Blood sampling in Irish hospitals

Sitric

Hi,

First of all, I do not want to start a nurse bashing thread with this topic, I know Irish nurses are respected all over the world, simply trying understand exactly what the situation is with regard to the use of peoples time in our hospitals.

From reading a number of threads recently, I was fairly surprised to read that irish nurses do not take venous blood samples or place peripheral venous catheters. Is this actually true? And why?

Of course with regard to central venous or arterial access, the greater risks involved and the degree of patient discomfort means these roles are generally performed by doctors in most countries. However, I have been told that irish nurses are not allowed to draw blood from a pre established catheter? Is this true? And again why?

I'm open to correction on the above, this is just what I have read.

I realise the latest OECD report quotes the 2006 figures for health personel, however according to those figues, we have less doctors (2.9 per 1000 of population) than the OECD average (3.1 per 1000 of population) while having an extremely high number of nurses, (15.4 per 1,000 of population), when compared to the OECD average (9.7 per 1,000 of population).

So, when we have this distribution of doctors and nurses, does it make sense for doctors to be taking all blood samples? If this is the case.

The same question applies to ECG's.

ZYX

To be honest not only is blood taking a waste of doctors time it is also a waste of nurses time. When I worked in UK we trained receptionist to take bloods. Leaves nurse free to do more important work.

Phototoxin

From reading a number of threads recently, I was fairly surprised to read that irish nurses do not take venous blood samples or place peripheral venous catheters. Is this actually true? And why?

my ma's a midwife and she can take venous blood.

tallaght01

The real unusual thing about the midwife situation is that very often they'll take blood, but won't put cannulas in!

metrovelvet

Everytime Ive had blood taken from an Irish nurse I end up with a 3 inch diameter bruise.

Is this the technicianship or is it cheap needles [i notice the irish hospitals dont use butterfly needles].

allsaintssue

Yeah, this actually really suprised me whenI started nursing as I (and most of my classmates) were convinced we were allowed to take blood!

It would save so much time on the wards, although having said that, I don't agree with the amount of specialist training now available to nurses, I mean I'm all for furthering education but I think this is taking nursing proffessionalism too far, and I know thats a very popular opinion to have amongst nurses but I honestly believe that the emphasis in nursing should be patient focused and about caring, I think nurses feel the need to do all thee courses, like nurse prescribing in an attempt to prove themselves and they don't need to and shouldn't feel the need to...Nurses are amazing (This isn't self praise btw, I think I'd be a useless nurse if it were my plan to stick with it!) and it is the fault of society that they don't give tasks such as caring and patience the respect it fully deserves.

Oh, and as for the ECG thing..nurses do ECGS...I've done ECGs and I'm in 2nd year!

tallaght01

allsaintssue wrote: »

it is the fault of society that they don't give tasks such as caring and patience the respect it fully deserves.

!

+100000000000000000000000000000000000

Sitric

Hi, thank you for your replies,

Allsaintssue, I agree completely with you, people have some strange priorities and notions about the value of caring. The majority of people don't appear to realise it's value until dependent on our system, which is surely stretched to the point where it is unable to provide the care and dignity everybody in our country is entitled to. Or have we made a collective decision, via our elected representatives, that we are actually not entitled to such care when sick? I don't personally know anyone who would subscribe to this point of view but it seems to be what has happened in Ireland.


I guess my original question still remains, why do nurses not take blood (are not allowed?) in Ireland?

ZYX, I realise it's a waste of nurses time too but there are a whole lot more nurses than doctors on the wards. How did they solve this problem in Australia when they implemented the 48 hr working week?

Dr Galen

you do realise that taking blood samples is a tiny part of any doctors normal duties?

Most hospitals in this country at least have a dedicated blood taking service which goes round each morning and takes most of the samples needed for the day. It appears from your postings that you think that doc's are running around taking bloods off every tome dick or harry under thier care, I'll happily stand corrected on that tho

Sure, doc's have to take some bloods themselves, and yep, its a bit of a waste of their time, but don;t be under the impression that they have to spend hours doing it everyday.

Phototoxin

Phlebotomists are the best.. they have the most practise..

The real unusual thing about the midwife situation is that very often they'll take blood, but won't put cannulas in!

bizzare ! I know that a hospital cant allow you leave with one in you so maybe its due to the protocols surrounding that.

RE: midwives taking blood.. midwives are practitioners in their own right.

Sitric

"you do realise that taking blood samples is a tiny part of any doctors normal duties?"

Hi Mystik Monkey, of course I realise that, my question is not why doctors sometimes have to take blood but why nurses are not allowed?


Every intern i've spoken to has complained that their training year seemed to mainly consist of running after x-rays, taking ecg's and taking blood samples. So I guess it is taking a considerable amount of time. Particularly for the doctors on call over the weekend.

"Phlebotomists are the best.. they have the most practise.." I agree but I learned from a nurse and in a lot of places nurses have the most practice and are the experts.

Echani

I was on an A&E placement recently and all the nurses there both took venous samples and placed cannulas. Is it different for A&E or is a per-hospital thing? I've never been aware of anything prohibiting nurses from doing it.

tallaght01

Echani wrote: »

I was on an A&E placement recently and all the nurses there both took venous samples and placed cannulas. Is it different for A&E or is a per-hospital thing? I've never been aware of anything prohibiting nurses from doing it.

Some A+E depts have traditionally been quite proactive in getting their nurses trained up in cannulations.

If you're going to see it anywhere, it's most likely to be in A+E I reckon.

Vorsprung

Phototoxin wrote: »

Phlebotomists are the best.. they have the most practise..

I thought that until they started not doing some of the routine morning bloods, and realised they were leaving down some of the request forms with "Couldn't get vein" written on them. Cue a bleep to the intern asking him to do them!

(Infrequent I'll admit, but annoying!)

worksucks

A bit off topic I'm a radiographer and I've done cannulation course does any 1 know where I can do a blood taking course my hospital don't offer them in house & it'd b so handy 2 b able 2 do them 2 check creatin levels before injecting contrast.
The nurses in my work r very tight lipped on this as they feel I'd b taking over their job

tallaght01

worksucks wrote: »

A bit off topic I'm a radiographer and I've done cannulation course does any 1 know where I can do a blood taking course my hospital don't offer them in house & it'd b so handy 2 b able 2 do them 2 check creatin levels before injecting contrast.
The nurses in my work r very tight lipped on this as they feel I'd b taking over their job

I know I'm not answering your question, as I don't know the answer to it....but who in hell made the blood taking and cannulation processes into two separate courses???!!!!

DrIndy

tallaght01 wrote: »

I know I'm not answering your question, as I don't know the answer to it....but who in hell made the blood taking and cannulation processes into two separate courses???!!!!

Beaurocrats

wheresthebeef

hi all. i'm currently working in a stroke care setting as a nursing intern (thats the new flashy name for almost qualified nurse). The majority of bloods are taken in the morning by the Phlebotomy Service which is staffed by Registered Nurses who have done the Phlebotomy Training Course. Any emergency bloods thereafter are taken by the Medical or Surgical Interns. There are a number of Staff Nurses trained to take blood, but who do not normally engage in doing so. Similarly, a large proportion of nurses in our hospitals have previously undergone Cannulation training but hospital policy dictates that in most clinical areas, doctors must be the ones to site the IV Cannula. I know that in the Paeds dept where i work, there is a combined phlebotomy and cannulation service staffed by nurses who perform both functions during the day time.
My cousin has recently commenced working in the Renal Day Care Unit in my hospital, and he can insert an IV Cannula.
To be honest, I'm not quite sure why we are not allowed. I know it would be in the best interests of patient care if we could.
As regards taking blood from an existing line, nurses can do this, but only immediately after the line has been inserted (i.e before any iv drugs are pushed down in), so if the doctor is there already to insert the IVC, usually they would just take the blood.

I have seen nurses taking bloods and cannulating, against hospital policy, particularly if an intern is having trouble doing so (this is more often a nurse who has come from overseas from a country where the nurses do phlebotomy and cannulation more often than docs).

In short, I don't think many nurses would object to occassionally having to site their own IV Cannulas or take the occassional blood sample, but to be honest, i think we have enough to be doing already without taking on more functions. Perhaps the Phlebotomy service should go around doing bloods and inserting IVC's routinely during the day time, freeing up docs time during the day.

as regards ECG's, i dont think i've never seen a doctor do one. Personally i've done about a hundred of them. Either Nurses or ECG Technicians do them, in my experience.

tallaght01

wheresthebeef wrote: »

In short, I don't think many nurses would object to occassionally having to site their own IV Cannulas or take the occassional blood sample, but to be honest, i think we have enough to be doing already without taking on more functions. .

I guess that's the issue. Any group in a hospital setting can say they're too busy to perform a certain task, and it automatically becomes the job of the intern.

We used to joke about this all the time.

I was just out with a few of the guys i did my internship with last night. We were laughing about how we had to do every single ECG in the hospital that had probably the highest cardiac disease ld of any hospital in Europe.

We would get called to a chest pain. So, we'd examine the patient, and then we'd have to find the ECG machine, which was often in another ward. I once had to go tot he other side of the hospital to find one lol.

Then we'd often have to change the roll of paper, before we ever got the ECG on. We were laughing about it, but it used to really impact on patient care.

I hope that kind of thing has stopped now, but I wouldn't bet on it.

tallaght01

DrIndy wrote: »

Beaurocrats

Too true mate.

But even aside from that. Why do people even have to go on courses to learn to take blood or cannulate? And how come we never got the benefit of these courses?

Honestly, we need someone with a bit of cop-on to just allow people to learn to cannulate on the job.

A while ago, the head nurse in a unit i was working in heard that i was letting all the nurses cannulate me, just for practice while they waited on one of these magic courses. She told them they weren't allowed practice on me!!!

Obviously, they're my arms, and it's my call. So, we used to practice in locked rooms. It felt a bit like learning to speak irish in the bushes :P

DrIndy

There is a certain validity having interns do a lot of cannulating - much as i complained at the time, the reason i can canulate anyone now from drug users to putting large-bores into very sick and shut down patients is because i have literally put thousands of them in at this stage and so in a crisis, i am now able to do so.

But on call, at night - this is where patients do suffer as a result because they can need to wait an interminable time for us to do so when things are busy (as they almost always are).

I think interns should have to do all canullation during day time, but there should be an alternative arrangement at night.

First dose antibiotics is a complete joke though - anaphylaxis can develop at any time, at any dose, be it the first or the 1000th - i see no validity here and this really does cause delays in patient care and is frustrating for nurses as well as doctors.