Lab and nursing

Good topic.

- What types of miscommunications do you notice the most?

- What type of information for our understanding would you like to share with us?

Hi. I'm a medical lab scientist and wanted to connect with nursing staff. It seems there is a lot of miscommunication between the two departments. I'm hoping to learn from you guys what lab can do to improve relationships. Most of the nurses I work with are awesome and they have my deepest respect. I could never do what you guys do. That being said I sometimes feel that nurses need more understanding of exactly why we do the things we do on lab. Hoping to get some positive feedback on how we can both help each other.

There are no conflicts between lab and nursing at my job ...in fact, there are no conflicts between any departments. When people are at each other's throats, it's usually due to short staffing. When there's plenty of help to go around, nothing seems too upsetting to anyone.

Not any animosity at my lab either. Just things like they don't understand why we can't take hemolyzed specimens. Or clotted specimens. The length of time it takes to run tests. I guess I'm more interested in answering any lab related questions or taking suggestions from you guys on an informal basis.

Interdepartmental communications is a big issue at large companies.

I work at a very large international conglomerate where interdepartmental communication is critical, not just for the day to day items but for technology sharing and innovation. I have noticed that there are several formal and informal interventions that have sprouted from this need;

-Networking lunches. I would say that the vast majority of employees spend 3-4 days a week eating lunch with a different person from a different department. The simple act of spending 30 minutes eating with someone from a different department is super simple but incredibly effective. When is the last time you sat down with a nurse and had lunch?

-Poster sessions. In most large technology companies and in many hospitals there is some kind of periodic poster or presentation session. Many hospitals have "skills fairs" for example. The lab can create an educational poster and present at one of these functions.

-Open houses. The lab can host an open house where nurses can come in to learn about the lab and network.

Not any animosity at my lab either. Just things like they don't understand why we can't take hemolyzed specimens. Or clotted specimens. The length of time it takes to run tests. I guess I'm more interested in answering any lab related questions or taking suggestions from you guys on an informal basis.

It's not that we don't understand why you won't/can't take hemolyzed/ clotted specimens it's that it's frustrating to get blood from a hard stick or need those lab values for treatment now and find there's something wrong with the sample. Not your fault or our fault, just frustrating.

Especially when I have no idea why it hemolyzed. However, I don't recall ever taking my frustrations out on lab. I like our lab people. Much better that I did at my previous hospital. The night shift lab person there was NOT FRIENDLY.

Interdepartmental communications is a big issue at large companies.

I work at a very large international conglomerate where interdepartmental communication is critical, not just for the day to day items but for technology sharing and innovation. I have noticed that there are several formal and informal interventions that have sprouted from this need;

-Networking lunches. I would say that the vast majority of employees spend 3-4 days a week eating lunch with a different person from a different department. The simple act of spending 30 minutes eating with someone from a different department is super simple but incredibly effective. When is the last time you sat down with a nurse and had lunch?

-Poster sessions. In most large technology companies and in many hospitals there is some kind of periodic poster or presentation session. Many hospitals have "skills fairs" for example. The lab can create an educational poster and present at one of these functions.

-Open houses. The lab can host an open house where nurses can come in to learn about the lab and network.

As a nurse, I don't actually remember when I last had a sit down lunch that wasn't at the nurses desk. I think it was my first day of orientation.

I'm not a nurse yet, but I do volunteer at a local hospital. They recently had an event where the lab made up several tri-fold boards on different procedures and practices explaining the how/why of certain things that pop up often. It was very well attended, both physicians and nurses. The free food may have helped, too. It's a once a year thing, to keep people in the loop with lab stuff. Maybe that's something you can look into.

I would like some insight into how samples occasionally get lost when in the lab. Not sure it happens where you work as it could be something with where I work.

At my last job, all nursing staff had an orientation session where we toured lab and pharmacy, then had short classes on the major topics of concern in each department. Super helpful; it gave me a greater appreciation for how massive the lab was, and the specific challenges we can encounter (like why a CBC with diff takes exponentially longer to result than a crit). For NICU, it also helped me appreciate how much the crit affects the volume of serum available to run tests, since our volumes are minuscule. Every year we had a short continuing ed module on the basics (why hemolysis happens, tube order).

This may be specific to NICU, but we also have an amazing reference packet with the tube color and specific volume we need for each lab (along with any pertinent notes, like sending on ice). In NICU, our most frustrating call is always 'insufficient sample' since the kids are so tiny. We have far fewer issues when using the reference packet. It's also way less annoying for lab staff, since we aren't calling before every lab to ask how much is sufficient to fill the microtainer.

I kind of want a bumper sticker that says "Hemolysis Happens"

*Shrug* ¯\_(ツ)_/¯

I have been in hospitals where there is a lot of animosity between lab and nursing staff, and I was a point of care coordinator at a prior system and had a lot of experience on the lab side of things. I think that everything comes down to two main issues: bad apples and frustration.

Frustration is the less controversial topic. Simply put nursing staff get frustrated when they have a patient rapidly deteriorating who have sent a EDTA tube for a CBC 3 times, and every time they hear that it is clotted. You can replace this with most of the lab tests we run and nurses very quickly are pushed to their wits end. This builds up day after day, patient after patient. This is not the labs fault in any way, but is a huge cause of stress for nurses.

Bad apples are the more difficult topic, and many will want to argue that this doesn't exist (it does, both in the lab and in nursing). I have had lab techs give me the most inane excuses for why the sample will not work. I have been told that my EDTA tube was hemolyzed so that they could not run the CBC (wait it gets worse) but they were able to result the chem panel from a SST on the same draw. I have been told that my urine sample opened up in the tube system when I had personally walked the sample up to the receiving desk ( I have been told the same thing for CSF, which I will never send through a tube system). I have had countless draws where I was told that the sample was hemolyzed but I still had a tube from the same draw for POC testing and wasn't the least bit hemolyzed.

I never worked for the lab, but I do remember getting a phone call from one of our POC sites and they wanted me to push through a sample that was so far out of the QC parameters for the machine that it wouldn't even populate a result for half of the indicies, the patient had no prior testing, and "I think it just clotted" when I asked if there was enough for me to plate the next day to make sure the sysmex wasn't acting up. I can't imagine getting those phone calls on a daily basis, and I would be willing to bet that the lab hears these kids of excuses just as much as we get them.

If a sample was dropped, I'd rather just be told that the sample dropped. If a machine is broken and the samples are being sent out to another facility, please tell me (a TAT of 3 hours for an ETOH level is sooooo frustrating)! If I'm told a sample is hemolized so I ask for a tech to come collect it, it's not because I'm being lazy or retributionary but rather I truly don't think I can collect the sample, so please don't scoff at me.

From the nursing side I wish people wouldn't take shortcuts. I had to hear about how our POC strep rates were dropping compared to cultures, but the collecting provider or nurse barely touched one tonsil. Or would collect a viral panel on a flocked swab and barely go just enough to no longer see the swab on only one side of the nostril. Or seeing a clot come out of a syringe and have it still put into EDTA tube, like why do you think this would ever work for a CBC !?!

I think a huge part of the difficulties is that nursing staff largely think that the people who work in the lab just put the tubes in machines to get results, and that the majority (at least of MLS) have at least a 4 year degree, and really know their stuff...

My new job has a gas machine on that unit that nurses are trained to run, and believe me it was a humbling moment when I ran someone's gas and the machine said it was clotted. I was so scared to go back and tell them. Actually knowing how the machine works I have a much better understanding why it is so easy for cap tubes to leak.