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Press Start: Lead an Empowered Life as a Clinical Laboratorian

CMS Says Nurses Can Perform High Complexity Tests

Published July 31, 2016 4:38 PM by Glen McDaniel
The Centers for Medicare and Medicaid Services (CMS) recently published a memo that it sent to CLIA inspectors on how to interpret educational requirements. CLIA had always specified the minimum educational requirements for individuals performing laboratory tests. 

 

In recent years there has been quite a  strong lobby from nursing to recognize a nursing degree as a biological science degree, having the requisite credit hours of biology, chemistry etc. Those of us with oversight for point of care testing (POCT) had also been unsure as to whether nurses could perform non-waived tests and maybe even fully manage a POCT program where non-waived tests were utilized.

 

Now CMS has weighed in definitively by saying that, yes, a nursing degree is a science degree making nurses qualified to perform non-waived tests. A careful reading of the CLIA regulations would suggest that if that is true, then nurses may in fact be allowed to even direct laboratory testing.

 

In my view, this is an encroachment on our scope of practice that also potentially endangers the patient health.  POCT and some other laboratory tests are seen as merely “recipes” by some inside and outside the profession. But we know that laboratory testing requires critical thinking skills way beyond the memory and motor skills required to add 1 drop of this, 2 drops of that and time for 5 minutes to see if a blue line appears or not.

 

The CMS guidance to its CLIA inspectors directs them to accept a bachelor’s degree in nursing as a biological science degree qualifying the  holder to perform even high complexity testing, and that an associates in nursing qualifies the holder to perform moderate complexity testing. Yes!

 

Lest you think this is something that no serious employer will follow, bear in mind that this came after lobbying from nurses who wanted to perform and supervise laboratory testing. They had a definite goal in mind and will certainly take advantage of this new development.

 

Not wasting much time the Veterans Administration  (VA) has already jumped on the band wagon.


 In a recent letter to its members ASCLS said the following regarding the VA decision:

 

"The Department of Veterans Affairs (VA) has published Proposed Rule that would expand the authority of Advanced Practice Registered Nurses (APRNs) beyond ordering and interpreting lab tests, as they can now, to supervising and performing laboratory testing. If adopted, an APRN could supervise and direct a clinical laboratory.

"In proposed § 17.415(d)(1)(i), a CNP would have full practice authority to provide the following services: Comprehensive histories, physical examinations and other health assessment and screening activities; diagnose, treat, and manage patients with acute and chronic illnesses and diseases; order, perform, supervise, and interpret laboratory and imaging studies; prescribe medication and durable medical equipment and; make appropriate referrals for patients and families; and aid in health promotion, disease prevention, health education, and counseling as well as the diagnosis and management of acute and chronic diseases."

 

This is setting a dangerous precedent. Nurses are valuable members of the healthcare team but they have a body of knowledge and a scope of practice different from those of medical laboratory practitioners.

 

This is not about competition and “staying in ones lane.” It is about a real risk to the public health. I can no more practice nursing from reading a package insert and following schematic workflows than a nurse can (safely and effectively) practice medical lab science.

51 comments

If Med Tech's were licensed, then things would be different.  It is odd to think high complexity testing can be performed and overseen by a 4 year RN that never had to take the registry whereas most labs require  Med Techs pass the registry in order to perform high complexity laboratory tests.  

Kathleen, Chemisty Coag POC - POCC December 8, 2016 3:44 PM

This is one of the most substantial posts I have read in a long time. This is what we feared guys. It is actually here when we hand over our profession others. Not only will nurses be competing to us, but we know how highly nurses are viewed in healthcare. So YOUR supervisor might soon be  a nurse.

Imagine calling your manager , a nurse, to resolve an issue in blood bank or hematology-or even an automated section like chemistry.

Mr McDaniel has long advocated for licensure as a way of protecting our profession. He also talked and wrote a lot about making sure we maintain control of our profession. Some of us listened, but most did not.

I am almost retired and am tempted to say I don't care. But I do. However it's up to those of you with many years left working to ensure that this does not happen. How? Write to CMS, contact ASCP and ASCLS to share your opinion. Support licensure, Pay a few extra bucks per year to ensure that only a certified MT/MLT/MLS can work in the lab and supervise in the lab. That is what licensure does.

If you don't do something, speak up, support licensure,  the profession will be dead and you will be out of a job or find yourself working for  anon-laboratorian who is much better paid that you. That's just the reality folks.

Melissa Nelson, MT, MT ll November 23, 2016 8:05 PM
Miami FL

This is absolutely ridiculous. It is what happens when we don't protect our profession. We don't care enough to get CEUS or  join professional organizations.  Most important we fight licensure which would protect our scope. We say it's necessary and would cost too much money. Guess what for a minimal cost it would codify who can practice the profession. By fighting and resisting licensure we have given the profession away. Donot blame CMS. We did it to ourselves.

Thomas T. , MLS September 17, 2016 11:11 AM
Dallas TX

Addendum :I meant CMS not CLS in the  2nd to last sentence of my previous post.

Deb September 16, 2016 1:14 PM
IA

Well I respect nursing and their knowledge base within their own field I feel this is a discredit to our field.  I have a 4 YEAR college degree which includes one FULL year of on the job internship training.  Our scope of training was much more intensive in the biology and the chemistry field than nursing's program when I was going through college. It pretty much seemed that where the nurses training in biology and chemistry ended was where the Med. Tech's program started. Much of their biology classes were in the first year while ours extended through the whole 4 years.  If I had taken one more class in Chemistry I would have had a major in that as well as my BS in Medical Technology and the Chemistry and Physics courses were some of the hardest and labor intensive classes that were offered and Nursing wasn't required to take those. We spent a great deal of time in the lab learning the principles behind the testing as well.  How are they suppose to interpret testing with out the intimate training necessary to know when something seems off with a machine, etc. before you report out a result.  They don't have the understanding behind the testing methodologies and how it ties in with results.  I also took boards for CLS and Med. Tech through ASCP ( and passed both) but they aren't required to do the same? It's a slap in the face to anyone who has put in the long hours of training to get the degree and then CLS thinks anyone with a biology degree can come in and take our place. It shows just how little they really appreciate the medical lab field and how little they know about what is involved in lab training and running a lab.

Deb September 16, 2016 1:06 PM
IA

Anyone who wants to sign a petition to have CMS change the rules please click on the following link...

http://cqrcengage.com/ascpath/app/petition-signed?signedBefore=false&engagementId=239813

Michele September 7, 2016 8:39 AM
IN

I believe that they should have to have just as much training and as much biological science and chemistry classes I was required to have in college. They should also be required to get their certification from the ASCP. We need people that are trained and educated properly to perform moderate to high complexity testing in the laboratory, especially in areas such as Microbiology and Blood Bank.

AO, Microbiology - MLS September 1, 2016 12:31 PM
IN

Sign the ASCP Petition here

 http://cqrcengage.com/ascpath/app/sign-petition?0&engagementId=239813

 

Glen McDaniel August 31, 2016 7:38 PM

Please point us to a copy of the CMS memo mentioned in this document.  We need to read it completely in order to understand exactly how to use the information.  This is truly disturbing.

Patricia, flow cytometry - supervisor, Poplar Healthcare August 30, 2016 10:32 AM
Memphis TN

I have worked in the Medical Technology Field for over 23 years. The Laboratory Professional and Nursing Professional usually only share 1 year of academic equivalence. When we begin to prepare for our majors, Lab Students are required to take much more  advanced classes in Biochemistry, General Chemistry, Organic Chemistry, Pathology, Microbiology, and Instrumentation in addition to data collection, interpretation and Quality Assurance. These skills are then honed for precise and accurate result reporting. It takes years to develop an appreciation for these skills. Something that OJT will not be able to teach. I've worked with Nurses who are very smart and detail oriented but just do not understand why we do what we do. Many times I explain the reasons and the next week or month, I am asked the same questions. Nurses just don't have a core understanding of what we do. We need to respect that a Lab Tech is not a Nurse and that a Nurse is not a Lab Tech. We work together and can have synergy but a Nurse should NEVER be expected to replace our High Complexity Lab Testing Professionals have the authority to Manage a lab. Leave this to the Clinical Lab Professionals

D Alexander, Medical Technology - Clininal Lab Supervisor August 29, 2016 9:20 PM
Rochester NY

I have been a CLS/MT for nearly 25 years. I also have graduated Physician Assistant school. I went to PA school with NP students and have tutored nursing students as well.

My opinion is: No one in their right minds should even let nurses come into a field where they have no training. If they want to work in a lab or be in charge of a lab, then they need to adhere to the same standards as MTs. Sure, they have some science, but this does not compare to the level we as MTs have to go through and live through every day. When I tutored these students, they couldn't even figure out basic chemistry or a periodic table. My experience with nurses shows that nurses need to learn their craft before trying to run something that is educationally above any science they will ever have as a nurse. Learning to measure meds and give shots, by the way, I have done this, is easy compared to learning how to troubleshoot an instrument or recognize when someone has given us the wrong specimen or its integrity is impaired and why.

I have had numerous encounters with a nurse just needed a number, even if the specimen needs to be rejected. There is going to be a tremendous increase in patient deaths if "you just want a number".

I can go on and on, but some of the commenters are correct; we as MTs are a group that has not stuck up for themselves - no voice. I worked for the ASCP for 4 years as a regional advisor to spread the word and encourage youth to consider this great career. People, we did it to ourselves.

can't give name due to working at VA, Medical Technology - Superivory MT, VA August 28, 2016 9:15 PM
TX

I have been in the laboratory field for 36 years and I cannot fathom any RN performing non waived testing on patients.  I agree with the other comments that attention to detail, especially in the preanalytical phase of testing, is not a strong point for an RN.  I cannot believe that this will really come to be true.  RN's are good at what they do and MLS's are good at what they do and they should not be mixed.  There has been a lot of changes in the lab medicine field and this is not a good change.

Patty, Pediatrics - Laboratory Director, POL August 28, 2016 7:51 PM
Thomasville GA

I am upset but not surprised. This will get worse unless we do something. We need to support our organizations so we tell them what we think and what we want. They in turn can speak with authority and credibility when they represent us to legislators and government agencies .  We have low professional membership . What does it sound like to hear an organization say  "we are speaking for 10% of medical laboratorians in this country."  No one will listen.

There is one comment that REALLY annoys me. One young lady -Michele  from Indiana- said something that is  the perfect example of our problem. She blames the author for not empowering us to do anything. Excuse me???? Knowledge is power. She must be the only MLS professional in this country  who has not read Glen McDaniel's articles for decades or heard him speak. His whole mission is to give us knowledge and point out how we can help ourselves.

People like Michele just sit back, do nothing, complaining that personnel licensure is just a scam to get money, do not join organizations and expect "THEM" to fix it for us. That's not how life works. I have written to ASCLS, AACC, ASCP and the  Department of Veteran Affairs. I called CMS and was told to send in an "addendum comment." If I can do that, so can you Michele!!!

Join ASCLS, join the Indiania society of ASCLS, speak up at work. Do something. But for God's sake don't ask, What are YOU going to do for us?" That is exactly why we are in this pickle.

Miriam T. August 28, 2016 7:20 PM
Atlanta GA

Thanks to all my colleagues who took time to read this blog and to thoughtfully comment. While there are so many great comments and suggestions, I think veteran laboratorian and professor Jim Griffith went straight to the core of the issue by pointing out  the low  level  of medical laboratorians' membership in professional organizations, participation in career matters and proactive involvement in patient care. Compare this with those in the nursing profession.

I get criticized for comparing us to pharmacy and nursing. But I do this because I am old enough to recall when we were all struggling professions together.

Pharmacy and nursing surveyed the landscape and pushed controlled entry into their profession, required personnel licensure, made themselves visible in patient care, interacted with the public, served on influential committees, and stared down employers/administration when it came to employment and salary.

Even as we play an increasingly important role in healthcare delivery, we have not been as visible, demanded the same protection of our scope,  nor clearly defined our value.

I am optimistic enough to believe it's not too late. However wagging fingers and sighing wont do it. Wondering why some mythical "they" don't rescue us wont do it. We have to stand as a group, protect our scope of practice through legislation,  and demand better from employers and regulators.

Glen McDaniel August 28, 2016 7:06 PM
Atlanta GA

I have worked blood bank for the past 9 1/2years of my twenty plus career as an MLS and I have yet to meet a RN, let alone an ARPN that can do basic blood banking and understand what is safe to give a patient. The horror stories I could relay just about charge nurses in ICU's and ER just with blood banking alone, makes me doubt they could ever competently run a lab. Yes,  I am not surprised the VA jumped on the bandwagon. Just ask the vets about the quality of care they get. Don't get me wrong all the others females in my family are RN's, ARPN and house supervisors, but thank God they respect there limitations. Just imagine a RN trying to run a lab and telling a veteran tech what to do for an antibody workup? Maybe we should lobby to be recognized as RN's, after all with this stupid legislation they imply the degrees are comparable....

Tania , MLS August 25, 2016 5:23 PM
Palm Harbor FL

Look at the curriculum,  nursing is a psychology degree, not a science degree. Nurses can't be bothered to properly label specimens or follow POCT QC protocols now.  I'm  glad I'm near the end of my career.

Tom McKinley, Laboratory - Asst. Lab.Mgr., PHB August 24, 2016 9:47 AM
Brookville PA

I have read with anguished interest all the comments above and must say that there is some great horror in all this for me. On the one hand, all of the observations cited above as well as the facts of the main article are TRUE, but so is another reality - that our field deserves some all this. We have NEVER been participants in the professional realm. A VERY high percentage of nurses DO participate as members of their profession, virtually none of us do. if you count all of the many clinical laboratory professional organizations (ASCLS, ASM, AACC, ASCP, etc), and ignore duplicate memberships, we have a total membership in the range of 5% when it should be 90%. How does that make our "lobbyists and representatives" get anything done for our field? That said, our national professional organizations ARE trying to represent us, they just do not have a lot of clout because of us. YES, this is the beginning of some bad stuff for our field, unfortunately it is the patients at risk, whatever we loose by comparison pales in comparison.

James Griffith, Clinical Laboratory Science - Chancellor Professor Emeritus, University of Massachusetts August 24, 2016 6:35 AM
Dartmouth MA

Recently retired. I am not surprised this issue has arisen. I am a Clinical Laboratory Professional and licensed to practice Laboratory Medicine in my state. Over the last several years there has been an ever increasing number of Schools of Medical Technology closing and the ones remaining seem to be concentrating on getting their students to pass the national MLS test for certification. The hospitals where they become employed then have to put them through about 6 months of closely supervised to get them proficient before they become competent. The real issue is that fewer and fewer students want to enter the field due to the lack of professional recognition, high stress, poor working conditions, and lower pay than nurses.  This seems to be a shortcut to meet CLIA requirements for testing. Soon there will be perhaps one (1) MLS B.S. M.T. (ASCP) or equivalent and a roomful of 2 year MLTS or Lab Assistants doing the testing. Old line Techs like me are retiring rapidly or dying off. Years of hospital administrators ignoring or dismissing laboratorians because they knew nothing about the lab and did not care to learn have contributed to this dismal state of affairs. What are the dear Pathologists going to do?

Sam Parker, LaboratorybScience - Lab Manager/Director, Natchitoches Reg Med Ctr August 24, 2016 2:11 AM
Natchitoches LA

I hope and pray that each hospital's administration and the Lab director will consider the liability of hiring nurses to do complex testing.  The Pathologists need to step up and fight this.  Back in the day, the Pathologists interviewed each applicant.  I can remember how stressful it was to be interviewed by a Pathologist.  When it comes down to it, the Pathologist whose name is on the report is ultimately responsible for the test results.

Janet Rhoades, Microbiology - Microbiology Supervisor, MCP August 23, 2016 8:17 PM
Plano TX

I am upset not only about the new regulations but how the author handled it. The author is doing the same thing of whining within our virtual professional walls without trying to affect any change. Complaining about it in a professional forum is understandable but I want to be heard by a decision maker. Empower us with information on who and how to contact within the government in order to change this regulation. I will be more than happy to make my voice heard!!

Michele August 23, 2016 4:49 PM
IN

I actually gasped when I read this. Having spent over six years inspecting labs for regulatory compliance and seeing how much RNs do NOT understand the basics of lab testing, this is a nightmare in the making. I see a LOT more labs going to denial of accreditation as a result, but the really tragic part will be the devastation of accurate results and patient care. WHAT ARE THEY THINKING????

Kathie, Consultant August 23, 2016 4:20 PM
St Louis MO

This is an old story with the twist of now being codified by a disfunctional government run by the inmates. The problem is those who ran the labs with GLP are now reaching the age to need GLP labs. We will be lucky if there are a few good labs left for our lab test. Class of '68

Joan, Generalist - MT(ASCP), Retired August 23, 2016 3:01 PM
Rockville MD

I would never attempt to perform nursing duties with my medical technology degree. I would never attempt to act as a pharmacist. Hopefully, those who hire staff will recognize the amount of OJT that would still be necessary for an RN to fulfill a career as an MLS (least of all as a laboratory director). %0d%0a%0d%0aWhat is the VA thinking? Having trouble getting laboratory staff? It will be interesting to watch this play out

Cindy Kessler, Industry - Sr Mgr, Beckman Coulter August 23, 2016 2:24 PM
Miami FL

We got in this position because of our small numbers compared to Nurses.  And most of those are overworked and underpaid.  Pathologists should be standing up for our profession.  Surely they realize, as Lab Directors, that there are major differences in our education and the way we approach a problem.   I have never seen a nurse check an expiration date:).

Michele, MT(ASCP) - Director of Lab Services, McBride Orthopedic August 23, 2016 12:41 PM
Oklahoma City OK

Just another example of government "thinking" at its finest. ARE YOU KIDDING ME???  Where are the lobbyists that represent the certified, competent lab professionals that work all over the United States?  This is very scary, to say the least.

Joy MLT Wilhite August 23, 2016 11:57 AM

I do not know what the Title will be but I can assure you that there will not be a pay cut. They have a strong lobby and will get paid appropriately and strike when they need a raise. I guess nurses can be doctors next since some nurse practitioners are already doing what some doctors are doing. I cannot wait to see what other profession will be next. MDs watch out.

Vikie, MT August 23, 2016 11:49 AM
MA

I do want to insert a note of caution that the VA has not "already jumped on the bandwagon" per se.  I am a certified MLS educator in the VA system, so I think a little clarification is needed.

The portion of the proposed regulations that are cited are for an overall change in the scope of practice of ADVANCED PRACTICE nurses.  The proposed regulation is highly focused on giving nurse practitioners more autonomy from MDs  in their role as medical providers.  While the regulation as written is disturbing, the portion of the reg describing the laboratory is almost a "throw away" statement to give the these advanced practice nurses a role commensurate to those of doctors.  This regulation is not really a response to the CLIA memo, but rather a call to clarify the role that nurse practitioners have in the health care system.  Many states have laws in place that do much of what the federal regulation is proposing, but as a federal entity these do not apply within the VA system. This regulation is meant to alleviate patient wait times and redundancies within the VA healthcare system at a time when the patient population is continually growing beyond our ability to retain providers - especially in the non-urban areas that the VA serves.

I agree with everything else regarding a nursing degree being biomedical science equivalent and performing high complexity testing.  I just want to make clear that the two documents discussed are not truly related to one another in the sense of the VA saying "Let's have nurses run the lab!"  Most VA laboratories hold out to employ certified MLS's, and not many will hire even certified MLT's even though functional statements and job postings list the other equivalences to MLS/MLT degree work and experience as being acceptable.

All of this just really highlights the fact that laboratory professionals need to get out of the lab and make themselves heard and seen so we can educate the healthcare team, administrators, patients, and the public about what we do and how important and irreplaceable we are to the medical community.

Patty, Medical Laboratory Scientist - Program Director August 23, 2016 11:25 AM

I lived with nurses during their training and it is not comparable with medical laboratory training. They lack the skills and understanding to do high complexity testing. Another issue that underlies this issue is the lack of qualified people to do high complexity testing in labs. Since I became a medical technologist over 40 years ago, 90% of the medical lab science programs in my area have closed. Hospitals have stopped taking in students to train for financial reasons. We should be doing more to promote the initiation of these programs in colleges, financial help for teaching hospitals and recruitment of students willing to become qualified medical technologists.

Denise Korzeniowski, Senior specialist August 23, 2016 11:24 AM
Medford MA

This, again, shows that the government lacks understanding about medical laboratory science and the education and skill sets required to perform quality laboratory testing.  It also points out, again, the effectiveness of the nursing lobby and our apathy regarding advocacy for our practice field and its practitioners.

Understand a lobby on our part to perform any type of nursing duties would not be given any credence and we would certainly not be granted any nursing duty privileges.  

The laboratory community should take this as yet another wake up call to come together as a practice field and lobby for appropriate education for laboratory practitioners to provide quality laboratory test results.  If we continue to be apathetic, more of this type of thing is going to happen and those healthcare professions with more passion about themselves and their ability to expand their roles will continue to erode our scope of practice.

Cheryl Caskey, Medical Laboratory Science - Compliance Officer, Pathology Resource Network August 23, 2016 11:13 AM
Shreveport LA

I too am horrified. I have been a Technologist for 39 yrs and a Lab Dir for the past 25 yrs. I work in a State that requires licensure to perform lab testing and still we realize that the folks entering the field today are not as knowledgeable as those from years gone by. That is because years of experience matter, as does level of education and the training that was required in our MT internships. Nursing Programs are not focused on Lab Medicine. I have a daughter-in-law who graduated 2 yrs ago top of her class as an ARNP. She always has questions about what we do in the Laboratory.... I also wonder how a Nurse can evaluate the performance of a Technologist, create a QA/PI Program and run a successful State/CLIA survey, just to name a few skills for a lab leadership role.

Roberta, , VP Laboratory Services American Health Associates Labs, Inc. August 23, 2016 11:08 AM
Fort Lauderdale FL

Has anyone thought to ask the American Nursing Association (ANA) or other nursing organizations what their official position and policy is on nurses doing laboratory testing under CLIA regulations?

Cathy, Education & Training - Director August 23, 2016 11:00 AM
Silver Spring MD

Although I have no doubt that nurses are highly competent health care professionals, their training is for nursing, not medical technology. Just as nurses would be horrified at the idea of allowing medical technologists to function as nurses, the idea of nurses performing and supervising laboratory testing horrifies me. If they want to be technologists, then they need to train as such. As we all know, there is much more to being a medical technologist than performing the test. We, as a profession, need to rise up and be heard on this matter.

Melanie Stallings, Cytology - Laboratory Manager, PMLS August 23, 2016 10:34 AM
Greenville SC

I find this trend toward nursing supervision of the laboratory very troubling.  Every day in this institution we have countless examples of nursing not understanding laboratory testing.  After all, when I was at university, the students who couldn't make it in the sciences required for our profession changed their majors and went into nursing.  That, by itself, is significant.

MARIAN, Laboratory Medicine - LIS Coordinator, UMMC August 23, 2016 10:28 AM
Batavia NY

Do we as laboratory professionals really see this as a reality?  Let's be real, friends, nurses are already stretched thin and adding laboratory testing to their list of duties seems unrealistic and unreasonable.  One of the reasons I believe this is happening to our profession is because we as a profession have allowed it.  One of the biggest mistakes of this profession was not requiring licensure for all laboratory professionals.

I do believe that if there was some (I emphasis some) nursing oversight of the lab that the lab-nursing dynamic could be greatly improved.  However, I work in a Blood Bank and witness too many near misses with patient sample collection by nursing staff.  I believe proper patient ID and labeling during sample collection is THE most important precursor of laboratory testing.  If the sample is not labeled properly, the results are invalid.  I also work in a Core Lab where the sample labeling requirements are not as strict as Blood Bank and I dare not even think of how many mislabeled samples I test on a daily basis...

My point is this:  I pursued a laboratory career because I possess a specific interest and skill set just as nurses pursue nursing for similar reasons.  

I see a major patient safety issue with allowing professionals who are not trained in proper laboratory practice analyze and release results.  

I supposed Pharmacists will be the next group of professionals that will be able to perform high complexity testing?

Maureen , Medical Technologist August 19, 2016 12:45 PM
Philadelphia PA

It is all fine to add our comments, but if anything is going to happen, someone or some entity must take action.  We have associations such as ASCLS that can be influential, but they need more support (and dollars) from every laboratorian.  We also need collaboration between all the different laboratory associations.  We can see by the nursing field that unification works (and there is strength in numbers).

Lois August 19, 2016 12:22 PM
MN

This turn of events is both frightening and outrageous, and yet without a strong lobby from the medical laboratory science community, it seems that it is destined to happen. Let me tell you how I see this going. I don’t believe nurses will make in-roads into the profession by being hired as scientists. They will start out in management positions. Hospital administrators will hire nurses to manage and supervise the lab. Those in the nursing profession have excellent social skills. Nurses are greater in number and hold many different management positions throughout the healthcare industry. It is not much of a stretch to see a nurse being hired to manage a lab. At first there will be clinical lab people around to handle the science work, and help them learn our profession. Once they have oversight, they will gradually begin to replace techs at the bench with nurses. Educational programs could change perhaps blending the requirements of what are now two very different programs. Over time the medical lab field could look very different. We need strong leaders and active representation when decisions such as these are being made if we want to keep our profession intact.

Dianne York, CLS August 19, 2016 11:46 AM
Newark DE

I find this unbelievable.... We have horror shows over POC here. The thought of the Nursing profession doing MORE lab testing is not a comforting one. I am not denigrating nursing at all. They have a scope of knowledge I do not, and the converse is also true.

Earl from TX makes a very valid appraisal of the two professions. We are two sides of a healthcare coin, and our mindsets are different.

I don't know who makes up their decision committee, but there have to be more RNs there than Pathologists or Lab Administrators. I could not see this getting by with adequate representation be the ASCP.

LOL - love the comments on the pay! But so true.

Michael, Medical Lab Sciences - Safety, Education Coord. August 19, 2016 8:03 AM
Bridgeport CT

So now we will have more unqualified workers in the lab! Many of the lab jobs are being given to HB-1 Visa holders. This has been happening for 30 years. The laboratory has tremendous turnover when new technologists learn the reality of the pay.  I personally have known (in my career of 35 yrs) more than 50 co-workers who left for a new career that recognized and rewarded an advanced degree in a related healthcare field or in the sciences. Why would a nurse want to take a pay cut to work in a lab? I am baffled and terrified!

Wanda, GENERALIST - CLS-MT-ASCP, RETIRED August 18, 2016 11:11 PM
Glen Rock NJ

How are they going to live on Laboratory pay?

Kristy Shanahan August 18, 2016 9:49 PM

In the over 40 yrs of working in almost every variety of lab, I have met very few nurses with the critical analytical skills to do this job. One I knew was a phleb who went on to be an RN and I knew I could trust her when she sent me a sample because she was trained in lab protocol. I have said for many years that these two disciplines require entirely different states of mind. Nurses are the compassionate caregivers and we are the dispassionate scientists. We speak two different languages and have very different ways of looking at the same thing. How many times have you had to figure out why a patient's H&H went from normal to a CV in 4hrs only to find out the nurse drew above the IV. A beginner phleb knows better than that. In the words of CCR " I see a bad moon rising" and this will not end well for the patients, lab techs, or the nurses.  

Earl, , MT Tech Consult POL August 18, 2016 6:52 PM
Anchorage AK

I have a B.S. in Medical Technology and have been a licensed Clinical Laboratory Supervisor for 32 years.  I also have an A.S. in Registered Nursing and have been a licensed RN since 1999. I can tell you unequivocally that most nurses have no idea what we do and how we do it in the laboratory.  QC is just an annoyance to most nurses.

I know both sides of this  issue and can only see a path fraught with peril to our patient's care.  I was at a physicians office helping them with their POCT glucose program and asked to see the QC files from the three glucometers they had been using.   I was told that they use which ever answer is best from the 3 glucometers that day and if they don't like the patient result on one they use a different one.  These were 2 B.S. level RNs and one ARNP.

What in the world is CMS thinking?  

This shows what a powerful lobby can do.

Kimberly, Generalist August 18, 2016 5:49 PM
Melbourne FL

I have always felt I could perform a nurse's job, and vice versa.  But, I also realize that our jobs are apples and oranges.  I mean, nurses are famous for being clueless when it comes to laboratory. The thought that someone who thinks a centrifuge is a hemolyzing machine running lab tests at all scares the hell out of me. Not exaggerating. And, yes I have overseen POC in a hospital setting. My main concern, though, is how this was snuck by us.  Who are these genius' who thought they knew best?  My Pathologist Director is outraged by that.

Additionally, "nurse's chemistry", as we called it, is much less complex than what was required by pre-CLS requirements.

chele, Generalist - Technical Director, US Specialty Labs August 18, 2016 5:16 PM
San Diego CA

Let those nurses do crossmatches and do a manual diff on an M3 leukemia for the idiots that thought this was fine.  They do not check wristbands, they still go by room number, draw the wrong patients.... Shall I continue....  

Paula August 18, 2016 5:14 PM

For Testing Personnel, CLIA's qualification is

- Possess a current license issued by the state in which the laboratory is located, if such licensing is require

- Have earned a high school diploma or equivalent, and have documentation of training appropriate for the testing performed prior to analyzing patient specimens.

It's really not a joke when people think high school graduates can work in the clinical lab...

Melody F, Blood Bank - Medical technologist August 18, 2016 4:43 PM
Jacksonville FL

Many states have separate requirements beyond CLIA; for  example, California still requires completing an exam and license (unless there is a reciprocity agreement).  Therefore, it is important to lobby at the state level as well as at a national level.

Where are the pathologists/lab directors in this discussion?  Do they want the liability of having a non-lab scientist putting out results for high-complexity assays?  Individual hospital/facilities may also have some concerns and it might be worth throwing this their way.  As with pathologists, liability might be a concern that is not being addressed.

And is there even any meaning to waived/moderate complexity/high complexity testing if the requirements are sufficiently generic?  

Are nurses really interested in lab science, or is this just a way to legitimize point-of-care testing?  I'm trying to imagine a nurse wanting to work in a lab, especially something as demanding as molecular diagnostics or GS/MS, HPLC, etc.

Mara, Regulatory Affairs August 18, 2016 4:39 PM
Carlsbad CA

Years ago Medical Technologist's were granted professional status in regards to forming unions. Not many laboratories have professional unions in my area. Union contracts have very specific guidelines as to who can perform a certain task. Maybe it's not to late.

Donald, , Medical Technologist Hospital August 18, 2016 8:35 AM
Hartford CT

Wow this is absurd. The medical laboratory fraternity globally has to work together to put the Laboratory profession the place it deserves. Here in Ghana Laboratarians are preparing to go on strike in the coming days. The reason is simple and at times disturbing. We want policies that has been drafted and approved by a centre minister to be launched and implemented. There is no rule or policy guiding laboratory practice here in Ghana. This is equally dangerous to patient's welfare. These are policies that were drafted with the help of the CDC,USA and the government of Ghana.

Here our issue is not with nurses but doctors. They want to head the laboratory. They want to work in the laboratory without joining the rank of the Lab and license approximately.

The world must pay attention to the state of laboratory, the WHO should help in this. Evidence base medicine must be universal.

Evans , Lab Scientist August 16, 2016 9:53 AM
Ghana

They should then be required to take ASCP Board exams & be legally certified like the rest of us in order to be eligible to have anything to do with medical lab testing.

Gail, MLT August 15, 2016 8:05 PM
Fargo ND

Don't worry they will never take the pay cut to work in a lab.

Kalen, CLS August 13, 2016 4:17 PM

Who cares?

V E August 4, 2016 2:20 PM
OK

That is awful. How did we ever get to that place where we just sit back and let things happen to our profession?

I see the shortage as an opening for nurses and others to slip in and offer themselves as able to perform lab tests. This could never happen without our laziness and don't care attitude.

John , MLS July 31, 2016 11:06 PM
Los Angeles CA

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