No More Fingersticks for Techs!!

I am not at all opposed to delegating information gathering tasks to trained NACs. But I expect all of my numbers be reported promptly not just the abns. I also have the sense to recheck abn values before acting on them regardless of who obtained the value.

I can honestly say that in 20 years of nursing I've encountered far more nurses who falsified documentation or lied about giving a med than I have a CNA lying about VS.

Are you ready to start doing all your own lab draws too? The phlebotomy class offered by my local community college is 8 hours on a Saturday. My kid took it 6 months ago and was hired by the largest hospital in town 2 weeks later.

MAs are not governed by the BoN so any ruling has no effect. MAs are governed by the Board of Medicine.

but that is not what THIS thread is about.....

[Eaglelady]

At my hospital in Florida techs not only do accu checks but they also do insertion of foley caths--I as a nurse do not exactly feel comfortable with the foley insertion so I usually do them myself

[creativemom, BSN, RN]

I work in Ohio for one of the largest hospitals and do the fingersticks all the time. Unlike other PCNA's I write them down so that the RN's have the exact figure. We have no ability to "chart" the numbers in the patients chart. I'm surprised to hear this. Any way for me to find this on the internet to show my nurse manager?

I wanted to add that we too use an "accu check" whereby it too downloads it into a main database whereby the RN's can review. Any issues and we can validate numbers, times, dates, etc through this database.

Edited Jun 3, 2009 by creativemom

[JoMark06]

I work in SC where techs/NAs do finger sticks all the time. With our system, the tech scans a barcode on the patient's identification band and then proceeds with the FS. The results are then downloaded into the patient's computerized chart. Before I ever administer insulin (or D5 in the event of hypoglycemia), I verify the blood sugar level in the system. It takes no extra time/work to do so since both the med administration software and the computerized charting software are both on my med cart. For me, it is no different than checking potassium levels before I hang IV fluids with potassium. It does, however, save me time when I have a heavy case load to have the FS done by someone else. As with anything we delegate, we, as RNs, are ultimately responsible for every aspect of our patients' care.

Every hospital I ever worked in always had the CNA's do them. Once it is done, we chart it. If it is out of the "normal" range, we personally notify the RN after charting so the nurse can assess the situation.

[Daly City RN]

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Phlebotomists used to do the FSBG checks in our hospital here in San Francisco...Then about 10 years ago, they said something about accountability, so the RNs and LVNs were the only ones doing FSBG checks...Then the hospital removed all the LVNs from all the inpatient units and we now have only all-RN staffing.

Serum glucose are both done by RNs and phlebotomists but if the order is STAT, then the RN has to draw the blood unless a kind phlebotomist happens to be on the floor and agrees to draw the blood saving valuable time for the RN. The RN will then take the tube from the phlebotomist, prints the lab slip and calls for stat pick up.

That's just one of the ways you survive in a busy acute care hospital.

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In regards to the fingers sticks, I am an RN that has always done my own. I work on a primary nursing care floor. We do not have additional ancillary staff, so I am just accustomed to doing every task possible for my patients. It is all just a part of my daily routine of care. Most of the other floors in my hospital have nursing assistants who are responsible for the vitals signs, fingers sticks, and other tasks. I actually love working on my floor. I feel as if I'm closer to my patients and can really care for them on a 1 on 1 basis.

In one of our local hospitals, the CNA's do fingersticks but in 3 others the nurses do it, but get this: Nursing students, such as myself, are not allowed! Luckily we got our "sticks" in before the rule changed.

I'm uncomfortable with this, and perplexed. I am not allowed to gather the information I need to give insulin, but I am allowed to administer a dangerous drug. Go figure!

[SunRose7]

yep, i worked in a hospital in colorado and as of a year ago we let cnas/pcts do fingersticks.

i had to take training to be able to do it and always wrote down the numbers for the blood sugar just incase something screwy happend to the docking electronics (which occasionally did:smackingf). i really loved doing fingersticks (no really!), call me crazy (and i'll probably get sick of them later), but it feels kinda "nursey" (compared to regular cna tasks i suppose) and it just felt really good to have that extra knowledge and be that much more useful.

btw:

can anyone tell me why at a huge hospital that is connected to a level ii trauma center and a brand new childrens hospital right next door would only let cnas on rpcu do fingersticks?

((since then i've moved to a more affordable small town w/ a great nursing program and only a one semester waitlist (i guess not a whole lot of people want to live/ go to school by the colorado/nebraska/kansas border- about 2hours from denver, lol. i can stick it out for a few years til i move to phoenix :vlin:.)) i now work at a nursing home where cnas arent even allowed to take vs unless the nurse is busy and can't do it herself and we can't fill o2 tanks, basically we are there just there to toilet, dress and feed. even a whisper of a cna doing a fingerstick would be a stupidly hideous suggestion:down:. they don't even let the cnas sit at the nurses station there which also baffles me.

I would love it if they made the nurses do them but they have not where I am. RNs have given too much away. If I am going to give insulin I want to make sure the fingerstick was correct.

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.

I am not sure that is ethical... at least in my eyes. Why would you subject the patient to a second stick? If you can't trus the first one, do it yourself all the time. I say the nurse giving the insulin should do the stick

I would love it if they made the nurses do them but they have not where I am. RNs have given too much away. If I am going to give insulin I want to make sure the fingerstick was correct.

Do you run your own labs before you give potassium? Why are accucheks and insulin so different? Do you do ALL of your own vital signs? What if that tech that's too incompetent to draw a drop of blood did a bad blood pressure reading? Or held the thermometer in the wrong place and didn't catch a 39.8 fever? If you don't do EVERYTHING yourself, bad things could happen. Of course, while you're doing EVERYTHING yourself, you could be failing to save because you're busy doing something that a tech could do instead of doing an extra assessment that only you as the nurse could do.

[pagandeva2000, LPN]

I am not sure that is ethical... at least in my eyes. Why would you subject the patient to a second stick? If you can't trus the first one, do it yourself all the time. I say the nurse giving the insulin should do the stick

I work per diem on med surg floors and each unit has different rules, so to speak. Some require the CNAs to go directly to the medication nurse to inform them of the fingersticks immediately, no matter what it is, others don't come at all. Some do it even if it was requested that the nurse do it. I'd rather do a second stick under confusing circumstances if I had to administer insulin. Now, it is a mute issue since they are not allowed in my hospital any longer.

[pagandeva2000, LPN]

The bottom line, to me is that inconsistency causes confusion. Not following what the state says causes it even more. I never said I personally agreed with the state BON's ruling, but if all facilities are not complying, and each floor is doing their own thing, it is not safe. To place all of this on the RN is insane, in my opinion because she is distracted from doing assessments and skills that neither an LPN or CNA can do.

The bottom line, to me is that inconsistency causes confusion. Not following what the state says causes it even more. I never said I personally agreed with the state BON's ruling, but if all facilities are not complying, and each floor is doing their own thing, it is not safe. To place all of this on the RN is insane, in my opinion because she is distracted from doing assessments and skills that neither an LPN or CNA can do.

Yeah. Those puny LPNs can do the grunt work. They aren't as good as RNs now, are they? You need to get your head out of the clouds. One day your LPN or CNA is going to catch something you missed and you're going to be be embarassed.

[cherrybreeze, ADN, RN]

Yeah. Those puny LPNs can do the grunt work. They aren't as good as RNs now, are they? You need to get your head out of the clouds. One day your LPN or CNA is going to catch something you missed and you're going to be be embarassed.

Seriously, you're being a little sensitive here, IMO. I don't think anyone is putting LPN's or CNA's down (not in the post you're referring to, at any rate, I haven't read them ALL in detail). The OP's point is that the RN has responsibilities that the LPN and CNA cannot do, so why give them TASKS that the LPN and CNA's CAN do, skill-wise? It is NOT a difficult skill, I'm sorry, it's not. It's not like they need to interpret the results, if they put the drop of blood on the strip on the machine and then the machine says "100," that's what it says. It's the RN (or LPN) that then executes what needs to be done with that reading (give insulin or not).

On a sidenote, I don't agree with the RN resticking them, either......I honestly don't believe, with the machines we have nowadays, that a result that's that far out of normal parameters is generally the result of user error. The machines tend to prevent that. If not enough blood is used, for example, it won't give a reading (whereas older machines might read low if the sample was too small). As I posted earlier, our CNA's go through a competency, and get checked off on the skill just the same as RN's and LPN's do. It is a TASK and can be delegated; the RN/LPN takes the appropriate action with the result.

BTW, unless something changed (and if it did, pagandeva, my apologies).......Steve, you just made your post TO an LPN. That's why I think you're being too sensitive and reading in to the post too much.

[cherrybreeze, ADN, RN]

OK, after I hit post, I had to go check the profile just to make sure. I wasn't trying to be mean or start a fight, hope it didn't sound that way. But yet, pagan is an LPN (and a DANG good one, from reading her posts here, if I may say so). So Steve, your anger is misdirected.

[cherrybreeze, ADN, RN]

The SAME person who does the glucose testing shoud treat the result. The people who do their own accuchecks also give themselves insulin.

The problem is that hospitals would rather staff unsafely and assign invasive important procesures to unlicensed assistive personnel.

Honestly, I think this is just another example of something that some RN's don't want to give up/are "possessive" about, in thinking that only they can do. We have seen a lot of this on the council that I'm on, as we review the LPN/CNA task lists. Several RN's have a hard time delegating ANYTHING. We have gone to using automatic blood pressure cuffs quite a bit more than we used to, and I'm OK with getting VS from my CNA's (and I would also be OK with it if they were doing them manually, I TRUST them, and it's within their scope of practice).

If you have a patient on routine blood pressure meds, do you always do your own VS? If a CNA tells you a patient's temp is elevated, do you recheck it before giving them Tylenol, or whatever? I don't, necessarily. They know how to take a temperature.

I guess you could use the argument then, that the RN should always do peri-care, too, since the CNA can't *assess* skin and therefore might miss signs of breakdown....one more thing you'd better do. Especially if they need Sensicare or some other skin barrier cream put on, right? If it has to be put on, you'd better be the one doing it, and looking at why, every time.

I agree with the comparison to lab results. I don't have to go down to the lab and run my own CBC to believe that the Hgb is low, and that those 2 units of PRBC's need to be administered.

A FSBG is not an invasive procedure.....