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Stepwise Success

I Got My Answer From the Nurse

Published January 28, 2009 3:02 PM by Scott Warner

A hospital receptionist concerned about a lab report on her son came into the lab asking what a "bicarb" level meant. I printed a page from Lab Tests Online, a resource I often use for patients. When I walked it down the hall to her desk, she was putting down a telephone. "That's OK," she said. "I just got my answer from the ER nurse."

She more or less dismissed me with a nod to place the literature on her desk. Clearly, in her mind I knew less about a lab test than the nurse who happened to answer the telephone in the emergency room.

Why was a nurse able to answer her question about a lab test better than the lab?

Nurses interact with patients in more ways and more often than anyone else in the hospital. They also work with clinicians, absorbing a provider's unique tone, temperament and knowledge. And a large part of this is learning to read patients.

Perhaps, the receptionist wasn't looking for an explanation of the test result. What she wanted was more practical: a simple, direct statement of what her son's doctor was looking for. Why is the doctor worried about this test? is a completely different question than What does a bicarb level mean?, for instance. Answering the former may soothe a mother's angst; the latter generates jargon. Apparently, the nurse read the need of this receptionist and answered her question appropriately.

How often do nurses explain lab results to patients? This may be an opportunity for the lab to be proactive about nursing education, but we may also take a lesson in what a patient needs. That human connection can make all the difference in patient care.

4 comments

Mary,

I'm glad to hear that your nursing students are taught laboratory values.

I have perceived nurses casually dismissing the laboratory.  For example, I have reviewed nursing collection and transfusion policies written without consultation or reference that I discovered after an incident; my suggestions were "considered."  This varies with the nurse, of course, but I've sometimes wondered if autonomy is stressed in nursing school to the degree of overlooking other professions.

New laboratory graduates, in my experience, are sometimes astonished at what they perceive as "nursing" arrogance, having chosen healthcare to be treated as a professional.  Seasoned techs may say, "Get used to it."  I've come to say, "What can you do to change perceptions?"

The laboratory can offer to help, but a work environment is created by an employer.  Management sets the tone.  An onboarding program that includes all departments is a good way to make sure no one gets stuck in a silo; it's hard to dismiss a professional's opinion after he or she teaches you something useful.

Our recent graduate hires spend a day or more in the laboratory, for instance.  I'd like to see this expanded to all nursing stuff.

Scott Warner February 28, 2009 6:53 AM

I cringed when I read the nurse's response to the suspected transfusion reaction.  As both an instructor in our phlebotomy program and a nurse, I agree that something is definitely missing in our interactions with our lab colleagues.  I know that our nursing studets are taught lab values, but I often wonder whether or not they are also taught the correlations between those values and how the patient presents.  Sadly, I think not.

Most of the lab persons I interact with on a regular basis, LOVE to teach/talk, and to a one, have always been willing to answer questions from both students and their teacher.  Too bad my nursing colleagues don't take more advantage.........

Mary Marks February 25, 2009 11:55 AM

I agree that it is our responsibility to bring the laboratory to nursing.

A physician can be a strong advocate for both professions and help bridge the gap.  I recall discussing a suspected transfusion reaction at a meeting once, and a nurse scoffed, "Oh, that blood pressure dropped because of the patient's meds!"  A hospitalist at the table said, "We don't know that."  This brought the discussion down to earth.

It's odd that nurses wouldn't consider the laboratory a valuable resource, when many clinical decisions that change the treatment they administer are based on laboratory results.  Maybe, they just need to be reminded once in a while.

Scott Warner February 2, 2009 7:30 PM

Scott:

Great post. This reminds me of an interaction with a home health nurse recently who told me that she was discussing a PT result with a patient per the physcian's orders, but the patient insisted on knowing the INR. The nurse admitted to me her ignorance about the INR, and that she finally said "it's similar to the PT, but not as popular or critical".

The patient insisted that she needed the INR for medication dosing so the nurse, to her credit, told her the INR and made a mental note to get more information .

Nurses often explain laboratory tests by default, whether or not they feel prepared to do so. I think the lab ought to involved in nursing education regarding lab tests. It's easy to sit by or even to use the catch all excuse "ask the doctor" rather than becoming directly involved.

Of course, laboratorians have to be current and well informed if they are to be credible and "I dont know" is always better than giving the wrong information.

But we have an opportunity to play a pivotal role in nursing and patient education as THE experts on CLS matters. Can you imagine a pharmacist telling a nurse or patient to "ask the doctor" when they enquire about a common medication?

You do make a good point when you say the approach has to be tailored to the situation. A patient doesnt want to hear about the Kreb's cycle when their glucose is high or their total CO2 is low on their BMP. They want to know "what does this mean? and what can they do about it?"

Glen McDaniel January 29, 2009 2:34 PM
Atlanta GA

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About this Blog


    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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