Test result question...please help!!!

[Tech_2_RN]

I am an ER tech and a nursing student. On this past Saturday, we had a peds patient in our department who was dx'd with rectal bleeding. The doctor collected a stool sample from the patient and handed me the Hemoccult card to test. The first thing I noticed is that there was only one smear and not the usual two smears on the front of the card. While this is surely not mandatory and the results will be the same irregardless of the number of smears, I just found it odd and thought I would mention it for this post. I tested the stool sample and it came back negative. I charted this and told the charge nurse, who had absolutely no reaction whatsoever. The CN was also the patient's nurse during his visit.

When the doctor asked me about the results, I told him it was negative too. He said he found that odd because he could see visible blood in two different areas, one in the patient's pamper as well as around his orifice area. The doctor told the nurse to specifically collect samples from these two areas and test them. She did and when they came back positive, she blew a gasket....making a really big announcement in front of any and all patients and other RN's who were within earshot. She loudly yelled, "did you run the stool sample on bed xyz..to which I responded yes (even though she knew I had because I had told her the results earlier and I peeked her looking at the chart...then she makes the announcement that she had just re-run it and it was incredible high positive...to which I said well based on the stool I was given on the slide, my test results were negative.....

She then talked about it all day today (and I mean ALLl day folks) and even said "yesterday, we had a misdiagnosis on a stool culture". For background, this is a VERY negative person and very seldom has anything good to say (to me anyway). She does however, seem to like the attractive fire fighters who bring in patients to our ER but unfortunately, I don't fit that mold. She has given me reason to believe that she is only a nurse there for the $$ (after 17 years) based on several of my experiences with her. Definitely, a drama queen!

Now, this is where I need help.

(1) Anyone familiar with Hemoccult testing knows that blood may not be evenly distributed in feces and you can get a false negative as a result of this. Can I be written up on the negative results in light of the patient was in fact positive? Also, she used blood that had obvious blood for her testing..that was not the case with my testing.

(2) You have earn the respect of the more experienced nurses and I have worked hard to do so. I do the best I can for any RN I work with. By making this into such a big deal, this nurse basically was telling the other nurses and techs, that I was incompetent to a certain degree without actually saying it directly. I am fearful the more experienced nurses will not want to rely on me as much when there is no reason for this.

(3) I am very bent out of shape over her behavior and how she responded to my test results. I do not want to be emotional however I found her reaction to be very embarrassing, humiliating, and unnecessary. She could have just called me to the side and discussed it with me instead of making a big deal over it. She didnt even have a reaction until the doctor said something to her. Is her behavior something that I would/shoud talk to my floor manager about or I am just being a big baby? I really dont have a problem with the message, just the delivery.

Shouldn't she have just asked me to redo the test without all of this drama?

Any advice and input is appreciated.

Thanks.

[Reno1978, BSN, RN]

My understanding of it is that it tests for occult blood in the stool...meaning usually that a positive result would be indicative of a GI bleed farther up the GI tract.

If there is bright red blood per the rectum, that would then be the source of the bleeding and I would think that if the stool is formed then it definitely would be possible to get a sample with no blood on it. We're are told NOT to test samples that have obvious blood on them. Again, the test is for occult blood...not obvious visible blood. Of course it's going to come back positive if you're testing bloody samples!

If I were you I would find the manufacturer's directions for how to run the test and see if it mentions anything about samples containing frank blood and whether you should use them or not. My bet is that it will probably tell you to use samples that do not contain obvious blood. Then this can be a learning opportunity for you, your coworker, the doctor who ordered bloody samples to be tested and anyone else in your facility who may be testing stool taken from patients when they are actively bleeding.

In my opinion you didn't do anything wrong. You tested a stool sample for blood, which is the intention of the test whereas your coworker basically tested a blood sample for blood.

[recoveringcory]

Hi there,

It sounds like you did everything right. Like the above post says, see what the protocol is for taking them.

Now for addressing the rude nurse.

#1. Don't let it bother you. Think about it, you have control on what does or doesn't bother you. Letting someone else bother you makes them have power over you, so don't let it happen.

#2. If you have a problem with her - DON'T go to your manager first. WAY to many people do this, and it isn't right. Whenever I had a problem with a doctor or a nurse, I addressed the problem one on one, in a calm professional manner, with the person I am having a problem with. People WILL HAVE MORE RESPECT for you if you address them first, and stick up for yourself. Truly, they will.

#3. If you think the problem wasn't resolved by talking with the person, THEN go and talk to the manager. See, if you do this before confronting the person, this is disrespectful, in my opinion, because you are going behind a person's back, and they may not know someone has a problem with them.

#4. Demand respect. I don't care if you are a doctor, nurse, tech, housekeeping, whatever. I for one do not address the techs in any different manner from a nurse. We each are deserving of respect, and if someone isn't respecting you, address it in a RESPECTFUL manner, and carry yourself in a dignified professional manner. People see this behavior, and respect that kind of person. Remember, don't lower yourself to a nother person's level if they are acting 'greater than thou'. That means they have some sort of insecurity that they think they have to be better than everyone. Carry yourself in a manner deserving of respect!

Hope that helps!

Cory

[LovingNurse, BSN, RN]

On the floor, we usually see stool for occult blood ordered "x3" (taken from separate BM's) precisely because it is possible to have a neg. result in one sample and a positive in another sample.

She doesn't sound very nice or very professional. I'm sorry you were treated this way. I think learning how to deal with difficult people/situations is (unfortunately) just another of the many skills required in the nursing field. Keep your chin up.:redbeathe

[Scrubby]

My advice to you is if anyone yells at you, puts you down or want to make 'an example' of you by bullying tactics cut them off and say as calm as you can 'I would prefer to discuss this privately'. If they continue with it then turn your back on them and don't respond. It's amazing how effective the cold shoulder can be in this situation.

Let her know that you feel uncomfortable in how she handled the situation. That yelling out in front of everyone, not letting the matter drop and going on about it all day and the next was highly inappropriate.

If she cannot discuss this rationally then report it to management.

[Tait, MSN, RN]

:icon_hug:

She can go suck an egg.

Hemocults are variable for all the reasons stated above.

Tait

[NurseyPoo7]

The poopy cards, as one of my old nursing instructors called them, check for OCCULT blood. Occult, meaning hidden blood. Whats the point in testing something for hidden blood if the blood is obvious? I've also been taught not to test those areas.

The kid probably has an anal fissure or something from constipation.

BTW, I'd tell that nurse to shut the f up, but of course, in a nicer and more professional manner! :lghmky: