I am a pediatric nurse in an office setting of a large health system and have been in this position for 17 years. We have a lab in our office and always have. They have decided to cut back on the lab hours, so the lab will close at 4 p.m. Our office is open until 8 p.m. They are now requiring the RNs and MAs to take care of the lab. Several of us in the office have never taken phlebotomy and have no experience with it. They sent us to a four-hour refresher course in phlebotomy, and we are now expected to draw blood and do everything surrounding the processing of the specimens for infants and children.
I do not believe this is adequate training and is very unsafe. Are there minimal requirements for phlebotomy? Can I refuse to do this on the grounds that I feel it is an unsafe practice? I feel that if they want us to do this then we should be sent to an actual course in drawing blood, choosing the correct tubes, processing the specimen and everything that is involved with this. By the way, the phlebotomist makes about fifteen dollars an hour, so by closing the lab early, the facility saves about $60 a day to compromise patient care.
Dear Nancy replies:
The answer to your question can only be obtained through a consultation with a nurse attorney or attorney in your state who can advise you of the regulatory laws, if any, affecting phlebotomy practice and the analyzing of human blood results. Although phlebotomy is not always regulated, a good CE or certification course would be important, as would any additional patient procedure one might be required to do.
Likewise, it is more likely than not that a state law exists regulating laboratory facilities. The requirements of that law would need to be adhered to by all healthcare professionals and
You might also seek an opinion from your board of nursing on this issue. Many boards tend to issue somewhat regular opinions on nursing practice, either through a “send in your question” format, through FAQs on the board’s website or through regularly issued opinions.
You should discuss with your attorney the concern you have about compromising patient safety with the arrangement you describe. As you know, legally you have a duty to, above al,l protect a patient from a foreseeable and unreasonable risk of harm and to practice consistent with your state nurse practice act and its rules. Ethically, you are a patient advocate and must strive to protect the health, safety and rights of the patient: Code of Ethics for Nurses With Interpretative Statements, 2001, ANA (http://www.nursingworld.org/).