Radiology tech: "this patient has q0600 portable chest X-rays part of his old ICU order set. They normally DC these but they didn't DC his. Do I really need to do this?"
#2:
Me, to a different radiology tech: "we just discovered he might have foot fractures and I'm putting in orders right this exact second. Do you mind grabbing images of his feet while you're here?"
Rad tech: "the order wasn't already in so your, have to get that later."
Me: "the order is in right now."
Rad tech: "no."
Two seconds later, does the images anyway, because she realized it meant she'd have to come all the way upstairs again.
#3:
Respiratory: "Earlier MD asked for a different patient to have ABGs done at 0800" (after RT's shift would be over) "so we can just do this patient's in a few hours, too, right?"
#4:
Lab, after walking the whole unit to find me: "that patient has a PICC, why can't you draw her?"
Me: "I don't have orders saying I can."
Lab: "I saw her get drawn off that line last week, you need to draw her."
Me: "her line isn't being used for labs. I don't have an order saying it can be. I CAN'T use it. You need to draw her."
If it weren't the same people trying to get out of their orders every time, I'd figure they were just confirming things, but I am absolutely convinced they're trying to get out of doing their job, and they're trying to get the RN's "okay" so they can pass the buck to us, I am so done with this! If they want to questions orders, they should call the people writing them. :\
This is almost the number one thing that annoys me the most at work. This and playing middle man between the other departments. I've never understood why lab must call criticals to the nurse, who then must turn around and page and notify the doctor.
On my floor, nurses do not draw any labs; peripheral, central or otherwise.
Lab calls me: There was an order put in for a BMP now and one at 0400. Is that what they meant to do, do you need one now? (Its 3 PM)
Me: I don't know, I didnt order them.
Lab: Oh okay.
Quit wasting my time and use some common sense! I think sometimes these other depts think that the nurses just have the docs available at the tip of our fingers, like they're just always sitting beside me, ready to answer every question I have. When really, some of the hospitalists on my floor could whiz in and out of a pt's room and then leave the floor and be entering orders in on the other side of the hospital, and the nurse has no idea that he'd ever even been in the pt room.
Lab comes out of confused restrained pt's room and says with attitude: He won't let me stick him and we're not allowed to hold patients down to draw. What do you want me to do, cancel it?
Umm really? No, I guess I will stop what I am doing and come hold the pt's arm for you so that you dont cancel it and write a note "RN stated not to draw."
https://www.youtube.com/watch?v=0uiTEbFUcZo&feature=youtu.be , Well let me just walk you though what the lab is like from our perspective, and you will see we both want the same thing (lab techs and nurses ) we aren't trying to be lazy . Most of the time we just want to get back to the lab so we can continue the work that is going on there which nurses do not understand . If a patient has a port and there are 5 nurses sitting at the nurses station doing pretty much noting and we ask you to draw a guy from his port, it's because we want to be efficient, get back to the lab so we can keep turn around times low .
I watched the entire video in which you spent nearly 13 minutes degrading nurses. There's a lot I want to say.
Newsflash: your lab's understaffing DOES NOT mean nursing must pick up your slack. Do you not understand that? Take up your staffing issues with your lab director. THIS is the reason why nursing feels that everyone's staffing problems becomes our problem. Your video shows this to be absolutely true. What's more infuriating is that you feel it's completely normal and expected. One of your key duties is blood draws. Why pawn off a key duty of yours to nursing? Do you think WE have the time to do one of YOUR basic duties? If, as you claim, your facility's nursing staff is so damned bad at blood draws, wouldn't it be in yours and patients' best interest to be adequately staffed so that additional blood draws are not necessary?
Five nurses sitting at the nurses' station doing "pretty much nothing"? Have you heard of the concept called charting or chart reviews so that we get a bigger picture of what's happening to the patient?
I concede we do not know the inner workings of a lab. You, in that video, concede you have no idea what we do. So don't pretend that you do.
I so so want to go off on your pompous, degrading, *******ry you demonstrated in that video. However, I will be content with hoping that a nurse manager or the DIrector of Nursing at your facility sees it and gives you a good old fashioned kick in the rear about your attitude toward the largest single group in a hospital--nurses.
I'm probably going to get CAPS LOCKED for this but as someone that has been a phlebo/lab tech, current PCT, and current nursing student, I can tell you there's usually two sides to the story. I know a LOT of lab techs can be lazy. Some used to throw labels away to avoid drawing patients, scary!! However, sometimes when things are cancelled, it's because we can see that one doc just ordered troponin x3 q6 and another doctor ordered the same and you may not have your results just yet or be able to check those orders just yet. That means the patient is getting drawn constantly for no reason when each just wanted a trop level q6. Or when a doc orders something within another test...like a potassium at 1430 that is w/in the CMP due at 1445...so a lot of times our "laziness" IS trying to spare our self extra work but also trying to save the patient unnecessary sticks. Same with the PICC, we'll hunt you down because usually someone with a PICC means their veins are crap. BUT on the other side being in nursing I now see drawing from that PICC can slow a nurse down that is in the middle of passing meds and lab techs don't always realize all the things nurses do. I really didn't until I saw both sides. Lab techs also don't always realize how important some of those draws are to be ON TIME like vanco trough. I swear the lab should make the techs shadow a nurse for a few hours and vice versa so they each understand the schedules. Lab techs will see a nurse sitting at the station and complain they couldn't help but little do they know they're charting their assessments, etc.
Those reasons for the cancelled draws make sense, and no nurse will find fault with it. We don't want to stick patients any more than we have to.
The other day, I sent down urine for osmolality and electrolytes right before the end of my shift. Got the patient back the next day. Osmolality was run, electrolytes weren't. I asked why. No one could give me an answer. Trops not drawn on time. Having to call for a timed vancomycin trough. I NEED to hang the darn thing. Having to put in a dupe order because they "can't see it" although many other orders put in on the same patient at the same time by the same doc under the correct "lab" heading can be seen. (Did someone cancel it accidentally, but no one is willing to own up?)
Babysitting lab is a necessity that takes me away from actual patient care. But Mike T, in all his wisdom about our jobs, seems to think we have all the time in the world to do his job, even though we do it so damn badly. On top of it, we're apparently idiots who commonly tell patients incorrect information, so we are bad at our jobs too.
I think we must work together! I had a young woman come in with an elaborate hair do, just "got did" and I really didn't think about the hundreds of bobby pins she had in. (Was more preoccupied with getting a line and labs and such...)
Boy was my butt handed to me.
I can take a lot. A LOT. But once you've pushed me over the limit of my BS tolerance, you're gonna get it. This particular tech and I had already had a few run ins. I'm just trying to turn my rooms over and get these patients taken care of.
When I read your post I thought; "Maybe we do work together." Then I check your profile and saw you're in SC, so nope. Lol
https://www.youtube.com/watch?v=0uiTEbFUcZo&feature=youtu.be , Well let me just walk you though what the lab is like from our perspective, and you will see we both want the same thing (lab techs and nurses ) we aren't trying to be lazy . Most of the time we just want to get back to the lab so we can continue the work that is going on there which nurses do not understand . If a patient has a port and there are 5 nurses sitting at the nurses station doing pretty much noting and we ask you to draw a guy from his port, it's because we want to be efficient, get back to the lab so we can keep turn around times low .
So here is my problem with your speech: It does nothing to help promote understanding and knowledge sharing between departments.
You raise some good points regarding nursing sometimes lacking education re: things like hemolysis and clotting of specimens. But rather than use this video to educate and share your knowledge....all you did was complain about how nurses don't know about spinning down blood specimens. Your video has over 800 views so far - who knows how many of them were nurses. Do you know why nurses say things like "It was fine when I drew it"? I bet I know what many nurses are thinking when they are surprised to hear that a specimen was hemolyzed that they thought would be fine (and its not that they think you did the test wrong or something). Unfortunately, no one who watched your video has learned anything about how to better draw specimens or the inner workings of the lab. Hopefully your next video will be put to better use.
They so help themselves to food in our break room without asking, especially if we have had a potluck.
Sorry, half of this is me venting again. I am sick of being nurse, phlebotomist, RT, PT, therapist, and housekeeper all in one.
One time, nurses in my unit made collective request for code lock for break room, citing a diappearance of someone's cell phone as a reason. The breakroom was door-to-door to a room where a patient with especially unmanageable family was staying at this time. After couple of times, management bulged in and we conveniently forgot to inform housekeeping of the code except for our unit "private" ones.
I had a CT tech totally rub me the wrong way the other day. I had a patient complaining of migraine come in and left sided weakness. The physician ordered a head CT to R/O stroke. I was sticking the patient for an IV and labs before CT shows up, because they are normally quick and I want to get the blood going and check a glucose ASAP to make sure that's not what was causing the symptoms. The patient had literally been in the ED room for 10 minutes, CT shows up and says; "You know, when you know the doctor is going to order a head CT you should take these clips out of their hair and their earrings out." I said; "I'm sorry, I was busy doing my job of starting the patients IV. Would you like me to take the clips and earrings out next time and you can stick the patient for an IV and labs over in CT before you bring her back?" She left me alone after that.
I am certainly not defending the CT tech for her words. However, generally speaking, a non-con head CT for a stroke pt. takes priority over IV/blood draws (a CBG would be about the only thing that has to be done before the CT). If we waited over 10 minutes for a patient to get to CT, there would be emails sent to the RN, the charge nurse, the MD, and to CT over why it took so long to get this pt. on the table. Again, the CT tech did not handle it appropriately, but I can see why they wanted to get the pt. over for his/her scan.
However, sometimes when things are cancelled, it's because we can see that one doc just ordered troponin x3 q6 and another doctor ordered the same and you may not have your results just yet or be able to check those orders just yet.
My issue is not when the lab cancels orders due to duplication (although I appreciate a phone call about the situation). The problem comes up where the lab thinks it is a duplicate order and cancels it (and, no, I don't think they do it out of laziness or out of a desire to get out of work). We had a patient with a severe GI bleed that had been going on for several days. First Hgb comes back at 3.1. A second, to confirm, was ordered and drawn minutes later. Sent to the lab. After no results in a timely manner, someone called the lab...the tech stated "it was cancelled because we just did one and this was a duplicate." Umm, no. A 15 second phone call could have prevented that.
So here is my problem with your speech: It does nothing to help promote understanding and knowledge sharing between departments.
You raise some good points regarding nursing sometimes lacking education re: things like hemolysis and clotting of specimens. But rather than use this video to educate and share your knowledge....all you did was complain about how nurses don't know about spinning down blood specimens. Your video has over 800 views so far - who knows how many of them were nurses. Do you know why nurses say things like "It was fine when I drew it"? I bet I know what many nurses are thinking when they are surprised to hear that a specimen was hemolyzed that they thought would be fine (and its not that they think you did the test wrong or something). Unfortunately, no one who watched your video has learned anything about how to better draw specimens or the inner workings of the lab. Hopefully your next video will be put to better use.
^^You said exactly what I was thinking. ^^
So, MikeT1 ---> Share your knowledge, kindly, with those who don't have a similar education and all will benefit greatly, especially the patient.
Wow. This thread has shown me how good I actually have at my hospital!! I have a particular PT that always puts patients back in bed a total mess....pillows on the floor and foley on the ground, a new housekeeper that never empties trash cans. Ummm, that's all I can think of at the moment.
ETA: I'm LTACH, so we (nurses) draw all our labs (from CVC/PICCs if possible) and send to the lab @ the big acute hospital across the street.
You guys would be so mad with the lab if they called every time there was a duplicate that was cancelled. They do a lot of cleaning up of doc's orders believe it or not. I totally get what you're saying though, keep you in the loop.
Unfortunately I can see that happening with the GI hgb level. The med tech is supposed to let the phlebos know if they need the redraw for a critical. Some places have certain rules like you don't touch h&h's. If it's ordered you draw it, no questions. If it's from the ED they almost always call the nurse to make sure. If on the floor, usually if it's the same doc that ordered it again we make sure because he obviously knows he just ordered one. If he/she did and then a different doc ordered the same just minutes apart it'll probably be cancelled. That's what my lab kind of went by. I think they try to avoid calling the nurses because you guys are on the phone bombarded as it is with every other ancillary but sometimes bad calls are made.
I am certainly not defending the CT tech for her words. However, generally speaking, a non-con head CT for a stroke pt. takes priority over IV/blood draws (a CBG would be about the only thing that has to be done before the CT). If we waited over 10 minutes for a patient to get to CT, there would be emails sent to the RN, the charge nurse, the MD, and to CT over why it took so long to get this pt. on the table. Again, the CT tech did not handle it appropriately, but I can see why they wanted to get the pt. over for his/her scan.
I understand that the tech wanted to get them to scan also. She walked in as I was taping the IV down. I was done and had the bed ready to be unlocked and the patient ready to go (besides the hair clips). Lol
DBK99
75 Posts
This is almost the number one thing that annoys me the most at work. This and playing middle man between the other departments. I've never understood why lab must call criticals to the nurse, who then must turn around and page and notify the doctor.
On my floor, nurses do not draw any labs; peripheral, central or otherwise.
Lab calls me: There was an order put in for a BMP now and one at 0400. Is that what they meant to do, do you need one now? (Its 3 PM)
Me: I don't know, I didnt order them.
Lab: Oh okay.
Quit wasting my time and use some common sense! I think sometimes these other depts think that the nurses just have the docs available at the tip of our fingers, like they're just always sitting beside me, ready to answer every question I have. When really, some of the hospitalists on my floor could whiz in and out of a pt's room and then leave the floor and be entering orders in on the other side of the hospital, and the nurse has no idea that he'd ever even been in the pt room.
Lab comes out of confused restrained pt's room and says with attitude: He won't let me stick him and we're not allowed to hold patients down to draw. What do you want me to do, cancel it?
Umm really? No, I guess I will stop what I am doing and come hold the pt's arm for you so that you dont cancel it and write a note "RN stated not to draw."
Enrages me.