by   Aneroo
    Quote from Aneroo
    Techs are allowed to do them here. Yes, it is up to the nurse to make sure that the skill delegated was performed correctly. It is up to the nurse to make sure that an abnormal value has an appropriate follow up- Just like vital signs. It's equally dangerous for a tech to fail to report a blood glucose of 49 as it would be for them to fail to report a blood pressure of 70/30.
    I wanted to add- This is all part of the delegation process. Making sure that the person you are delegating to is properly trained in doing a procedure, whether it's removing a foley, taking a blood glucose or taking a temp is a MUST. Again, the nurse has a duty to make sure the value is accurate before taking action. I wouldn't go in and push labetalol on a patient with a reported BP of 200/100 without double checking it myself first- therefore I also wouldn't go give 10 units of insulin for a high glucose reading without doing another reading as well. I've learned this even more in school nursing- I make sure my diabetics have an extra glucometer here at school. If they forget theirs, they come here to check b/c that machine does not leave my office. Many times I've had students get a false high reading b/c of something wrong with strips or glucometer. I would have been up the creek had I acted on what they told me without double checking that value first.
  13. by   pagandeva2000
    I understand your point, Tait...it undermines the skills and the relationship with the techs for sure. I guess what I am trying to say is that there is no consistency, even though the BON made this rule. Most people follow the policies and procedures set by the facility they are employed with (or they should). If the facility themselves is in violation, then, where does that leave the nurses and everyone else, for that matter? Here is the scenerio I imagine coming from facilities that are not adhereing:

    - Abnormal glucose from tech that (according to the state is not allowed to do this in the first place. Not reported.

    - Nurse follow through with treatment, adverse reaction occurs because she did not get report for some reason.

    - Investigation occurs, nurse may be blamed, then, somehow, it is discovered that the tech was not supposed to do this in the first place, but has been allowed to for some time. Then, whose back does this lie on?

    As I am reading this thread (had no idea it would have many participants), I see the inconsistencies...not with the contributions from our members, but from the BON/facilities. The facilities, to me, seem to be darting away from the issue as long as they can get away with it. Again, let me repeat, personally, I have no issues with anyone doing it as long as it is reported to the proper discipline. Allow everyone to retain their value, their contribution to patient care and to the health care team. But, I see that the inconsistencies allowed between facilities versus what is supposed to be legal are the same things that bring problems that cause discord between caretakers and can lead to a negative outcome in patient care.

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