I had a patient the other day - CABG x 3 but had to go back to the OR for a bleed. Upon returning to the unit, the pt was still bleeding some. The MD wanted to give some platelets and draw some bleeding studies. The pts platelet count was within normal limits, but he wanted the platelets anyway. OK, no problem.........I get a phone call from the lab - not the blood bank - the lab - asking me "why do you want to give platelets? The platelet count is within normal limits. Does the doctor know what the count is?" I said yes he knows and that I need them. She proceeded to ask me why - over & over - "Why would you give plts if the count is normal" Keep in mind, this conversation is pulling me away from pt care - fresh post op - on levophed - kind-of sick (coworker watching pt while I was on the phone!!). We kept going back & forth :argue: - After I quickly and as nice as I possibly could at the moment - told her this was a very sick pt - I hung up on her. I had a coworker call the blood bank and got my plts up.
One more situation - when we draw aptts - the lab calls and gives us the out of range result, but always asks if they are on heparin? Do they have to document this somewhere? Why do they ask?
Shouldn't they just give us the out of range levels and be done? We as nurses will call the MD with the abnormals if appropriate.
Has anyone else had the lab question them like this?
Regarding Physical therapy post... just because its ordered for physio does not mean as a NURSE you cannot put your patient back to bed. Why would you let your patient sit for 3 hours if immediately post op and likely deconditioned and barely able to tolerate 1 hour little own three? The PT has to do an assessment when the move the patient, and if there is any doubt about how to transfer the patient then review their assessment as it should clearly indicate assist of 1 or 2... walker... pivot or total lift ie. ceiling lift etc etc.
In hospital, I worked on a 40 bed surgical unit where we shared a PT and PT assistant between two units of the same number of beds. They simple don't have time to come back to put the patient to bed after they have mobilized them and then settled into a chair if they aren't too tired after taking a short walk (which assists in keeping those lungs clear). Why not just spend the 2 minutes it takes to put them back to bed after 45-60 minutes of sitting?
Just my 2 cents.
I think the bigger problem is that when they are stretched thin it falls back on the nurses. This doesn't only happen when PT is short staffed, whether it's the unit secretary, the NA, housekeeping, a nurse, etc, it affects our job. We're the only group that's not allowed to be too busy (not a valid legal defense) even when we are short staffed. It's also not always 2 minutes to put a patient back to bed, I wish it was.
I agree with what you are saying. However, I would add that just because it is an emergent situation, this does not mean that we should just "do what's ordered" if it will do the patient more harm than good. These protocols are in place for a reason. Most lab tech (and nurses) would argue that taking a few minutes to consider whether you are making the best decision is worth the time.
If you had given this reason for wanting the platelets, I would have given them to you. However, I am under the impression that the OP did not do this. She just continued to insist that the blood bank issue her the platelets without giving a good reason.
Not to sound snotty -are you an MD? I'm quite aware that docs aren't God and they make mistakes too, but I think that the nurse is the one standing beside the patient and if this patient is unstable, I don't think it's the lab techs job to decide if the patient "really needs" the blood or not. After all, the nurse isn't giving the blood without an order and if you are telling this nurse that the patient doesn't need the blood that's like practicing medicine without a license. Just my 2 cents...
I am a first time user here and got caught up in this Lab vs RN thread. I am a Medical Technologist (MT) and have worked in the blood bank department of a level one trauma center for the past ten years now. I have seen a lot of things both bad and good from both nursing services and laboratory services. I wanted to share a couple of comments with everyone here. To become a Medical Technologist (an MT not a medical laboratory technician MLT) requires a BS degree which takes 4 to 5 years of college depending on how the program is set up. I have come to believe that many RNs and other non-lab personnel know little about what we do or our educational level. In my hospital the only time RNs see anyone from the lab is when a phlebotomist comes to draw a sample. No disrespect to them but they are a poor example of a lab employee and are NOT to be confused with a technologist.
As far as RNs go they have a hard job that I would not and could not do. At my hospital there are a few very knowledgable RNs I very much respect. However, there are far more than makes me wonder about the quality of care that is being given. Here is one recent example: An RN (who happened to be black) presented to the blood bank issue window requesting a unit of blood for her sickle cell patient. Now in our hospital we have a protocol for sickle cell patients requiring us to give blood matching their phenotype to limit the possibility of developing antibodies. This testing is reflected on the unit by a sticker. When the RN looked at the unit she noticed the "Sickle Cell Negative" sticker and asked me what that meant. Quite surprised I asked her if she was this patient's RN to which she replied yes. I then respectfully told her that she should be aware of this and proceeded to further delay testing on several patients to explain Sickle Cell disease to her. Once completed I asked if she had any questions to which she replied:"Is this blood safe to give to humans?" What do you say to that?
As far as platelets and CABG patients go I have to agree with the RNs stating if they need the product then we should provide it. However, recent research indicates that platelet transfusions may not benefit these patients. At our hospital we do several CABG patients daily and they rarely require platelet transfusions. However, they order them on every single one which requires us to inflate our supply. Unfortunately this creates a real problem since platelets have a very short shelf life (about 5 days) and when we receive them from the Red Cross there is usually only a day or two remaining on them. So if the MDs order these platelets and they are not used then they get wasted and the Red Cross will refuse our orders for platelets in the future its a bad cycle that MDs and some RNs do not understand.
As far a questioning orders I feel it is quite appropriate...to a point. I had an order for 3 units of PRBCs when I looked a the patient's Hgb it was 11.0 g/dl. I called the RN to verify the order, to which she gave the standard reply "that is what the MD ordered." I then asked her if she was aware of the patient's Hgb to which she said yes. Suprised that didn't ring a bell for her I told that I was going to contact my pathologist because I didn't feel the patient needed the blood. She then told me that is was for volume expansion. I told her that the current hgb was well within normal levels and that didn't seem indicated and that PRBCs are not indicated for that purpose. She then proceeded to argue with me telling me to that I just need to do what she says and to keep my mouth shut. Long story short the patient didn't get the blood, but would have if I didn't question it.
Lastly MTs are professionals as well. We do work very hard behind the scenes to make sure that patient is given the best care possible. Some RNs here questioned why we do certain things. Policies are usually established as a result of something that went wrong and they want to prevent from happening again. At our hospital there is a zero tolerance policy for mislabeled samples for blood bank. We constantly get RN's yelling at us because we tell them we require a recollect. We get samples that are completely blank and RNs want us to use it for there patient! They often say they will come down and label it. This is quite suprising and sad since the number 1 cause for fatal transfusion reactions is misidentification of the patient.
To conclude I would like to say that RNs need to understand that MTs do care for their patient and in my blood bank we will bend over backward to get the RN what they need when they need it. It is often the case that RNs and most MDs do not understand how long it takes for testing to be completed. Calling 20 minutes after we receive a sample and wondering why blood is not ready yet is an example of an unrealistic expectation. To that end listed below are working turn around times for blood bank tests:
Type and screen 30-45 minutes. (if the antibody screen is negative)
Type and crossmatch for x units 40 minutes (no previous patient history)
-if patient has a history within 3 days then crossmatch blood is available immeadiately.
If the antibody screen is positive then it can be anywhere from 1 hr to literally a day or longer depending on the complexity of the antibody identification work up.
DAT (direct coombs) about 5 minutes
antibody titer 1.5 to 2 hrs
cord blood testing 15 minutes
RhoGam work up 10-40 minutes depending on mother's gestational age.
Most of the time we can have up to 10 or more patients we are running at the same time so we assign priorities with cord bloods almost always on the bottom.
Down south we have a saying....well bless his heart.....
It's kind of hard to explain but it's related to the "look" and to the "oh really?"
It's putting the ball in the other person's court without their knowing it.
IE: Pharmacy question...and I beleve pharmacy is one of my favorite depts) calls and says "what mg. does Dr. X want?"....
Answer: "Well bless his heart he didn't specify? His number is 254-xxxx-let me know what you find out ok? and bye now."
IE: Lab question "Your PTT is out of range is your patient on heparin?
Answer..."Well bless your heart....let me find out.....yes he is but it was a peripheral stick below the heparin and we turned it off for 2 minutes....bye now"
Another strategy is to find ONE person in each department and be on a first name basis......you don't have to socialize, you don't even have to LIKE them, but do have to be NICE to them.
Every opportunity you have to choose who to ask......ask your "contact."
Supply: Hey Brownie, what's the number for those new slings....hey thanks and how's the grandbaby?
Nice begets nice. These people are working hard, they may not understand what we do, but if we respect them...we will get respect back. Please no cynics here, it works, I've done it for 30+ years and it makes a much easier day.
As far as PT getting people up....Most PT departments charge the patient by what they call a modality.....crutch walking....a modality...$100 please.OOB $100, back to bed $100 etc.
TEACHING to get OOB a modality. Concentrate on their TEACHING. IF they lifted the patient to the chair....that's pretty dumb, but that's a reason to go to a no lift policy.
Your unit needs hoyers. If they pivoted the patient to the chair.....y'all need to learn how to pivot. All my preceptees spend 3 days in Physical Therapy....they work their buns off but soon the staff can pivot with the best.
We are all in health care...and we need to CARE about each other. They aren't out to GET us they're out there so we can help each other to help our patients.
I understand the PTT thing; I've seen the different reference ranges listed on PT/PTT results. I've read enough about pathologists responsibility with blood transfusions to understand the questioning regarding transfusions. Transfusions are full of potential for major disasters and we need everyone helping out to get the best outcomes.
But I have major issues with lab at the hospitals I've worked at through the years. We have had them admit after intense questioning that a blood sample was dropped and that's why it needed to be recollected (not the original reason of it's clotted). One reason for big conflict is that our unit collects their own samples and we have tiny patients requiring that smaller samples be sent (neonatal ICU). I don't think the lab would be all so ready to insist on a new blood sample if they had to do the collecting from these little guys.
But my favorite two examples:
I sent a Fractionated Bili on an infant I was caring for; a relatively healthy preemie. The results came back on a downtime lab form (I guess the computers were down that morning). My results were:
Total Bili: 5.8
Direct Bili: 6.2
Indirect Bili: 0
For those who work with newborns this would be a distressing and confusing result; generally newborn jaundice is from Indirect bili, the direct would indicate true liver damage especially at that high of a number. Also, for those who can add; the Total Bili is always a sum of the direct and indirect added together; so we had a problem.
The "lab tech" I talked to and I don't know their specific credentials insisted these results were right, he was reading them straight from the computer screen (I guess the computers were back up). I tried to explain they couldn't be right because they don't add up and a "total bili" cannot be less than either one of the components. Like talking to a rock. I insisted on talking to the supervisor who took a while then came on the phone; told me the results had been entered incorrectly and gave me a whole new list of results that actually made sense. The kid just had a slightly elevated indirect bili as one would expect from a 4 day old preemie.
My other favorite; my husband (who also works NICU at a neighboring hospital) sent down a meconium drug screen. Once more; I wouldn't expect that average med/surg nurse to know about this but I would expect people that work in a lab to know about this test; it's fairly common. For those who don't know meconium is the baby's first stool and has substances in it that have accumulated over a large part of that baby's gestation. It can show drug use by the mom during the pregnancy not just in the last few days.
He got a call back a few minutes after sending the sample stating "you want a drug screen but you sent me poop". Ok, first of all, not so much "poop" as meconium, a special kind of "poop". My husband tried arguing with this tech that this was a valid test done all the time, was not experimental (as they insisted) and finally "fine, just please check with your supervisor and if they don't know what to do with it call me back".
And I agree with P_RN, the key to getting more cooperation is to get to know a few people personally. That has worked like a charm for me. The previous hospitals where I worked and others had problems with the pharmacy, I got to know the two main pharmacists who worked nights and I knew their ways of dealing with things. If there were issues I would call and deal directly with them and generally could work things out just fine that way.
I will have to give kudos to the hospital pharmacy where I currently work, they are very cooperative and generally very rapid response. The lab on the other hand. . . .
One more thing about our lab. It's almost kind of fun to call down there to ask "how much blood and in what kind of tube" because you will likely get as many responses as the number of techs you talk with. We don't even bother collecting send-outs at night because they are wrong about 90% of the time and the lab will have to be recollected the next morning when the send-out people who really know what they need arrive.
Specializes in Infection Preventionist/ Occ Health.
Wow, Robert4524, when I read your post I felt like I could have been the one writing it! I have encountered almost all the situations you described and then some!
Unfortunately, nursing curriculum is woefully lacking in the areas of pathophysiology and interpretation of laboratory values. When most nurses say "Well that's what the doctor ordered", it's because they do not have the proper educational background to make a sound argument for their position. It is our job as medical technologists to educate them with as much patience as possible, even though it is frustrating.
As a nursing student, I often was put into the position of explaining collection procedures, test results, and pathophysiology concepts to my classmates and even my clinical instructor. I should NOT have to tell an RN that the first drop of blood from a capillary stick cannot be "saved" for the hemoglobinometer cuvette. It must be wiped away because it is contaminated with tissue fluid (what's that?)
I have learned that it is best to see situations like these as opportunities to teach in a polite, straightforward manner. However, I do get frustrated when the other nurses say "It's not my job to know that stuff", because that is certainly not the case.
I think that nurses and medical technologists should take opportunities to learn from each other whenever possible, so that stressful encounters can be minimized. We all have something to contribute to patient care, and it is important for nurses to remember that laboratory technologists care about the patient just as much as the direct caregivers do.
Those of you from other departments read up: it is the NURSE who gets written up for "delay of care" when it takes too long to get a lab result, blood products, meds, etc., no matter what the "excuse".
That is why we're so hot on this topic! It ALWAYS falls back to the nurse!
That maybe true where you work but is a one-sided point-of-view. We have established TATs that we must comply with. We also get written up for delay of patient care, as well as just about everything else RNs call and complain about.
In my hospital we are constantly battleling not only the RNs but the MDs with erroneous requests that cause substantial delays for our patients. It is very frustrating to have to stop working on a multiple GSW patient just so I can answer a phone and listen to an irate RN not understanding why her patient's Rhogam isn't ready yet, then the other 35 calls each 30 seconds apart from 10 different RNs wanting to know the exact samething you told the other RN 30 seconds ago. Then when its all said in done they cannot understand why it took so long to get the products ready?
In our blood bank we have two technologists working weekends. When we get a major trauma, our other work doesn't stop. We usually have one tech thawing the plasma, cryo and allocating the platelets, then issuing everything. This frees up the other tech to answer the non-stop phone calls and crossmatch the blood as well as squeeze the other work in as time permits.
RNs need to understand that to provide safe and compatible products takes time. I understand the bleeding thing ....really! I do not need to be told. I have had an RN tell me she needs FFP stat and asked how long it would take. I told her approx 20 minutes, to which she got upset and stated that she didn't have that long to wait and would be coming to get it emergency release. She presented to our window with an emergency release form in her hand. So I went to our freezer and handed her to bricks of frozen plasma. She asked me what that was, and I told her it was your frozen plasma you didn't have time to have thawed. She then stated that she thought I was lying to her and though she could force me to get it quicker if she was at the window. I told her I don't work that way and that the name has "Frozen" in it for a reason.
Speaking of plasma do not ask for O negative plasma for your emergency needs. O negative plasma is NOT the universal donor for plasma. Blood types are determined by the combination of A and B antigens on the red blood cell surface. When you are dealing with a non-red cell product (FFP, PLTS, etc...) then you need to think in terms of antibodies not antigens. Therefore AB is the universal donor for plasma. I consistantly get requests from both RNs and MDs for O negative plasma. Also the Rh is only listed on the bag by convention. For FFP and CRYO you can give these products without regard to the Rh status.
Blood types seem to allude RNs and sadly some MDs. I have had RNs ask me for "zero negative" blood and I find that really sad. We recently had an AB positive trauma patient that required over 50 units of blood. Since AB positive people are "universal recipients" we issued A first but then switched to O since we were running out of A. This completely blew their minds to the point we had the house coordinator get involved. I told them the blood was safe, the RNs refused to give it and returned it to the blood bank. I refused to accept it back and tried to convince them that the blood is safe and this is what I do for a living. They of course didn't believe me, the patient died (probably would have anyway) and the RNs wrote me up stating I gave them the wrong blood which caused the patient to die!
More often than not I find that this sort of thing happens more often with the floor RNs rather than the RNs in the units.
Most lab techs belief that most RNs think we are idiots. And I know for a fact that a great many MTs feel the same way about RNs. I believe neither one of us can or wants to do the other's job so we need to respect and trust in each other's abilities.
ok, so, what's getting me here is that most of the real estate in this thread is taken up by non-RN's posting about what idiots the RN's at their hospitals are. maybe this thread was started to be inflammatory and rag on lab staff, but i'm betting it wasn't. i'm betting that the OP's intentions were only to vent and allow others to do the same, while recognizing that neither lab staff or nursing staff are idiots; we all do important jobs and have different knowledge bases. dude, can't we all just get along?
I found this thread very interesting... It's intriguing to hear what the MTs do and how they do it. I'm sure I'm not the only one who learned a thing or two from the postings. Thanks guys.
DusktilDawn
1,119 Posts
I think the bigger problem is that when they are stretched thin it falls back on the nurses. This doesn't only happen when PT is short staffed, whether it's the unit secretary, the NA, housekeeping, a nurse, etc, it affects our job. We're the only group that's not allowed to be too busy (not a valid legal defense) even when we are short staffed. It's also not always 2 minutes to put a patient back to bed, I wish it was.