In October’s CLN Patient Safety Focus column, James S. Hernandez, MD, MS, describes a fictional scenario that illustrates how laboratorians and nurses can get frustrated with each other’s behavior:
Nurses have been cutting off patients’ wrist bands in the hospital and attaching them to the patients’ gowns or even to their beds. When the phlebotomist arrives to collect blood, she balks, since she is not certain that the patient is properly identified. She notifies her supervisor about the situation.
The natural reaction in these instances is to admonish the nurses by sending them an e-mail and telling them to follow the correct procedure—or else, observes Hernandez, an associate professor of laboratory medicine and pathology, and medical director and chair of the division of laboratory medicine at Mayo Clinic in Scottsdale and Phoenix, Arizona.
His suggestion is to step back from scenarios like these, suspend judgment, and ask why the nurses may have done what they did. Give them the benefit of the doubt that they are rational human beings who have their patients’ interests at heart in everything they do.
In the scenario described above, the laboratory supervisors and the director met with nurses, not to criticize them, but to understand why they were cutting off patients’ wrist bands. They found the nurses had good reasons.
For example, the nurses said that pediatric patients, edematous patients, and obese patients were uncomfortable wearing standard wrist bands, and so the nurses felt they were relieving patients’ suffering by removing the bands. And since they attached the cut-off wrist bands to patients’ gowns or bedding, they did not perceive the patients as being unidentified.
After collegial brainstorming, the nurses and laboratorians came up with two simple solutions. For pediatric patients, the team recommended softer pediatric wrist bands specifically designed for infants. For obese and edematous patients, the team recommended special expandable wrist bands. The incidence of nurses cutting off wrist bands plummeted to zero.
Hernandez in his article discusses other fictional scenarios where nurses and labs might clash—and offers potential solutions for each of these conflicts. He also summarizes the main points of a 2006 article that lists the common misunderstandings that take place between nurses and labs.
Laboratorians should consider working more closely with nursing colleagues to make our systems safer, Hernandez advises. Because laboratorians are adept at seeing the big picture, analyzing data, and seeing patterns and process flows, we complement our nursing colleagues, who see problems at the bedside.
Pick up the October issue of CLN to read more about strengthening the laboratory-nurse relationship to develop better communication and patient care protocols.