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.

[Shorti2382]

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.

[SteveS743]

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.

[rainyann]

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.

[rainyann]

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

[wooh, BSN, RN]

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.

[SteveS743]

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.....