No More Fingersticks for Techs!!

[pagandeva2000]

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.

[pagandeva2000, LPN]

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.

I agree with you also. The more you place on the nurses, especially the RNs, the more you overwhelm them and it increases the chance of mistakes.

[pagandeva2000, LPN]

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. :)

They did not specify INR, but I guess I would assume that with the complexity of problems presented by patients taking Coumadin, I would not be surprized if it were. I used to work in the Coumadin CLinic, and my facility never let the techs do our fingersticks on the CoaguChecks, only licensed personnel, so, I was never confronted with that issue. Most of my nurse friends felt the way you do...they were shocked, but don't plan to add more headaches to their own overwhelming loads.

[cursedandblessed]

fsbg is not rocket science, and especially in a facility where the wristband is scanned, and the info sent to the computer automatically or entered while the cna or tech is standing there with the glucose meter in their hand. certainly we do have a form that the cna takes to each room as she does her vs rounds along with her fsbg readings that the nurse has to review. as well our patients bg is written on their white board on the wall across from their bed along with their vital signs, their nurses name, and their cna's name.

[LHH1996]

maybe i missing something here, but don't many non-nurses do their own blood glucose testing, or their loved ones, heck..some teenagers do their own checks. so maybe the point is anyone can be trained to do the checks, know the s/s of hyper/hypoglycemia, etc etc..

i guess the difference is their is no liability if you aren't licensed doing it to someone else?

just a thought

[herring_RN, ASN, BSN]

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.

I know people who do their own TPN at home, give themselves IV antibiotics, or do so for their family member.

But this is ONE person, a love one.

Patients are all too often not bathed, turned, walked, or given suffient time to eat when they need to be fed. Why not staff appropriately and let everyone work within their scope?

PS: I volunteer at a vaccination clinic too. During the years I was an LVN an RN assessed each child. Even now I don't do that. I just make some cry.

It is like an assembly line with parents and children lined up around the block. Usually an NP, sometimes another RN assesses the child in one room and sends them with the parent and paperwork to me in the next room.

PPS:

We worked for this law because our hospital laid off RNs and LVNs replacing them with people from dietary and housekeeping who had never chosen patient care.

When the nurse is certain that an experienced tech is competent I think of it like a speed limit law. It may be safe to drive 70 mph but if there is an accident you will be found at fault if you were exceeding the limit.

Or if the tech makes an error just as a licensed RN or LPN could do.

[Penelope_Pitstop, BSN, RN]

The SAME person who does the glucose testing shoud treat the result.

I hate to be difficult here, and I'm not jumping on you, herring, but why should the same person who does the testing treat the result?

[pagandeva2000, LPN]

Here is another interesting tidbit...my LPN friend called me just now and told me she went to an inservice conducted by the Department of Health in our city regarding the implantation and reading the results of a PPD. She said that according to the DOH, LPNs can administer PPDs but cannot interpet them, because this is an assessment. She called our nursing supervisor who promptly said "Oh, My GOD, DON'T SAY A WORD! It will be chaos, here". Just goes to show what herringRN stated...people will do what they can get away with.

Also, my friend told me that they described the implantation of the PPD protocol differently from what we are taught on the job...she said that after administering the PPD, it should be measured immediately, then documented, so that a comparison is made when the person returns for the results. I have NEVER gotten a PPD implant where the practitioner, may it be physician, Nurse Practitioner, RN or LPN immediately measured anything. Oh, Goodness Gracious...

[pagandeva2000, LPN]

I hate to be difficult here, and I'm not jumping on you, herring, but why should the same person who does the testing treat the result?

I can understand your question...and here is a thought....maybe if it is done in the physician's office, clinic or hospital, the results has to be reported to the person that can initiate treatment immediately? Just throwing thoughts...

[wooh, BSN, RN]

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.

Absolutely agree. Everytime my facility decides to take something stupid away from the techs, the techs rightfully get a bit offended. After a current decision, we've sarcastically decided that the techs are able to count, but apparently it takes nursing school to learn to read.

But really, with the attitude some on this thread have, do they even trust the techs to take people to the bathroom and clean up vomit? What if the vomit has blood in it and the nurse doesn't see it? What if they help someone to the bathroom and they flush the poop without letting the nurse assess it? What if they wipe a butt and leave a speck of poop on it? Or is it ok to delegate the jobs that are "dirty" and we don't want to do?

I have some fabulous techs at work. And the ones that aren't fabulous are still capable of checking a blood sugar. It only involves sticking a finger, collecting some blood and reading a number. If you're so worried about the result, then FIND THE TECH AND ASK THEM. They don't take them at random times. You know they're doing them, go ask them if they haven't found you first. If you're too busy to follow up on a blood sugar, you're too busy to do it yourself. If the number doesn't look like the patient, then recheck it, just like you would a temperature or a blood pressure or a pulse.

[LHH1996]

"Absolutely agree. Everytime my facility decides to take something stupid away from the techs, the techs rightfully get a bit offended. After a current decision, we've sarcastically decided that the techs are able to count, but apparently it takes nursing school to learn to read.

But really, with the attitude some on this thread have, do they even trust the techs to take people to the bathroom and clean up vomit? What if the vomit has blood in it and the nurse doesn't see it? What if they help someone to the bathroom and they flush the poop without letting the nurse assess it? What if they wipe a butt and leave a speck of poop on it? Or is it ok to delegate the jobs that are "dirty" and we don't want to do?

I have some fabulous techs at work. And the ones that aren't fabulous are still capable of checking a blood sugar. It only involves sticking a finger, collecting some blood and reading a number. If you're so worried about the result, then FIND THE TECH AND ASK THEM. They don't take them at random times. You know they're doing them, go ask them if they haven't found you first. If you're too busy to follow up on a blood sugar, you're too busy to do it yourself. If the number doesn't look like the patient, then recheck it, just like you would a temperature or a blood pressure or a pulse. "

good point wooh!!!

[WalkieTalkie, RN]

The newest and dumbest thing that CMS has stipulated at my hospital, is that techs can no longer stock saline flushes in our drawers. Apparently they aren't "competent" enough to do this. Several of them are offended because of this, and I don't blame them.

We now routinely run out of flushes if we are super busy and don't have time to stock them ourselves. The techs aren't even allowed to touch an unopened box of them. How ridiculous.

[pagandeva2000, LPN]

Please allow me to say that this thread was not created because I believe that techs are not capable of doing fingersticks. That was not the purpose. I was posting to see if anyone else noticed the inconsistency of facilities deciding to do what they want after the BON has specifically stated that they can't. To me, that is using everyone and this decision is to the advantage of no one.

My hospital just got through upgrading CNAs to PCAs, which fingersticks was part of the job description. Now, they have essentially wasted their money and valuable resources because now, these people are paid to do a skill that is now being told that they cannot do. But some hospitals are still saying to go ahead and do it, which makes me question the integrity of our nursing governmental bodies in both, the state as well as our facilities. It is as though the facilities that either don't know or even worse do know, but are saying "We'll do it as long as we are not caught", but yet, question the intelligence and integrity of the people they hired and trained to do this skill and others.

I then posted another development where the DOH says that only RNs can interpet a PPD, but not LPNs, who have been doing this for years as well. The first thing the nursing supervisor said to my friend, who only went there as an inservice "Don't say anything!". Where does that leave us? I was taught to believe that the BON is the final word and the facilities must follow, but the examples I am seeing is the opposite. So, how do we trust the people who have the power to grant as well as take away our licenses, our livelihoods at the drop of a hat?? It makes me believe that these decisions are more subjective than evidence based and leaves a bad taste in my mouth the same way it must have to many of you. This does not promote teamwork and self worth, it causes friction and adversarial relationships, which do nothing to promote patient care.