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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Any Clown Could Do That!

Published June 19, 2011 8:42 PM by Glen McDaniel
This past Saturday, I was on the way to an appointment when I stopped to get gas. I was filling up, preoccupied with my thoughts, when to my surprise and disbelief a fully dressed clown casually emerged from a van. But I digress; back to the clown later. This made me recall an incident I had witnessed recently.

I was observing point of care (POC) competencies for nurses organized and conducted by the lab. During one especially impressive moment, the MLS was trying to get a nurse-manager to demonstrate not just skills, but understanding, of the rapid strep test since this testing is done by nurses whom she supervises. I could tell by her body language that she was getting increasingly agitated and frustrated with the line of questioning.

Nurse-founded clown ministry fosters chuckles.The MLS asked, “Suppose you timed the test for 5 minutes, but you did not see this blue line would you report the patient result?”

Nurse: "It depends."

MLS: "On what?"

Silence.

MLS: "Can you tell me what the internal controls are in this test? In other words what three things must be present before you can confidently report the patient result?"

Dead silence.

MLS: "OK, I can’t really mark you as competent. We need to arrange some time to go over this in more detail. You need to know what the controls are, and why they must all be there before you can say the test is valid."

At that point the nurse manager had taken all she could. “What? You are telling me I can’t do this simple stupid test? You just add the sample and wait for 5 minutes. One line is negative, two lines is positive. Any clown could do that!”

I thought: well, at least she did not use the proverbial “any monkey could do this.”

This incident demonstrates why laboratories are so reluctant to relinquish POC testing to nurses. That is why laboratorians appear so “anal” to other healthcare providers.

This was a strep test; but it could have been pregnancy, urinalysis, mono, glucose, troponin or any number of POC tests where significant clinical decisions are made based on the result reported to the doctor.

This nurse had no concept of internal and external controls and was quite ready to report results regardless of whether or not she could demonstrate the test system was “in control.”

Saying, “any clown” can perform lab testing comes from the deceptive simplicity of many tests. But as we know it takes theoretical understanding of test principle and the use of critical thinking to perform and confidently report results of even technically simple tests.

Our professionals deserves better than to be compared to clowns and the patients certainly deserve better than to have their tests performed by someone who would approach the process so cavalierly.

(Note: So maybe all clowns aren't so bad? The image above is from a ADVANCE for Nurses article about a fun clown ministry in Delaware that brings smiles to patients at a hospital there. Check it out.)

4 comments

The fact that nurses treat POC with so much disrespect has always bothered me. It's not that the lab wants to hang on to all testing. It's just that nurses and doctors dont really understand the science of testing. They think you just add A to B and look for  a blue color. What is A? What is B? Ask them why is timing and temperature important? They have no clue.

I read the article about the patient in Lehigh who died because nurses using POCT meters kept reporting high gluclose so the doctors kept treating the patient with more and more insulin. In reality the patient was hypoglycemic. The patient eventually died directly from shoddy POCT testing. This is a shame and shows that POC requires trained, competent people. Only the lab can train those folks. The lab needs to have control of POC testing wherever it is performed in the hospital.

Ronald T, MT July 18, 2011 9:13 PM
Philadelphia PA

That is what is wrong with the lab profession. everyone thinks they can do what we do without any training at all. In my lab we still get calls from college graduates with biology and chemistry and even business degrees to ask if we have any vacancies in the lab. I bet they would not even think of asking a nurse or doctor that stupid question. In California luckily we have CLS licences thank God. But in other states a lab manager might allow a friend to slip in and work without the proper qualification. We have to stand up and let folks know that we are not just educated but educated in a professional field. We have degrees, but not just any random degree in any science field. Clinical lab science is a very complex and specific field.

Jearvaise T , MT July 7, 2011 11:57 AM
Garden Grove CA

You know how nurses and doctors are always yelling for results? They tell the patients they are waiting on the lab to write  a prescription or decide to admit or discharge a patient. In any other world that would mean the lab is very important. Only in our crazy healthcare world does that mean we in the lab are useless flunkies, monkeys and clowns. If anyone could do what we do, why dont the doctors and nurses do their own tests? I have never heard an answer for that.

Mervina S MT(AMT) June 26, 2011 2:32 PM
Boston MA

Nurses sometime sthink we have these instruments that magically spit out numbers and we just baby sit them and take the numbers off. I have been asked what did the machine read? or even "are you sure the machine is working right today?" How insulting. That suggests we are just clerks who copy instrument readout and send to the floors. No wonder they think POC instruments are foolproof too.

Justin S. June 20, 2011 10:07 PM
Brooklyn NY

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