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.

[blondy2061h, MSN, 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.

They're technically a prescription medication, which is where I suspect this comes from, but still lame (both the stocking, and that they're prescription).

We actually have a prn order for "flush line as needed with 10cc NS" on our patients. I keep saying that some shift I'm going to actually sign out every time I flush the line on the MAR. We had a new pharmacist who started sending up saline flushes with the patient's addressograph labeled on them for us to put in our med cart. That didn't last long I know some nurses here have said they need to get flushes from pharmacy or out of pyxis.

[herring_RN, ASN, BSN]

I went to the NY BON site and could not find the regulation or law.

At my hospital and many others in California up to 50% of the RNs and LVNs were laid off and replaced with dietary and housekeeping personnel. NOT certified nursing assistants. They caled them "Patient Care Partners". This was a couple years after the experienced nursing assistants were laid off.

These people were trained, not educated. Most are smart people with no desire to do patient care. They didn't have the education or training to do the job after a weeks orientation and CPR class.

No I could not have them take vital signs. An honest young man told me he couldn't count fast enough to take a pulse.

A different PCP charted 12 patients pulse as 72. I took my six patients vital signs and found on pulse was 114.

They did not remember to measure urine output. Disconnected IVs to walk patients to the bathroom and became angry when we tried to explain that some IVs should not be turned off. They didn't know how to change a gown with an IV running. The guy from Dietary didn't know how to make a cup of tea for a patient.

So they hid out in the lounge watching the OJ trial while RNs and LVNs ran like crazy to care for patients.

After we documented all this they were offered a CNA course. Those wo took it became good assistants.

The dietary guy got a good paying construction job.

I do not trust management to validate competency. I know a person certified as a nursing assistant does know how to take vital signs, measure I&O, walk a patient, and feed a patient. Also that person has not been convicted of a serious crime.

Threason I will not treat a glucose level done by another person is that I am responsible for my actions. I could not take the chance of giving insulin to someone based on an erroneous result.

I will trust an LVN to do a glucose and administer insulin as ordered. He or she is a licensed nurse.

And I expect to be told just as I told my supervising RN during the 19 years I worked full time as an LVN.

As I said nursing is not just a series of tasks. It is a process.

Our patients deserve safe staffing. Allowing a hospital to decide to eliminate nurses and have others practice nursing is unsafe. It is budget based and not patient focused. Why doesn't the hospital help these excellent tech become nurses?

[blondy2061h, MSN, RN]

Threason I will not treat a glucose level done by another person is that I am responsible for my actions. I could not take the chance of giving insulin to someone based on an erroneous result.

Would you give insulin based on a lab drawn glucose? Would you have done that one? What about give a blood transfusion or run of K+ on someone who's CBC or chemistry you didn't do?

[cjcsoon2bnp, MSN, RN, NP]

I'm a nursing student and a CNA on a Med/Surg floor in a large teaching hospital and as a CNA we are able to do EKGs, fingersticks and venipuncture for labs as well as the usual CNA tasks. So while I can't speak for every CNA/tech, here is my opinion on the issue.

I can understand both sides that are being argued, obviously the RN who is treating a patient with hypoglycemia/hyperglycemia wants to be assured that they have the right results for the right patient. This can be achieved by the RN doing the fingerstick themselves or they could double checking any abnormal results that a tech reports to them before they administering a treatment. Whether a tech or an RN does the fingerstick a mistake can be made, but by having safeguards such as scanning identification bracelets and rechecking fingersticks when results are out of acceptable ranges, errors can be minimized. Its about education, training and standards if you provide your staff with education and training and set standards high then the results you get from your staff are going to be better.

I've worked for a few different facilities and I will agree with Tait when you take away the ability of techs to do tasks like fingersticks your telling them that they are not capable of doing a simple, delegated task and that they do not possess any higher thinking skills and it makes them shut down, it turns them into nothing more then drone who is only trusted to empty urinals and fluff pillows.

I know that at my facility I don't just feed and clean up patients because I have been encouraged to used my higher thinking skills and am trusted by the RNs I work with. When I'm cleaning a patient I look for open sores and signs of pressure ulcers and if I notice anything out off the ordinary then I report it to the RN immediately. I even check the IV site of any patient who has an IV running, this means I look for signs of swelling or redness and I ask the patient about pain and if anything is out of the ordinary I report it to the RN immediately. Do I have to check IV sites? No absolute not, its the RNs job but it never hurts to have a second set of eyes helping out. Don't get me wrong I like being a CNA but its good to know that the nurses I work with can trust me to do things like fingersticks and provide them with accurate results, its also good to know that I'm encouraged to go above and beyond my job and that my thoughts/opinions matter. It makes me and the other CNAs/techs feel that we are being trusted with greater responsibility and so we strive to do better and be better. I was once told a nurse that I heard a patient wheezing and she responded by telling me to "stick to emptying bedpans" and she proceeded to go into the room and tell the patient that she heard them wheezing and will administer a breathing treatment.

I can tell you that to this day when I work with this nurse I will not do a single thing that isn't specifically in the scope of my job, she has since asked me to empty drains and preform other tasks that are specifically designated for an RN to do but are tasks most RNs don't like doing so they ask CNAs/techs to do them instead but I will never do that for her. It has to be a two way street, you can't tell me that you can't trust me to do XYZ because its not part of my scope and then ask me to do ABC which isn't part of my scope but its just a part of your job that you don't like doing.

To herring_RN I understand why you have worked to hard to return the task of fingersticks to RNs and I understand your point about taking away the jobs of RNs and replacing them with unlicensed personnel. I guess my point is that if we're going to insist that an RN must be the one who do the fingerstick then I would suggest you begin lobbying to return other tasks that RNs used to do back to them (including providing mouth care, making an occupied bed and even cleaning patients who are incontinent) because those tasks can also be done incorrectly by techs and could potentially risk a patient's safety. I'm sure you will find a population of RNs who would never want a tech or CNA to do a fingerstick but I'd like to see if even half of them would be willing to lobby to stop CNA/techs from cleaning incontinent patients or do all of those tasks that techs do now but RNs used to do. If your going to tell your CNAs and techs that they can only "feed and clean" then don't be surprised when they shut down mentally and emotionally and only "feed and clean".

:spbox::oornt:

!Chris

[kids]

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 think most of us can remember a tech or two, lying about VS or something else...if not personally, it has been mentioned here at AN more than once

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.

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

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.

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. :)

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

[herring_RN, ASN, BSN]

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.

I tried to make it clear that it was NOT a CNA lying about vital signs.

It was people who were forced to be "patient care partners" or be unemployed because the hospital chose to lay off licensed nurses and couldn't get back our CNA friends who they laid off a couple years before.

These were NOT people who wanted to care for patients and they didn't do it for long. This was in the ninties when they could get another job and most did.

They had no experience and didn't know how to make an occupied bed, count a pulse, or hear a BP. If the machine didn't work they couldn't take vital signs. If a number came up on the display they wrote it down (pre computer charting). They had no CNA class and only one week of training. How much could they do?

I'm typing about good smart people placed in a horrible situation.

And too many hospitals would do it again.

In the same week we moved our tele unit to a new building, lost 1/3 of our RNs and 1/2 our pharmacists. Our assignment went from 7 to 10 patients each with the help of people who didn't know how to feed a patient. We didn't know where things were and it took twice as long to get newly ordered meds.

SURPRISE! Med errors doubled. Most were meds given late.

Our PCPs didn't lie. They didn't know how to do their job and they admitted it. It was not their fault.

And management wanted US to teach them to insert Foley catheters and do accuchecks!

NO!

We worked to stop this and get safe staffing ratios in our state.

Now we have CNAs, not uncertified unlicensed assistive personnel who don't know how to assist.

It has nothing to do with intelligence. It does have to do with education, experience, and motivation.

I've been told I was only a nurses aide, only an LVN, and only a nurse. All of our work is very valuable.

More so than most top management that focuses on the budget to the exclusion of our patients.

In my state the law is clear: http://www.rn.ca.gov/pdfs/regulations/npr-b-29.pdf

It is not an insult to insist the law be followed.

I bath my patients, do oral care, clean them when they are incontinent, feed those who need to be fed, and show appreciation for all of us who do these important things no matter the licensure.

Please don't think I disrespect people with less education (so far) as I have. I was a nursing assistant at the VA during the Viet Nam war, an LVN for nearly two decades, 42 when I earned my RN license, 49 when I finally earned my BSN. And I'm no more intelligent now than when I was a SNA.

Learned a lot though.

Enough to appreciate caring and know that emptying bedpand and urinals and fluffing pillows with caring is not a job for a drone. It requires special maturity and communication skills to show compassion when doing these seemingly menial tasks.

We caregivers are doing important work.

[morte, LPN, LVN]

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.

[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.

[johnsboo]

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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