Any Clown Could Do That!
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.
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?"
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?"
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.)