Saturday, November 1, 2008

Powerpoint Fun!

There's a good chance I could be fired on monday.

Last night I called a floor and informed the unit secretary that a protime on a patient was clotted and would need to be redrawn.

Five minutes later a nurse calls me and asks what I did to the specimin and informs me that it was a good draw and looked fine to her. I told her that there was nothing I could have done to MAKE it clot. She replied that she wished the lab would just own up to their mistakes and maybe she wouldn't hate us so much and hung up.

I brushed it off, hey everyone deals with stress and needs a release. She was probably busy and didn't want to deal with the nuisance.

Five more minutes passed and I got a phone call from the nursing supervisor asking if I had "dropped the specimin". I said I hadn't and privately wondered why the hell she asked me that. The nursing supervisor hung up and called back about two minutes later to inform me that we needed to run the protime on the specimen we had and that she'd be writing up a QI report detailing how I refused to accept a good specimin. She went on to say that the nurse is postive it was a good stick and the problem must have happened in the lab.

I knew full well that there's not point in doing a clotting study on a sample that's already clotted, evidently I couldn't explain this to her. Sometimes I wonder if nurses always know what tests are for, or if they simply know if something is out of range, and what needs to be done i.e. call the doc. Either way, eventually I convinced her I wasn't going to run the sample and she had to have it recollected.

Most normal people would let this slide. I knew I hadn't done anything wrong but frankly, if my time is going to be wasted on filling out/sitting through a reading of a QI report, I was going to waste her time.

I decided to spend the rest of my free time that evening creating a power point illustrating how the coagulation cascasde works and how sodium citrate works in binding calcium to prevent the cascade from ever starting. Thereby illustrating how if a sample is collected correctly, nothing I can do, short of adding more calcium would make it clot. This included the dropping scenario. No matter how many times a specimin may be dropped it won't spontaneoulsly clot.

I can't figure out how to post a powerpoint on here but if I ever figure it out I'll try to. I haven't gotten a response to this yet. I'm waiting, probably untill monday but hopefully it's not too bad. Surely my bosses know I'm a smart ass by now.

I'd like to end this post by telling everyone that we're accused of "not getting it". We just don't seem to understand that patients are critically ill and a nurse can't be bothered to redraw a specimen. My favorite line is that we only ask for redraws when we don't want to run something. Let me tell you, I get it. We're all on the same team here and we should have patient saftey and quality of care in the forefront of our mind. There is too much inter-departmental strife that was created because of an "us vs. them" mentality. It also takes me longer to pull one specimin out of my work flow and have it recollected than it would take to just run the sample and send out erroneous results.

I promise I understand that being a nurse isn't easy, I could never/would never do patient care. I also know that nurses are paid much better than we are even though we have similar degrees, ours may actually be tougher in terms of learning bodily processes on a molecular level, and I also know that the squeaky wheel gets oiled. The nurses always seem to be that squeaky wheel. Anyway, I'm tired of being accused of not getting it or just trying to avoid work. Just understand that shit happens. I'm not sitting in the lab making fun of someone for a clotted or hemolyzed sample. Shit happens it's not a reflection on your phlebo skills it's just something that happens, and there's nothing either of us can do to avoid it. I promise I've never had anything recollected out of spite or laziness.

Please pray that I still have a job monday.

1 comment:

Sonotek said...

I encounter several nurses here who don't understand why tests are ordered, let along how they work. They don't understand the difference between an test "indication" and the test "result". For ultrasound we are required to enter an indication (which is supposed to be on the requisition, but is frequently not, due to the usual pervasive carelessness). When asked, the nurse might say "to rule out gallstones"; no, that's the result of the test. An indication might be something like "epigastric pain" or "elevated liver function tests". After a futile attempt to explain the distinction, the nurse repeats with much exasperation "to rule out gallstones". I usually don't bother to call; I hunt through the patient's labs or history. Most of my co-workers continue to waste time calling and getting frustrated.

Also, these same nurses don't seem to know what's going on with their patients and seem offended that I would expect them to; their excuse is "I just came on shift". So what was going on during all that "report" during change of shift ?