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No More Fingersticks for Techs!!

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

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.

amarilla, RN

Specializes in MS, ED. Has 2 years experience.

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

pagandeva2000, LPN

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?

Cindy-san

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:

pagandeva2000, LPN

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?!

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

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.

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

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

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

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.

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

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.

pagandeva2000, LPN

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

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.

cherrybreeze, ADN, RN

Specializes in Med/Surg.

Yes, nursing is a process and not a series of tasks...but taking a fingerstick blood sugar is a TASK. A simple one at that. In the hospital, our CNA's do it (years ago when I was a CNA in the nursing home, the RN's or LPN's did them; not sure if it's changed in LTC in the 8 years since I've been an RN). I'm in WI.

Granted, the system is better now, since patient MR numbers are entered in to the accucheck machine at the bedside (we don't scan yet), so the results can be checked in the machine. Even still, IMO, this is NOT a task that an RN or LPN has to do. The CNA's, LPN's, and RN's all do the same yearly competency on taking blood sugars. They are all qualified to do it. Of course, it is the RN's responsibility to interpret the result, treat as ordered, whatever. That doesn't mean we have to do the stick itself!

Obviously, the CNA GETTING the sugar should be reporting it promptly to the RN, whether it's normal or not. I know I am extra-fortunate to work with amazing CNA's that I don't have to worry about abnormals not being reported to me timely. BUT, how hard is it for the RN, who knows what patients have blood sugars due when, to ask the CNA what the result was, if they haven't been told yet? Then either they get the result, or if the CNA hasn't done it yet, says, "I haven't done it yet, I'll go do it and tell you what it is." Simple. The whole "unreported" abnormal result issue is an excuse, in my book. All it takes is 2 seconds for the RN to ask what it was, if they haven't been informed. If you're not doing that, the problem is just as much yours as it is the CNA's that took it in the first place.

herring_RN, ASN, BSN

Specializes in Critical care, tele, Medical-Surgical. Has 49 years experience.

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.

I would copy the written response you received from the BON and show it to my colleagues.

Then write a letter stating that it is not not legal for unlicensed personnel to perform fingersticks in the hospital therefore hospital policy needs to reflect current law.

Nurses will not assign this task to a tech.

Management needs to be told that the facility, not the nursing staff, will be responsible for any adverse effects on patient care if this practice continues.

All licensed and unlicensed staff who agree should sign the letter. Since this is on several units I think a small group should make an appointment with the DON, VP of Nursing, or whatever the title of the top nursing officer is at your facility.

But you know your hospital better than I do. I'm hoping they just didn't know and will do the right thing when informed.

Techs need to know it is not personal. (When I was an LVN my RN friends treated me with respect. It seems you have great techs. They need to know they are at risk if they perform a procedure outside their legal scope.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

If they forget theirs, they come here to check b/c that machine does not leave my office.

My school nurse did that for us diabetics and it was a life saver for me a few times.

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

My school nurse did that for us diabetics and it was a life saver for me a few times.

I don't trust them enough to bring it back. :lol2: One cooked his strips during August heat during football practice, another just didn't bring it in at all and his glucose was almost 600 by the time he came to me (they are high school age, so I don't check on them daily).

Penelope_Pitstop, BSN, RN

Has 13 years experience.

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

The bar code isn't assessing the patient; rather, it serves to identify the patient and match him or her with the lab result.

Yes, of course, a tech could scan patient in bed A and then test the patient in bed B. The system isn't perfect. The only way to be absolutely certain that identification errors made by UAPs and skill errors made by UAPs don't occur is for the nurse to do everything, including vital signs, patient weights, emptying foleys, and drawing all labs.

I live in Delaware, and, to be honest, until I came across this thread I had no idea techs did not perform accuchecks everywhere! I may sound stupid, but I simply do not understand why this task cannot be delegated.

marilynmom, LPN, NP

Specializes in Adolescent Psych, PICU.

I'm an RN and I too think it is RIDICULOUS that tech's can't do finger sticks! Can they not do vitals as well then? Can they not be trusted to do I & O's? Come on.....

Most of the tech's and CNAs I have worked with are not idiots and a lot of them have many years experience!

Gosh, I can think of plenty of errors that nurses make. Mistakes do happen in the health care system by techs, CNAs, drs, RNs, LPNs, etc. Your never going to get away from that. The more nurses have to do the more mistakes will be made.

featherzRN, MSN

Specializes in Outpatient/Clinic, ClinDoc. Has 30 years experience.

What about INR fingersticks? I'm in NY and MA's do the coumadin clinic fingersticks. Is that against the BON also? Or is it just for glucose measurements? I'm sure as heck not going to say anything to them, just curious. :)

pagandeva2000, LPN

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

I would copy the written response you received from the BON and show it to my colleagues.

Then write a letter stating that it is not not legal for unlicensed personnel to perform fingersticks in the hospital therefore hospital policy needs to reflect current law.

Nurses will not assign this task to a tech.

Management needs to be told that the facility, not the nursing staff, will be responsible for any adverse effects on patient care if this practice continues.

All licensed and unlicensed staff who agree should sign the letter. Since this is on several units I think a small group should make an appointment with the DON, VP of Nursing, or whatever the title of the top nursing officer is at your facility.

But you know your hospital better than I do. I'm hoping they just didn't know and will do the right thing when informed.

Techs need to know it is not personal. (When I was an LVN my RN friends treated me with respect. It seems you have great techs. They need to know they are at risk if they perform a procedure outside their legal scope.

It's not my facility that is doing it, the steps you mentioned were already done back in March at my place of work; it is the other facilities within the area that are not complying. Several of my friends that work in other facilities have not even heard this. This makes me feel that now, not only do we have to read policy and procedure with a magnifying glass, but that now, do we also have to ask the state everything? I mean, do I have to arrange for an appointment to sit with the BON to review each of a large hospital's policies with them to see if I am complying? Makes me wonder...:imbar

I say this because I remember when I first got my license in 2006, I worked as a flu nurse for a very popular, national agency. It was a fun assignment. Went to several locations such as chain stores like Pathmark, Costcos, local drug stores, etc... to administer these vaccines. Sat through an entire orientation, was shown the standing order and protocol of epinepherine in case of anaphylaxis, etc and thought it was okay. They used to send several LPNs alone without RNs to do this. Then, based on a seperate situation regarding vaccinations, I emailed my state BON and they told me that LPNs cannot honor standard orders without an RN present to do an assessment for vaccinations, but can only honor patient specific orders because since we don't have assessment priviledges, the provider has assessed and placed the patient specific order. This lead me to inquire about the flu clinics I used to do (and was still actively involved in). The state SPECIFICALLY said that many of these agencies fly under the radar and that under no circumstances should an LPN do this without the RN assessing first, which basically meant that one should be present. If something were to happen to a patient and a big deal was made, it would have been my rear end. I had to quit immediately, because it is so easy for a person to go into anaphylaxis...no doctor around, no RN...the thought of it horrified me.

Now, I occasionally work for an agency that dispatches nurses to administer vaccines to soliders who are being sent overseas. This one is within my scope because an RN is present at all times.

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