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?
My first cousin was a MLT at St Vincent's in NYC. I was amazed at how different things work depending on the facility and the area of the country. Here RespTx does blood gases. There the lab does them. If you send a tube for a UA you just might get a call saying we can't do a Uric Acid on urine.
On the floors things are different than they are in the unit.
First we have more than 1-3 patients. The 10-15 we have are in various stages of disarray. One of my guys might have a spleen lac, a fx tib.fib/ be diabetic, sickle cell/ and depressed. I know a lot about most of those, but for some I do rely on the doctor's request. I promise not to argue if you will give me the benefit of the doubt that I humanly cannot know everything.
Now I can help put in a steinman pin, rig some tx, balance the weights, align the ropes, get the IV started, clean and oint the multiple road rashes. I can get a 16 in and give a unit in a flash for my fella who is spraying blood from the curtain to the bathroom door. BUT remember I still have the other 7-13 patients to worry about.
The post partum nurse who wants her rho-gam might be trying to save her patient the cost of another day after delivery.
The physical therapist has to do a chart review and eval on every patient before she can touch her. They can't just pop in the room and get a stranger to bed. They work 12h too 7/365/and have a case list of about 10 patients while on bedside. In the department they're likely to have nearer 20 whirlpool, strength training etc.
And an earlier poster is so on the mark when they said it all falls back on the nurse. Everything from delivering meal trays, emptying trash, putting up new sharps boxes, to respiratory treatments, to knowing everything in the MLT exam is not possible. But guess who gets the big :Melody:DING:Melody:
We gotta work with not grate against each other. For the MLT, how about offering some classes on the stuff you have listed here.
My facility requires so many teaching hours a year, yours probably does also.
Our PharmDs give coag cascade lectures, new drug reviews, new and old revisions to the formulary.
Great reply, Robert, glad you took the time to respond;
I have an idea for your hospital. It sounds like you probably have a lot of newer nurses working the floors (hence all the "stupid questions" ) but here's how you can help:
How about volunteering to make a presentation at unit meetings to educate them to these matters. If you want the phone calls to slow down, here's the perfect chance to get your point across.
Remember, though, not to be condescending! We all have to work together.
I am fortunate in that I have never really had these types of problems. My opinion as to why this is happening would be that we have become such a litigious society that everyone needs to CYA and triple document everything. In Wisconsin, a nurse was recently indicted on felony charges due to a medication error that caused the death of a young woman. In that light, it is hard to fault people for being extra careful, as frustrating as it may be at times.
As an RN whose previous life was spent as an MT (AMT), it is rather ironic reading these posts. Robert, couldn't have said it better myself. I was written up once when I worked in the lab because there were several people in car that slammed in a bridge. Back in the early days pneumatic tubes were just marvelous, except for the specimens we never received. So when the RN downstairs called me over and over my answers began with it's not here, no I can't comeget it because I am the only person in the lab, to now I have it, to I can't look through the microscope AND answer the phone at the same time. Another time involved me calling in a critical value to the ICU. Per protocol the RN repeated the value bcak to me and then asked how to spell pH. Seriously. Little p, big H. I think the thing is we all see the patient with the perspective of what we need to do. It is easy to simply assume because you know how important your job is for patient care that nothing else matters. I tried to atone for my frustrated labtech behavior once I was in nursing school by going out of my way to explain lab concerns to nurses and vice versa. I agree with the poster who suggested communication, but I realize that with the current staffing issues nurses are facing these days there is simply no way to schedule a brown bag lunch and have anyone attend. As a lab tech I had no clue the time constaints nurses face. In my lab days few were the times I did not get lunch, and I never ate a granola bar on the toilet for my sole break in a 12 hour shift. As a nurse, most people do not realize that if samples are not collected accurately no matter how sick someone is or pissed off the doc is you cannot just "give them a number". I guess the fact is we all want to help the patient, and maybe try and use these clashes as opportunites to learn rather than to point fingers.
I work in a hospital lab and believe me, problems happen at both ends. But I would have to say that most of our problems come from the nurses themselves. Whether it be not filling out the form correctly, ordering an incorrect test, or not even sending down the specimen and wanting results (this acutally happens a lot).
In the specific hospital that I work at, there's a recieving department that orders tests and then pass them to the correct department. We also answer any phone calls for results from the floors. Most of the people I work with (actually 98%) have no "medical" background- they have science degrees. So they may not know about normal results, or what a specific test is. If they question it, try not to give them an attitude- they're asking for a reason.
Also, we try very hard to not inconvience the patient, nor delay results. We have a sign thats posted in our deparment "It's not a specimen, it's a patient".
P_RN, ADN, RN
6,011 Posts
My first cousin was a MLT at St Vincent's in NYC. I was amazed at how different things work depending on the facility and the area of the country. Here RespTx does blood gases. There the lab does them. If you send a tube for a UA you just might get a call saying we can't do a Uric Acid on urine.
On the floors things are different than they are in the unit.
First we have more than 1-3 patients. The 10-15 we have are in various stages of disarray. One of my guys might have a spleen lac, a fx tib.fib/ be diabetic, sickle cell/ and depressed. I know a lot about most of those, but for some I do rely on the doctor's request. I promise not to argue if you will give me the benefit of the doubt that I humanly cannot know everything.
Now I can help put in a steinman pin, rig some tx, balance the weights, align the ropes, get the IV started, clean and oint the multiple road rashes. I can get a 16 in and give a unit in a flash for my fella who is spraying blood from the curtain to the bathroom door. BUT remember I still have the other 7-13 patients to worry about.
The post partum nurse who wants her rho-gam might be trying to save her patient the cost of another day after delivery.
The physical therapist has to do a chart review and eval on every patient before she can touch her. They can't just pop in the room and get a stranger to bed. They work 12h too 7/365/and have a case list of about 10 patients while on bedside. In the department they're likely to have nearer 20 whirlpool, strength training etc.
And an earlier poster is so on the mark when they said it all falls back on the nurse. Everything from delivering meal trays, emptying trash, putting up new sharps boxes, to respiratory treatments, to knowing everything in the MLT exam is not possible. But guess who gets the big :Melody:DING:Melody:
We gotta work with not grate against each other. For the MLT, how about offering some classes on the stuff you have listed here.
My facility requires so many teaching hours a year, yours probably does also.
Our PharmDs give coag cascade lectures, new drug reviews, new and old revisions to the formulary.