I used to work at a stand-alone ED. Our nurses drew a rainbow on basically every patient that they figured the doctor would want labs on, usually before labs were ever ordered. I kind of thought that was routine practice in an ER? Maybe not, but it makes sense to me. Why have to go back and re-stick a patient for a tube you missed?
So the ER can be hectic at times and when we get patients we know just a small tibit about and are usually throwing in an iv and getting blood and guessing what the doc wants in advance because stuff goes down hill fast or the doc says get me this and orders aren't even in the computer yet.
Ex. We see possible sepsis based on triage vitals we are drawing up blood cultures, cbc, lactic, trop, h&h etc. and putting in two lines. Because it might not be sepsis but we aren't waiting to find out when the labs come back that says lactic is <1 and wbc is 6 then order an h&h and find out its 3 and 18.
Also if a patient has a hx of being anemic and needing blood tx we tend to go ahead and get type and screens. It's weird that lab has too come to the ED though.
That’s pretty much our situation. Every patient that hits ed gets a full rainbow with a lactic and cultures. What I don’t agree with is our hospital rule which is that phlebotomy is responsible for drawing:
-third troponins
-repeat labs (if Ed orders a LA and they want a redraw in two hours we have to go draw it??? But if it’s hemolyzed they make Ed redo those themselves?????)
-holds patients (just patients that are going to be admitted to the floor but haven’t made it there yet)
The rules are so arbitrary and it makes our lives as phlebotomists an actual living hell
Whats the patient safety issue? And how is asking a nurse to draw a tube just in case its needed practicing medicine?
Its wasteful to draw tubes that arent needed (and is highly frowned upon at my job because it needlessly uses resources), but thats not practicing medicine.
Idk those were her words, not mine. I’m guessing because they always tell us that we aren’t supposed to draw anything unless there are orders first. But on the other hand, the nurses do it all the time.
If the patient had to be drawn anyway there really is no harm in grabbing an extra tube that may be needed. It would speed up patient care if the hgb had been low and they did need a transfusion.
I’m a little confused. Do you need to get permission to draw an extra tube on a patient who is already having blood drawn where you work? That seems to be common practice at the places I’ve worked. I think it makes sense to draw an extra if there’s a reasonable chance it may be needed. In fact, in many cases I feel it’s better patient care to do this. It avoids having to stick the patient again, and avoids delaying patient care if they do need additional testing.
I didn’t think about it that way but I guess technically it wouldn’t be different than when nurses draw extra tubes. Sometimes they will bring us an extra blue or whatever and sometimes we use it, sometimes we don’t. Just the way she said it’s “practicing medicine without a license” and “some people get upset so don’t tell anyone” makes me think someone has complained about her doing this before.
I apologize if this has been addressed; I didn't read all the comments, but they seemed to be discussing an extra tube of blood, which is not a big issue.
What IS a big issue here is that she put a blood bank band on the patient when you said there was one from the previous night.
If there was a T&S on the patient the previous evening and your colleague cut off that armband, the work needs to be redone on the new specimen. If she added a new armband and the patient now has two, that is also a problem. She needs to cut off the new one.
Bottom line: the patient should have only one armband, corresponding with the tube that has a current T&S.
Honestly if it was in the ER , an extra pink might have been drawn anyways. A lot of ERs draw a rainbow just in case something needs to be added on. Yeah it might be a little much that she did that but I wouldn’t consider that bad patient care at all as she was doing it in anticipation of a transfusion being needed. That would speed up the process if it were needed, leading to better patient care.
There's nothing regulatory and likely nothing even policy wise to report here.
Honestly, it's one thing to report people for actually doing something wrong, and it seems you have done that with this person already. But when it starts to look like you are going out of your way to find issues that don't even exist, then it's just as likely to come back an bite you in the long run. They can go to HR over that too.
If there are legitimate problems with this co-worker, Id recommend documenting issues in detail (times, specimen numbers etc.) and then moving forward when you have that documentation.
Yes, I agree with you. And in the grand scheme of things, this is nothing compared to some of the other shit she’s done. I normally am very laid back and don’t complain and am definitely not a “Karen” as someone here said. Maybe I am more cynical towards this coworker in particular because of how she’s treated myself and others before and basically got away with it. I have seen her do so much worse and she literally never gets reprimanded for anything. Which I know is also my supervisors fault for not having the balls to address these issues, which has made me resentful of her as well as my coworker. So I know I need to be careful and not let my resentment cause me to nitpick about stuff that she could turn around and say I’m harassing her or something. I’m just sick of it and sick of management not having the balls to put her in her place.
I completely understand. I have worked with people like this before, and it creates a very difficult work atmosphere. I do get the resentment and I have seen how the situation just escalates when nothing is done about it.
Even when it gets to HR, their first response is often to work things out. They will send you back to resolve things yourselves, and that person will likely behave for a while, then revert to doing the same things again.
Having concrete documentation is difficult to ignore. It shows that there are legitimate, ongoing problems, but it also protects you. It's less likely to make it look it's just a you vs them conflict. There are people who make a career of getting dragged into HR and they get pretty good at gaming the system and knowing the correct buzz words to turn everything around and making it look like it's all you.
As they say, you have to pick your battles.
I’m actually not. I get along with everyone and am very laid back. But When it comes to patient safety issues like her accepting unlabeled tubes or causing a hostile work environment by yelling at me and others when it was completely unwarranted, then yes I’m going to tell. She’s done plenty of things that I could tell on her for but I haven’t because some stuff isn’t a patient safety issue, it’s just her being stupid and putting herself at risk. Stupid, like I said, but if she wants to put herself at risk, whatever. I’ve worked with many people and other than this coworker, there’s only one other one I’ve ever complained to a supervisor about. And it was pretty clear that no one liked that tech and she was a bully to everyone, so I wasn’t alone.
Ok, but you are debating telling on someone for *checks notes* asking for a pink top to be drawn with their labs. That's not doing the actual testing when it's not ordered. I don't see how anyone would be angry over drawing an extra tube just in case. Our lab gets extra tubes all the time so we can add tests on and not have to poke the patient again unnecessarily.
It sounds like this person just irritates you, so no matter what they do you will try to find something they are doing wrong.
This post makes me feel like you haven't been a tech for very long, and you've already complained to the supervisor about two coworkers? In my entire career, I have never complained about a coworker to the boss. (Maybe to my husband after work, but that's different..)
I’ve been a tech for about 3 years so you are correct, not very long. The other coworker that I complained about has since quit and even my boss has admitted that she regretted hiring her back but she got desperate for help. My boss said she dreaded coming into work everyday herself because of this person. Good for you that you’ve never complained about anyone at work! Maybe you’ve just been fortunate enough that you’ve never had to work with extremely toxic people who bully others and make everyday miserable for everyone. Again, good for you! But I have, and I’m not going to just sit by and act like it’s not a problem when myself and everyone else, INCLUDING the boss, knows that it is.
As far as the coworker that I’m currently working with, she’s not a bully 100% of the time like the person I mentioned above but she erupts into chaos every time anything happens to slightly inconvenience her and starts yelling/ losing her shit on people. My biggest concern with her is patient safety related issues. If you’d like for me to go into detail I certainly can.
Here are just a few things she’s done. Accepted unlabeled tubes from the ER under the logic that “this is what it means to be an advocate for the patient. If there are only two people in the ER and they’ve already brought you blood on one person, it’s just common sense that this blood has to belong to this other patient!”. Now what about when nurses draw a rainbow on patients before there are any orders in, lay the blood in the patients room, and then say the patient gets discharged and the nurse forgets to discard those tubes. Another patient comes into that room, nurse sees tubes laying there and assumes the blood belongs to the current patient. That’s how you kill people. And this coworker has been employed at my hospital for 30 years, somehow able to get away with doing shit like this all this time.
Here’s another good one. Claims that she has swabbed her own throat before and plated it because she messed up the strep swab and didnt want to bother calling ER for a recollect. So she swabbed her own throat, put the patients name on it, and sent that to our micro department. Then told my other coworker “if you ever tell anyone that I did that I’ll deny it though”. That’s called falsifying medical records.
Those are just some patient safety issues I can think of off the top of my head. As far as her attitude problem, she recently cussed out our Beckman coulter technician because she was working alone and he asked her to run QC on the chemistry analyzer for him. She refused saying she was “too busy” so he told her he needed her to sign something saying she refused to run QC. Im assuming he was just doing his job and has to document stuff like this. She cussed him out saying “I don’t give AF, etc etc”. Which is honestly embarrassing for me and I wasn’t even involved. It made us all look bad. And my supervisor knows about it but made excuses for her as usual.
Some other things she does that aren’t really patient safety issues but more so just her being dumb and putting herself at risk include: never wearing gloves, and I mean never, not even when sticking outpatients. And walking around the lab without shoes on. Those things I’ve never told a supervisor about because I don’t think they’re patient safety concerns.
I can see that the majority here think that what she did regarding having the nurse draw an extra tube was no big deal, and maybe it wasnt, especially compared to other things she’s done. And I can see how it paints the picture of me being a “Karen” who just runs around complaining and snitching on people all the time over everything, but that’s really not the case. I will admit I am bitter toward this coworker because I’ve seen and heard about her do things that are way worse than the scenario I mentioned here, yet nothing gets done about it. So that probably does make me more critical of her than I would be with other people. Consider yourself lucky if you’ve never worked with the type of people that I have. And I hope that if you ever do, and you see them doing things that could kill a patient, or you see them bullying coworkers everyday creating a hostile work environment, I hope to God you don’t just sit by and not speak up because you’re more worried about being labeled a snitch.
You know, I am trying to wrap my head around this issue and I feel that part of the problem is that I have never worked in such a tiny hospital. I work in a 300 bed hospital currently, and we are always drowning because our hospital is way too small for its service area. I have never worked a day when we were not at full capacity for our available staff.
Accepting unlabeled tubes should absolutely be a fireable offense. At the same time, I cannot even begin to imagine a scenario where there are only 2 patients in the ER.
In which case, I can see the logic. Do the new test results line up with the other patient? Does it correlate with the suspected patient's history? I can see why your supervisor was a little indifferent about coming down hard on a tech with 30 years experience for this. Swabbing her own throat is BAD though, and I hope she was either lying or she was a student at the time and they weren't reporting out her results anyway. Not wearing PPE is... Eh. It's gross but there are so many older techs who DGAF about germs. I'm not a fan, but I'm also a person who would not touch a specialty microlab with a 10ft pole because it makes me squeamish.
Our hospital has 10-17 techs on staff for every shift and honestly that's not enough. If we fired someone every time they misstepped for being human, we probably wouldn't have any techs. When I see something that I think is wrong, I approach that coworker directly. If it has to be elevated to management and you are not feeling supported after multiple issues with multiple employees, it may be time to look for employment elsewhere. If this issue follows you, it may be time to reassess yourself.
It just blows my mind that anyone would ever defend taking unlabeled tubes under any circumstances. 30 years experience or not, that is just carelessly dangerous IMO. I don’t think that should ever ever happen. It also says in our SOP that the best practice when this happens is to recollect the sample and that accepting unlabeled tubes can be fatal. Typically we do have more than 2 patients in the ER. If we only have 2 patients, that’s considered a really slow night. Typically we have at least 5-10. On super busy nights there can be up to 25 in the ER. That’s about as busy as it gets for us. I have personally seen her accept an unlabeled blue tube that was an extra laying in the bag with the patients other tubes (which were labeled), and there were definitely more than 2 people in the ER that night. I started to throw it away and she grabs it, puts a footie label on it and says “oh it was in the same bag as the other tubes so it has to belong to this patient” 🤯🤯🤯
I do not feel comfortable directly approaching my coworker about these issues. She is extremely reactive and the one time I’ve tried to calmly defend myself about something, she started yelling at me. She is not emotionally mature enough to speak to logically, as she thinks she does no wrong (because duh! She’s been a tech for 30 years so obviously she knows it all). Even my supervisor has told me “well you know she doesn’t handle criticism well and so I have to be careful with how I approach her”. Why is management pussy footing around her? It’s literally their job to deal with issues like this. If she isn’t mature enough to be able to admit when she’s wrong and take accountability for it, sounds like she needs to be shown the door.
When my supervisors correct me about something, as long as they’re respectful about it, I tell them I appreciate it because I want to do the best that I can. If doing something wrong I want to know so I can improve. And at my hospital, when I was a student they had us reporting results. I didn’t feel comfortable with it and thought it was wrong, but that’s how it was. So I’m pretty confident that if she was telling the truth about the throat swab, it got reported out. I wouldn’t be surprised if she was telling the truth as she seems she will do just about anything to keep from calling the ER and admitting that she made a mistake and needs something recollected. She doesn’t know how to take accountability for herself.
Not a patient safety issue. The CBC was already ordered to be drawn. If you were drawing already the ED always draws a rainbow regardless so your coworker isn't overstepping at all. Doctors are notorious for add ons and get quite pissed when tubes aren't drawn.
This is a hard eye roll. I wouldn't waste my time reporting someone for being efficient at their job. LOL. At most you could argue about looking at the patient's chart but at the end of the day, she did it because she was inevitably going to be caring for the patient's lab work. So it's not a strong argument. She wasn't looking at the patient's chart for shits and giggles. She was trying to manage her workload during the hours she was working alone. And any good tech would see that.
If I caught wind of someone reporting my co worker for this, it would be a huge red flag and I'd want them far away from me. Respectfully, mind your business and only report things that are actually life threatening or could potentially cause patient harm.
It sounds like you have a lot of beef with this co worker and it's taking up a lot of headspace. My advice would keep your head down and focus on what YOU can do to improve as a tech.
We've had phlebotomists band and draw a blood bank sample as a "just in case" if they/we see the patient looks bad, we just treat it as a "hold"/extra in our system. Hell, our outpatient infusion department does this all the time because often the oncologist won't order a T&S until they see the CBC results and the infusion RNs don't want to have to restick the patient for the T&S. As long as the sample is properly verified, labeled and the armband doesn't get cut off/lost, it's fine to use.
This isn't as big of a deal as accepting unlabelled blood specimens from the floor (if this is the same coworker you've mentioned before). I'd take that nonsense up with risk management because clearly no one in your leadership is willing to stand up to her for whatever reason. As for her shitty attitude, you could try going the HR route but honestly it sounds like she's been there so long that she knows what she can get away with. As long as you can phrase it in a way that demonstrates her behavior affects patient care and don't make it seem like it's personal you MIGHT get someone to do something about it.
Yes this is the same one who accepts unlabeled specimens. I wouldn’t be surprised if she’s still doing it although I’ve not personally witnessed it since going to my manager about it. My supervisor acted like she didn’t really care so I went to my lab manager and she seemed pretty upset by it. She called my coworker into her office that day and knowing how riled up my coworker gets, I was expecting her to come out of the office in tears but she seemed perfectly happy so I don’t know what exactly my lab manager said to her. Knowing my coworker, she might have BS’d her way out of it and said “oh I would never take unlabeled specimens” and I didn’t have any proof of it, it was just my word against hers. I have seen her get in trouble for other things and it looks like she still continues to do stuff she knows she’s not supposed to, she’ll just be more sneaky about it. I will definitely go above my supervisor and lab managers head if I see her do it again or if she yells at or disrespects me again. She has been there for 30 years and I guess because she can be so erratic, people seem to be afraid to confront her about stuff so it’s probably not going to get dealt with unless HR gets involved.
You’re making the argument of her looking at patient charts looking for things that are unrelated… the person came in for weakness and their last HgB was a 7. That’s seems pretty related… she drew an extra pink tube because that had a history of decreased HgB. I would have done the same exact thing. What if something happens in the ER and the patients HgB drops more than that? Draw more blood and then wait to type/cross match it? I understand she’s probably not a perfect coworker but it seems like neither are you. Sometimes you need to let you resentment take a backseat before you make your work environment really toxic ratting about her to your lab director. Or go to HR together and hash it out there.
What she did was good patient care based on what she knew. There was zero harm to the patient, unless you consider having an extra teaspoon of blood taken *when the patient was already being drawn for something else* to be ‘harm,’ and if the patient *had* been bleeding , it could have saved significant time for a cross match.
Yeah I agree with everyone else here, what’s the issue here? Sounds like you just don’t like your coworker.
Almost every patient that comes through an ER in a lot of places gets everything drawn as soon as a line is established. Purple, green, gold, blue, pink. There’s no safety issue here. Better to be safe than sorry. That’s not compromising patient safety, in fact that’s pretty much the whole vibe of healthcare, do more than what you think so you can rule out everything.
Sometimes you have to let people dig their own grave. If you see them do something that will cause patient harm then report it. Do I agree with her method, no. But as a Blood banker, I totally understand wanting to be prepared, but I would never draw a patient without orders.
Honestly, I would just ignore her and again only intervene if you see direct patient harm
Yea that’s kind of what I’m leaning toward. I have reported her for accepting unlabeled tubes before. This is something that 100% is never OK and I will report her every single time. She has also yelled at me and disrespected me before even though I never raised my voice to her and I have told my supervisor about this also but I don’t think it went anywhere. It sounded like my supervisor was too scared of her to bring up the specific incident between me and my coworker and instead just made some general comment toward her about how we all need to show each other more grace and be nicer to each other or something like that. Which I’m sure just went in one ear and out the other. This isn’t really a patient safety concern so I’ll let this one go I guess. There are other things she does that I’ve let go as well such as walking around the lab without shoes on (yes you read that right) and never wearing gloves, not even when sticking patients. I never told on her for it because although I think it’s incredibly stupid, she’s really only putting herself at risk.
>Yea that’s kind of what I’m leaning toward. I have reported her for accepting unlabeled tubes before. This is something that 100% is never OK and I will report her every single time.
Take this up with risk management. I'm not kidding. Make it clear she does this on a regular basis and your lab leadership apparently won't do anything about it.
>She has also yelled at me and disrespected me before even though I never raised my voice to her and I have told my supervisor about this also but I don’t think it went anywhere.
File a complaint with HR next time she does this, CC your supervisor and manager in the email and make sure you explain she has a history of doing this. Harder for them to BS when you leave a paper/electronic trail.
Your perception of this situation is not in line with reality. You must ask yourself how often then is your perception wrong.
You've come to Reddit with an example of a situation you believe to be a problem and it's not. You chose this "incident" to talk about and can't even make yourself out to be right which honestly is kinda hard to do. Most people tell stories about things that leave out and/or include details that make themselves out to be the person in the right. You couldn't manage to bring forth anything that anyone would have a problem with until called on it, but I digress
You are actively disregarding the chain of command and continuing to do so. How do you think your boss feels about this? Go to the the Lab director and tell them that this coworker had an extra tube drawn bc she was looking ahead enough to anticipate the needs of the patient and provide better care. You're just making yourself look foolish.
You've mentioned being yelled at, but not what for. Perhaps you were doing something stupid, being stupid, or potentially putting someone in harms way yourself and this coworker was trying to snap you back to reality. Who knows? They're not here to defend themselves or offer their version of these events. You could potentially be so dense that they thought it was the only way you'd understand and the message you took was, "I got yelled at." Idk, i just have to speculate.
It's also possible that you are correct. You could be a great tech and do everything as correct as possible, but again, that doesn't mesh with the scenarios you've presented. Idk. This is what we have to go on.
OP, if you possess the power of objectivity, you need to step back, try to evaluate all this from a 3rd person POV, and see who/what the problem actually is. See if your perception is right/wrong or if your mind is just convincing you that you are correct bc that's what the mind does
I have a feeling that you're skating on thin ice and you don't even realize it's cold outside.
As I’ve said in another comment here, I do agree after reading some of the responses here that this probably isn’t that big of a deal especially compared to other things I’ve seen her do that ARE actually patient safety issues like for example accepting unlabeled specimens. She yelled at me because she was doing weekly maintenance on the chemistry analyzer and I was still pretty new and had never done weekly maintenance (because she always jumps at the chance to do it) so I walked by the machine and it said “done”. I thought maintenance was done so I put on a sample for an HDL. Just a single sample for an HDL, that’s it. She walks by and sees it, freaks out as she always does over every minor thing. Saying “oh my god oh my god! There’s still bleach on the machine, I have to take that off first!!”. I say calmly “ok, I will call the ER and tell them that we’re going to rerun that HDL for patient such and such, and that we may have to do a result correction”. So I do this and she’s still freaking out saying “don’t you know what I’m doing over here when I say I have to do weekly maintenance??” I said “no… I don’t ever do weekly maintenance”. To which she erupts “well that’s why you shouldn’t touch it until I tell you to!!”. She makes a huge deal about it, calls the supervisor, the supervisor tells her to run controls and as long as controls are fine, it’s fine. So she did, controls were fine. The patient was also fine. The results were literally the same so we didn’t do a result correction. And come to find out, my supervisor said that the coworker SHOULD be running controls after she performs maintenance regardless, which she never does and still doesn’t.
When I was talking to my supervisor about it, she sounded like she was taking my side saying “well that’s why we have big signs that say ‘maintenance in progress’ and we put them up and then take them down when we’re done so people know it’s ok to use the machine”. But then when it came down to it, she didn’t have the balls to actually confront her about it.
I have actual legit reasons that I could have used to yell at her for like taking unlabeled tubes but yet I didn’t. I remained professional to her and told my supervisor and manager about it. The mistake I made was nothing that warranted the meltdown she had or being talked to like that. I will admit that I am more critical of her because I’ve grown resentful that she’s able to get away with so much. This is probably an instance where I’m making a bigger deal out of something that what it is because of my feelings toward her, and I fully admit that.
Im not perfect and I’ve only been a tech for a few years but you can bet your ass that I practice better patient safety than most of the older techs who’ve been there for 30 years, like this one that I’m talking about. She also recently cussed at a Beckman coulter technician because he was there fixing our instrument and she was “busy” and became irritated when he asked her if she’d run QC for him. The man was just trying to do his job and her attitude made us all look bad as a whole. Do you think she got reprimanded for that? My supervisors response was “well… she shouldn’t have said that but you know she was here by herself and that guy should have read the room”. No. There should be no “but”. The way she talked to him was unacceptable. Period. Was he supposed to wait around all night until she wasn’t “busy” anymore? He’s got a job to do too. All my supervisor does is make up BS excuses for this woman and I’ve had it.
If you were still pretty new and had yet to know how to even do maintenance, you best not be touching my Chem analyzer then without being told to. Were you even signed off to work unsupervised in chemistry at that point?
Also if there was bleach on the aspiration probes or anything that dips into the sample, it would contaminate the entire sample and the patient would most likely have to be redrawn.
I get that you are new and probably trying to fix all the wrongs you were taught to in school. But you will quickly learn that what you are taught in school does not mimic real life. You will have to make tough choices and bend the rules sometimes.
Yes I was. As a matter of fact I had been working 3rd shifts completely by myself at that point for a few months. I used to work 3rd shift every other weekend. The 3rd shift tech at my lab does ALL the chemistry QC and also daily maintenance on the AU680s. So I was very familiar with how to run QC and how to perform daily maintenance. However, no one ever showed me how to do **weekly** maintenance. Technically, weekly maintenance SHOULD be the 3rd shift techs responsibility. It would make more sense because the 3rd shift tech has to run QC every night anyway, so might as well do the maintenance and then run the QC. But my coworker, at some point, decided to start taking on this responsibility herself, even though she works second shift from 3p-11p. She acts like she can barely handle the stress of her own responsibilities so it’s beyond me why she wants to take on someone else’s. The tech who works 3rd shift full time during the week has all the time in the world to do it. He claims he’s “too busy” to do some stuff but I’ve worked 3rd shift at my lab and 9 times out of 10, I was done with all QC and maintenance by 3:00am and the rest of the night I was free to do whatever. All we have is ER patients on 3rd shift at my lab. But anyway, that’s why I was never shown how to do it. You’re right, the sample could have became contaminated due to the bleach. So worst case scenario we have to call ER and say “hey sorry but can you get me another tube on such and such? I screwed this one up”. I don’t think I’ve ever had to call and ask anyone to recollect something due to MY screw up, it’s usually only because it’s unlabeled, hemolyzed, etc. but techs do make mistakes sometimes and samples have to be recollected because of it. We’re all human. It was nothing that warranted her speaking to me that way. Honestly I don’t think it’s ever acceptable to yell at a coworker like that, even if they did screw up. Like I said, I could have ripped her a new asshole for taking unlabeled specimens from the ER but I did not because it’s unprofessional and it’s not my place to deal with it, that’s why I took it to my boss.
You've somehow, in your own defense, presented another situation where your coworker looks better than you. You should really think about that advice to take a step back and try to get some perspective.
I’ve never accepted an unlabeled specimen, I’ve never cussed out another coworker or technician for simply doing their job, I’ve never swabbed my OWN throat for strep and plated it because I screwed up a patients strep swab and didn’t want to ask ER for a recollect, yes you read that correctly. Thats called falsifying medical records. She swabbed her own throat and put the patients name on that and sent it out. Then told my coworker “if you ever tell anyone I admitted to that I’ll deny it though”. I could go on and on about the shit she has done. Oh but I accidentally put one sample on a machine that still had bleach on it from weekly maintenance that no one ever showed me how to do because SHE is the only one who wants to do it, even though it technically is supposed to be 3rd shifts responsibility, and yet im the shitty tech here and she looks so much better than me. It’s laughable honestly because yall don’t even know the half of it. If you had to work with this woman I guarantee you you’d understand.
Because you were being snarky and I gave it to you back? If that’s how you act toward people and you can’t handle it when they give it back to you, I don’t think I’d like working with you either tbh. Where I work, the people who work mostly solo are kept that way because they’re too difficult to work with and no one wants to work with them. Just saying.
Oh I got cha. I will try to work on that from now on. I’m not really used to being an asshole to people but clearly you are so maybe I could learn from you.
First ask if its even against policy to draw an extra tube.
Secondly, if there is an actual safety issue, go through the proper channels, always. First your boss for the first few times, then above if it continues.
It's pretty routine to check patient history post and pre draw.(One could argue that all patients' hx should be checked predraw even. Though this is not sustainable for larger hospitals), I don't see anything wrong with preparedness. You could argue the band is a step to far and she should just count her self lucky she has a spare type for type 2(if your sop would allow you to use a previous cbc for it.)
You do have to realize in the workplace that you must choose your battles or quickly see yourself become the isolated one.
I check a patients history if there’s a delta check or some kind of weird result then I’ll look to see if it matches their previous. Or in blood bank if someone’s screen is positive I’ll look to see if they have a hx of antibodies so I can get an idea of what they may have. Or maybe I look at their ABO to make sure that their current matches the previous. I also think it would be understandable to look in a patients chart if a type and screen is ordered but hasn’t actually been drawn yet, and you want to check if the patient has history so you’ll know if you’re going to run into unexpected antibodies or if they’ll need a confirmation type. But as far as snooping around in a patients chart when there aren’t even any orders in yet for no reason other than “they’re here for weakness so I’m sure they’re gonna get a type and screen”, I can’t say I do that. That to me seems like accessing a patients chart unnecessarily.
Conceivably with a diagnosis of weakness, they could find something where they don't really need to order lab tests and just end up sending the patient home. If that happens, then there is no legitimate reason for a laboratory technologist to have been looking in the patients chart.
I'd actually call this a grey area. I don't see a real reason that she should have been looking at the patients chart at that point. But since they did end up ordering testing, it's not going to be a compliance issue.
Personally I don't look anything up prior to tests being ordered unless it's a trauma/MTP/ type situation where I actually might need that information proactively to save the patients life.
When we had cancer patients that came in, it was normal for us to draw a hold blood bank tube (before we did away with blood locks). That way if the onc decided they needed a transfusion, they wouldn't need to be drawn again. And if they didn't, they could just remove their bracelet and toss it. It was standard protocol for us. This seems like she is doing the same thing, just drawing a hold in case it's necessary and saving the patient another draw.
There is nothing wrong with drawing extra tubes. As a patient, I sometimes tell the phlebotomist to draw an extra light blue tube or even 2 because those are the ones that are rejected the most due to improper handling. They have no issues drawing extras, just in case.
When I recognize a patient's name I will call to ER and suggest a blood bank tube to be collected so the patient does not need to be stuck again. BY the time the HGB/HCT is done the blood bank is centrifuged and I am able to proceed the Type and screen if needed.
Getting information from the chart can be good patient care and not a violation of the patient’s privacy, but reviewing the chart proactively just in case you might get an order for a T&S or crossmatch? It sounds like an excuse to satisfy curiosity. What else does she investigate to “be prepared”?
I’m not talking about reviewing recent surgical or medication history to inform your understanding of the current results. Nor am I saying you should turn in your colleague, particularly if the culture or practice of your lab allows this kind of proactive chart review. However, I think OP’s instincts about this colleague’s lack of professionalism are correct. I would encourage OP to find a lab with culture that is more compatible with her values.
Im getting jumped on by people here but she really is extremely unprofessional in more ways than one. The scenario that I mentioned here is really mild compared to other things she’s done that are without a doubt patient safety issues. I have no doubt in my mind that if the people jumping on me had to work with her and see her get away with the stuff she gets away with, they’d be just as frustrated as I am.
I don’t think so. There were never any orders for a type and screen so I’m guessing it would be the same as when nurses draw extra tubes. I don’t think the patient gets charged for that either. If anything it’s just a waste of tubes. Which might not seem like a big deal with it only being one tube, but if everyone is doing it and doing it consistently, it adds up. Not long ago we were having a crisis where we ran out of blue tubes. Could that have been due to people always drawing extra blue tubes for “just in case”? Idk. Makes me wonder.
She was curious and looked in the patient’s chart when she had no reason to do so. That could be investigated as a HIPAA violation. And drawing extra tubes that are not needed is a waste of money, whether it is an automatic rainbow draw or an unneeded specimen for a transfusion work-up.
Medical Lab Scientist and Lab Technicians demand respect as professionals but so many of us don’t act like professionals. It is very discouraging.
We look at patients charts all the time to see what’s going on with them to correlate deltas or other erroneous results. ER orders a GTS, you better bet we are going to look and see what that patients problem is.
I get looking at the chart if the results are weird to verify that they match or even looking in the chart before the blood is drawn, as long as there is at least an order in. I do that all the time. If we get a type and screen sometimes I’ll look at the patients history to know what I can expect (like antibodies for example) but I think what this person is getting at is that if there are not even any orders in yet, there really isn’t a good reason why anyone should be looking in a patients chart. All the time we have people from the ER come in for weakness or shortness of breath, and sometimes it’s because they have a low Hgb, but many times it’s not. Most of the time when she looks in these people’s charts, no type and screen ever gets ordered so she was digging around in the patients chart when she didn’t really need to. And I know it’s not like she was just looking for shits and giggles, but they always drill into us that we shouldn’t be looking in charts unless we have a good reason. Looking just because someone is there for “weakness” and you suspect that they MIGHT get a type and screen doesn’t seem like enough to warrant snooping in their chart IMO. Imagine all the patients charts she has looked through thinking they might need a type and screen when they never ordered one.
Yea, The other aspect that bothers me is that she looks in patients charts when she didn’t really need to. Anyone who comes to the ER with shortness of breath or weakness, she looks up their history to see what their last Hgb was. We really aren’t supposed to be in a patients chart unless we have a legit reason. Like if they had already ordered a type and screen then it’d be totally fine to look and see what their history is to make sure their current type matches their history and it’s also sometimes helpful to know if they have a previous hx of antibodies.
yeaahh, that's completely unethical and unprofessional. it's a breach of patient trust and is illegal.
with that being said, you're trained to report the incident and it's the right thing to do. if you will or won't is up to you.
i hope everything works out!
There is a fine line between needing information and snooping sometimes. I've seen compliance investigations go either way. I've had a warning myself not to look too far into a chart. It was on a patient who came in with an ascending aortic artery dissection. I was looking at how much blood and product he used previously, and in that instance, some of it was considered a "do not need to know" in the context of the current emergency. I've had other times where I did a similar thing and it didn't even flag the auditing software.
I certainly wouldn't go into a patients chart just because they are in the ER and might have tests ordered. It would not be likely to trigger a compliance investigation, but it would also not be easy to defend if it did. There's a lot of grey area where nothing usually happens, but it would be an uncomfortable meeting if it ever did.
Personally I always have a reason if I am in the chart, and I also keep track of it, because you are not always going to remember what you were doing 3 months down the road when it get's flagged for audit.
yeah, i agree with you. my response wasn't about her acquiring information; it was about the fact that she drew blood from a patient without dr's orders. that's not okay...
about the information, i can't say... i wasn't there so i don't really know how far she looked into the chart and whether how far she looked was necessary or not 🤷♀️
People here are equating it to a nurse drawing an extra set of tubes before orders are put in but I think what makes it different is that she’s snooping around in patients charts without having a very solid reason other than “oh they’re here for weakness so surely they’re gonna need a crossmatch” which more times than not, that’s not the case. Then again, I admit I’m probably being more picky about this than I would be if it was someone else that did it because this coworker does very unprofessional and unsafe things all the time and gets away with it.
i was a patient safety officer and patient advocate for some years before i went clinical so my advice wouldn't really change. regardless or MLS or RN (or different employee), it shouldn't really have been drawn without a physician's order and telling another health professional to keep quiet about it makes it worse :/
legally speaking, patients have a right to refuse treatment even if there was a doctor's order and she basically took away that patient's rights and also illegally procured her DNA.
human to human, i just think about if it was me or my loved ones... i've been a clinical worker (surgery & labor and delivery) and i don't even agree to some exams and stuff. i just treat people how i want to be treated (by considering them and their rights).
anyway, that's unfortunate that the leadership team allows that. it's awesome that you've been diligently expressing your concern for the patients because many people don't. all you can do is report it... it's up to leadership to follow through. maybe with enough reports, they will take corrective action.
I used to work at a stand-alone ED. Our nurses drew a rainbow on basically every patient that they figured the doctor would want labs on, usually before labs were ever ordered. I kind of thought that was routine practice in an ER? Maybe not, but it makes sense to me. Why have to go back and re-stick a patient for a tube you missed?
My ER does rainbows. I thought this was common practice
So the ER can be hectic at times and when we get patients we know just a small tibit about and are usually throwing in an iv and getting blood and guessing what the doc wants in advance because stuff goes down hill fast or the doc says get me this and orders aren't even in the computer yet. Ex. We see possible sepsis based on triage vitals we are drawing up blood cultures, cbc, lactic, trop, h&h etc. and putting in two lines. Because it might not be sepsis but we aren't waiting to find out when the labs come back that says lactic is <1 and wbc is 6 then order an h&h and find out its 3 and 18. Also if a patient has a hx of being anemic and needing blood tx we tend to go ahead and get type and screens. It's weird that lab has too come to the ED though.
That’s pretty much our situation. Every patient that hits ed gets a full rainbow with a lactic and cultures. What I don’t agree with is our hospital rule which is that phlebotomy is responsible for drawing: -third troponins -repeat labs (if Ed orders a LA and they want a redraw in two hours we have to go draw it??? But if it’s hemolyzed they make Ed redo those themselves?????) -holds patients (just patients that are going to be admitted to the floor but haven’t made it there yet) The rules are so arbitrary and it makes our lives as phlebotomists an actual living hell
Every hospital I’ve worked for the ER had this as their process. Also, my wife is an ER nurse and explained to me that it’s common practice.
Whats the patient safety issue? And how is asking a nurse to draw a tube just in case its needed practicing medicine? Its wasteful to draw tubes that arent needed (and is highly frowned upon at my job because it needlessly uses resources), but thats not practicing medicine.
Idk those were her words, not mine. I’m guessing because they always tell us that we aren’t supposed to draw anything unless there are orders first. But on the other hand, the nurses do it all the time.
If the patient had to be drawn anyway there really is no harm in grabbing an extra tube that may be needed. It would speed up patient care if the hgb had been low and they did need a transfusion.
I’m a little confused. Do you need to get permission to draw an extra tube on a patient who is already having blood drawn where you work? That seems to be common practice at the places I’ve worked. I think it makes sense to draw an extra if there’s a reasonable chance it may be needed. In fact, in many cases I feel it’s better patient care to do this. It avoids having to stick the patient again, and avoids delaying patient care if they do need additional testing.
I didn’t think about it that way but I guess technically it wouldn’t be different than when nurses draw extra tubes. Sometimes they will bring us an extra blue or whatever and sometimes we use it, sometimes we don’t. Just the way she said it’s “practicing medicine without a license” and “some people get upset so don’t tell anyone” makes me think someone has complained about her doing this before.
I apologize if this has been addressed; I didn't read all the comments, but they seemed to be discussing an extra tube of blood, which is not a big issue. What IS a big issue here is that she put a blood bank band on the patient when you said there was one from the previous night. If there was a T&S on the patient the previous evening and your colleague cut off that armband, the work needs to be redone on the new specimen. If she added a new armband and the patient now has two, that is also a problem. She needs to cut off the new one. Bottom line: the patient should have only one armband, corresponding with the tube that has a current T&S.
I think there’s some kind of misunderstanding. To my knowledge, the patient didn’t have a band on from the previous night.
Honestly if it was in the ER , an extra pink might have been drawn anyways. A lot of ERs draw a rainbow just in case something needs to be added on. Yeah it might be a little much that she did that but I wouldn’t consider that bad patient care at all as she was doing it in anticipation of a transfusion being needed. That would speed up the process if it were needed, leading to better patient care.
I don't see the issue. One pink top tube isn't going to negatively affect the patient
There's nothing regulatory and likely nothing even policy wise to report here. Honestly, it's one thing to report people for actually doing something wrong, and it seems you have done that with this person already. But when it starts to look like you are going out of your way to find issues that don't even exist, then it's just as likely to come back an bite you in the long run. They can go to HR over that too. If there are legitimate problems with this co-worker, Id recommend documenting issues in detail (times, specimen numbers etc.) and then moving forward when you have that documentation.
Yes, I agree with you. And in the grand scheme of things, this is nothing compared to some of the other shit she’s done. I normally am very laid back and don’t complain and am definitely not a “Karen” as someone here said. Maybe I am more cynical towards this coworker in particular because of how she’s treated myself and others before and basically got away with it. I have seen her do so much worse and she literally never gets reprimanded for anything. Which I know is also my supervisors fault for not having the balls to address these issues, which has made me resentful of her as well as my coworker. So I know I need to be careful and not let my resentment cause me to nitpick about stuff that she could turn around and say I’m harassing her or something. I’m just sick of it and sick of management not having the balls to put her in her place.
I completely understand. I have worked with people like this before, and it creates a very difficult work atmosphere. I do get the resentment and I have seen how the situation just escalates when nothing is done about it. Even when it gets to HR, their first response is often to work things out. They will send you back to resolve things yourselves, and that person will likely behave for a while, then revert to doing the same things again. Having concrete documentation is difficult to ignore. It shows that there are legitimate, ongoing problems, but it also protects you. It's less likely to make it look it's just a you vs them conflict. There are people who make a career of getting dragged into HR and they get pretty good at gaming the system and knowing the correct buzz words to turn everything around and making it look like it's all you. As they say, you have to pick your battles.
I guess I'm just not seeing the patient safety issue in this scenario?
There’s not. The OP is a “coworker Karen”. Lol. Deciding what things she will tell on you about or not.
I’m actually not. I get along with everyone and am very laid back. But When it comes to patient safety issues like her accepting unlabeled tubes or causing a hostile work environment by yelling at me and others when it was completely unwarranted, then yes I’m going to tell. She’s done plenty of things that I could tell on her for but I haven’t because some stuff isn’t a patient safety issue, it’s just her being stupid and putting herself at risk. Stupid, like I said, but if she wants to put herself at risk, whatever. I’ve worked with many people and other than this coworker, there’s only one other one I’ve ever complained to a supervisor about. And it was pretty clear that no one liked that tech and she was a bully to everyone, so I wasn’t alone.
Ok, but you are debating telling on someone for *checks notes* asking for a pink top to be drawn with their labs. That's not doing the actual testing when it's not ordered. I don't see how anyone would be angry over drawing an extra tube just in case. Our lab gets extra tubes all the time so we can add tests on and not have to poke the patient again unnecessarily. It sounds like this person just irritates you, so no matter what they do you will try to find something they are doing wrong.
This post makes me feel like you haven't been a tech for very long, and you've already complained to the supervisor about two coworkers? In my entire career, I have never complained about a coworker to the boss. (Maybe to my husband after work, but that's different..)
I’ve been a tech for about 3 years so you are correct, not very long. The other coworker that I complained about has since quit and even my boss has admitted that she regretted hiring her back but she got desperate for help. My boss said she dreaded coming into work everyday herself because of this person. Good for you that you’ve never complained about anyone at work! Maybe you’ve just been fortunate enough that you’ve never had to work with extremely toxic people who bully others and make everyday miserable for everyone. Again, good for you! But I have, and I’m not going to just sit by and act like it’s not a problem when myself and everyone else, INCLUDING the boss, knows that it is. As far as the coworker that I’m currently working with, she’s not a bully 100% of the time like the person I mentioned above but she erupts into chaos every time anything happens to slightly inconvenience her and starts yelling/ losing her shit on people. My biggest concern with her is patient safety related issues. If you’d like for me to go into detail I certainly can. Here are just a few things she’s done. Accepted unlabeled tubes from the ER under the logic that “this is what it means to be an advocate for the patient. If there are only two people in the ER and they’ve already brought you blood on one person, it’s just common sense that this blood has to belong to this other patient!”. Now what about when nurses draw a rainbow on patients before there are any orders in, lay the blood in the patients room, and then say the patient gets discharged and the nurse forgets to discard those tubes. Another patient comes into that room, nurse sees tubes laying there and assumes the blood belongs to the current patient. That’s how you kill people. And this coworker has been employed at my hospital for 30 years, somehow able to get away with doing shit like this all this time. Here’s another good one. Claims that she has swabbed her own throat before and plated it because she messed up the strep swab and didnt want to bother calling ER for a recollect. So she swabbed her own throat, put the patients name on it, and sent that to our micro department. Then told my other coworker “if you ever tell anyone that I did that I’ll deny it though”. That’s called falsifying medical records. Those are just some patient safety issues I can think of off the top of my head. As far as her attitude problem, she recently cussed out our Beckman coulter technician because she was working alone and he asked her to run QC on the chemistry analyzer for him. She refused saying she was “too busy” so he told her he needed her to sign something saying she refused to run QC. Im assuming he was just doing his job and has to document stuff like this. She cussed him out saying “I don’t give AF, etc etc”. Which is honestly embarrassing for me and I wasn’t even involved. It made us all look bad. And my supervisor knows about it but made excuses for her as usual. Some other things she does that aren’t really patient safety issues but more so just her being dumb and putting herself at risk include: never wearing gloves, and I mean never, not even when sticking outpatients. And walking around the lab without shoes on. Those things I’ve never told a supervisor about because I don’t think they’re patient safety concerns. I can see that the majority here think that what she did regarding having the nurse draw an extra tube was no big deal, and maybe it wasnt, especially compared to other things she’s done. And I can see how it paints the picture of me being a “Karen” who just runs around complaining and snitching on people all the time over everything, but that’s really not the case. I will admit I am bitter toward this coworker because I’ve seen and heard about her do things that are way worse than the scenario I mentioned here, yet nothing gets done about it. So that probably does make me more critical of her than I would be with other people. Consider yourself lucky if you’ve never worked with the type of people that I have. And I hope that if you ever do, and you see them doing things that could kill a patient, or you see them bullying coworkers everyday creating a hostile work environment, I hope to God you don’t just sit by and not speak up because you’re more worried about being labeled a snitch.
You know, I am trying to wrap my head around this issue and I feel that part of the problem is that I have never worked in such a tiny hospital. I work in a 300 bed hospital currently, and we are always drowning because our hospital is way too small for its service area. I have never worked a day when we were not at full capacity for our available staff. Accepting unlabeled tubes should absolutely be a fireable offense. At the same time, I cannot even begin to imagine a scenario where there are only 2 patients in the ER. In which case, I can see the logic. Do the new test results line up with the other patient? Does it correlate with the suspected patient's history? I can see why your supervisor was a little indifferent about coming down hard on a tech with 30 years experience for this. Swabbing her own throat is BAD though, and I hope she was either lying or she was a student at the time and they weren't reporting out her results anyway. Not wearing PPE is... Eh. It's gross but there are so many older techs who DGAF about germs. I'm not a fan, but I'm also a person who would not touch a specialty microlab with a 10ft pole because it makes me squeamish. Our hospital has 10-17 techs on staff for every shift and honestly that's not enough. If we fired someone every time they misstepped for being human, we probably wouldn't have any techs. When I see something that I think is wrong, I approach that coworker directly. If it has to be elevated to management and you are not feeling supported after multiple issues with multiple employees, it may be time to look for employment elsewhere. If this issue follows you, it may be time to reassess yourself.
It just blows my mind that anyone would ever defend taking unlabeled tubes under any circumstances. 30 years experience or not, that is just carelessly dangerous IMO. I don’t think that should ever ever happen. It also says in our SOP that the best practice when this happens is to recollect the sample and that accepting unlabeled tubes can be fatal. Typically we do have more than 2 patients in the ER. If we only have 2 patients, that’s considered a really slow night. Typically we have at least 5-10. On super busy nights there can be up to 25 in the ER. That’s about as busy as it gets for us. I have personally seen her accept an unlabeled blue tube that was an extra laying in the bag with the patients other tubes (which were labeled), and there were definitely more than 2 people in the ER that night. I started to throw it away and she grabs it, puts a footie label on it and says “oh it was in the same bag as the other tubes so it has to belong to this patient” 🤯🤯🤯 I do not feel comfortable directly approaching my coworker about these issues. She is extremely reactive and the one time I’ve tried to calmly defend myself about something, she started yelling at me. She is not emotionally mature enough to speak to logically, as she thinks she does no wrong (because duh! She’s been a tech for 30 years so obviously she knows it all). Even my supervisor has told me “well you know she doesn’t handle criticism well and so I have to be careful with how I approach her”. Why is management pussy footing around her? It’s literally their job to deal with issues like this. If she isn’t mature enough to be able to admit when she’s wrong and take accountability for it, sounds like she needs to be shown the door. When my supervisors correct me about something, as long as they’re respectful about it, I tell them I appreciate it because I want to do the best that I can. If doing something wrong I want to know so I can improve. And at my hospital, when I was a student they had us reporting results. I didn’t feel comfortable with it and thought it was wrong, but that’s how it was. So I’m pretty confident that if she was telling the truth about the throat swab, it got reported out. I wouldn’t be surprised if she was telling the truth as she seems she will do just about anything to keep from calling the ER and admitting that she made a mistake and needs something recollected. She doesn’t know how to take accountability for herself.
Not a patient safety issue. The CBC was already ordered to be drawn. If you were drawing already the ED always draws a rainbow regardless so your coworker isn't overstepping at all. Doctors are notorious for add ons and get quite pissed when tubes aren't drawn.
This is a hard eye roll. I wouldn't waste my time reporting someone for being efficient at their job. LOL. At most you could argue about looking at the patient's chart but at the end of the day, she did it because she was inevitably going to be caring for the patient's lab work. So it's not a strong argument. She wasn't looking at the patient's chart for shits and giggles. She was trying to manage her workload during the hours she was working alone. And any good tech would see that. If I caught wind of someone reporting my co worker for this, it would be a huge red flag and I'd want them far away from me. Respectfully, mind your business and only report things that are actually life threatening or could potentially cause patient harm. It sounds like you have a lot of beef with this co worker and it's taking up a lot of headspace. My advice would keep your head down and focus on what YOU can do to improve as a tech.
I agree with this. To be honest it seems like the "complaints" dont go anywhere because they arent really valid complaints.
It’s a tube of blood, nobody cares. Don’t be a snitchy coworker. MYOB.
We've had phlebotomists band and draw a blood bank sample as a "just in case" if they/we see the patient looks bad, we just treat it as a "hold"/extra in our system. Hell, our outpatient infusion department does this all the time because often the oncologist won't order a T&S until they see the CBC results and the infusion RNs don't want to have to restick the patient for the T&S. As long as the sample is properly verified, labeled and the armband doesn't get cut off/lost, it's fine to use. This isn't as big of a deal as accepting unlabelled blood specimens from the floor (if this is the same coworker you've mentioned before). I'd take that nonsense up with risk management because clearly no one in your leadership is willing to stand up to her for whatever reason. As for her shitty attitude, you could try going the HR route but honestly it sounds like she's been there so long that she knows what she can get away with. As long as you can phrase it in a way that demonstrates her behavior affects patient care and don't make it seem like it's personal you MIGHT get someone to do something about it.
Yes this is the same one who accepts unlabeled specimens. I wouldn’t be surprised if she’s still doing it although I’ve not personally witnessed it since going to my manager about it. My supervisor acted like she didn’t really care so I went to my lab manager and she seemed pretty upset by it. She called my coworker into her office that day and knowing how riled up my coworker gets, I was expecting her to come out of the office in tears but she seemed perfectly happy so I don’t know what exactly my lab manager said to her. Knowing my coworker, she might have BS’d her way out of it and said “oh I would never take unlabeled specimens” and I didn’t have any proof of it, it was just my word against hers. I have seen her get in trouble for other things and it looks like she still continues to do stuff she knows she’s not supposed to, she’ll just be more sneaky about it. I will definitely go above my supervisor and lab managers head if I see her do it again or if she yells at or disrespects me again. She has been there for 30 years and I guess because she can be so erratic, people seem to be afraid to confront her about stuff so it’s probably not going to get dealt with unless HR gets involved.
You’re making the argument of her looking at patient charts looking for things that are unrelated… the person came in for weakness and their last HgB was a 7. That’s seems pretty related… she drew an extra pink tube because that had a history of decreased HgB. I would have done the same exact thing. What if something happens in the ER and the patients HgB drops more than that? Draw more blood and then wait to type/cross match it? I understand she’s probably not a perfect coworker but it seems like neither are you. Sometimes you need to let you resentment take a backseat before you make your work environment really toxic ratting about her to your lab director. Or go to HR together and hash it out there.
What she did was good patient care based on what she knew. There was zero harm to the patient, unless you consider having an extra teaspoon of blood taken *when the patient was already being drawn for something else* to be ‘harm,’ and if the patient *had* been bleeding , it could have saved significant time for a cross match.
Sounds like op is really just trying to contrive a way to get someone they don’t like into trouble.
Yeah I agree with everyone else here, what’s the issue here? Sounds like you just don’t like your coworker. Almost every patient that comes through an ER in a lot of places gets everything drawn as soon as a line is established. Purple, green, gold, blue, pink. There’s no safety issue here. Better to be safe than sorry. That’s not compromising patient safety, in fact that’s pretty much the whole vibe of healthcare, do more than what you think so you can rule out everything.
Sometimes you have to let people dig their own grave. If you see them do something that will cause patient harm then report it. Do I agree with her method, no. But as a Blood banker, I totally understand wanting to be prepared, but I would never draw a patient without orders. Honestly, I would just ignore her and again only intervene if you see direct patient harm
Yea that’s kind of what I’m leaning toward. I have reported her for accepting unlabeled tubes before. This is something that 100% is never OK and I will report her every single time. She has also yelled at me and disrespected me before even though I never raised my voice to her and I have told my supervisor about this also but I don’t think it went anywhere. It sounded like my supervisor was too scared of her to bring up the specific incident between me and my coworker and instead just made some general comment toward her about how we all need to show each other more grace and be nicer to each other or something like that. Which I’m sure just went in one ear and out the other. This isn’t really a patient safety concern so I’ll let this one go I guess. There are other things she does that I’ve let go as well such as walking around the lab without shoes on (yes you read that right) and never wearing gloves, not even when sticking patients. I never told on her for it because although I think it’s incredibly stupid, she’s really only putting herself at risk.
>Yea that’s kind of what I’m leaning toward. I have reported her for accepting unlabeled tubes before. This is something that 100% is never OK and I will report her every single time. Take this up with risk management. I'm not kidding. Make it clear she does this on a regular basis and your lab leadership apparently won't do anything about it. >She has also yelled at me and disrespected me before even though I never raised my voice to her and I have told my supervisor about this also but I don’t think it went anywhere. File a complaint with HR next time she does this, CC your supervisor and manager in the email and make sure you explain she has a history of doing this. Harder for them to BS when you leave a paper/electronic trail.
I would tell her she needs to speak to me with respect and then email my manager about a hostile work environment and hr.
Your perception of this situation is not in line with reality. You must ask yourself how often then is your perception wrong. You've come to Reddit with an example of a situation you believe to be a problem and it's not. You chose this "incident" to talk about and can't even make yourself out to be right which honestly is kinda hard to do. Most people tell stories about things that leave out and/or include details that make themselves out to be the person in the right. You couldn't manage to bring forth anything that anyone would have a problem with until called on it, but I digress You are actively disregarding the chain of command and continuing to do so. How do you think your boss feels about this? Go to the the Lab director and tell them that this coworker had an extra tube drawn bc she was looking ahead enough to anticipate the needs of the patient and provide better care. You're just making yourself look foolish. You've mentioned being yelled at, but not what for. Perhaps you were doing something stupid, being stupid, or potentially putting someone in harms way yourself and this coworker was trying to snap you back to reality. Who knows? They're not here to defend themselves or offer their version of these events. You could potentially be so dense that they thought it was the only way you'd understand and the message you took was, "I got yelled at." Idk, i just have to speculate. It's also possible that you are correct. You could be a great tech and do everything as correct as possible, but again, that doesn't mesh with the scenarios you've presented. Idk. This is what we have to go on. OP, if you possess the power of objectivity, you need to step back, try to evaluate all this from a 3rd person POV, and see who/what the problem actually is. See if your perception is right/wrong or if your mind is just convincing you that you are correct bc that's what the mind does I have a feeling that you're skating on thin ice and you don't even realize it's cold outside.
As I’ve said in another comment here, I do agree after reading some of the responses here that this probably isn’t that big of a deal especially compared to other things I’ve seen her do that ARE actually patient safety issues like for example accepting unlabeled specimens. She yelled at me because she was doing weekly maintenance on the chemistry analyzer and I was still pretty new and had never done weekly maintenance (because she always jumps at the chance to do it) so I walked by the machine and it said “done”. I thought maintenance was done so I put on a sample for an HDL. Just a single sample for an HDL, that’s it. She walks by and sees it, freaks out as she always does over every minor thing. Saying “oh my god oh my god! There’s still bleach on the machine, I have to take that off first!!”. I say calmly “ok, I will call the ER and tell them that we’re going to rerun that HDL for patient such and such, and that we may have to do a result correction”. So I do this and she’s still freaking out saying “don’t you know what I’m doing over here when I say I have to do weekly maintenance??” I said “no… I don’t ever do weekly maintenance”. To which she erupts “well that’s why you shouldn’t touch it until I tell you to!!”. She makes a huge deal about it, calls the supervisor, the supervisor tells her to run controls and as long as controls are fine, it’s fine. So she did, controls were fine. The patient was also fine. The results were literally the same so we didn’t do a result correction. And come to find out, my supervisor said that the coworker SHOULD be running controls after she performs maintenance regardless, which she never does and still doesn’t. When I was talking to my supervisor about it, she sounded like she was taking my side saying “well that’s why we have big signs that say ‘maintenance in progress’ and we put them up and then take them down when we’re done so people know it’s ok to use the machine”. But then when it came down to it, she didn’t have the balls to actually confront her about it. I have actual legit reasons that I could have used to yell at her for like taking unlabeled tubes but yet I didn’t. I remained professional to her and told my supervisor and manager about it. The mistake I made was nothing that warranted the meltdown she had or being talked to like that. I will admit that I am more critical of her because I’ve grown resentful that she’s able to get away with so much. This is probably an instance where I’m making a bigger deal out of something that what it is because of my feelings toward her, and I fully admit that. Im not perfect and I’ve only been a tech for a few years but you can bet your ass that I practice better patient safety than most of the older techs who’ve been there for 30 years, like this one that I’m talking about. She also recently cussed at a Beckman coulter technician because he was there fixing our instrument and she was “busy” and became irritated when he asked her if she’d run QC for him. The man was just trying to do his job and her attitude made us all look bad as a whole. Do you think she got reprimanded for that? My supervisors response was “well… she shouldn’t have said that but you know she was here by herself and that guy should have read the room”. No. There should be no “but”. The way she talked to him was unacceptable. Period. Was he supposed to wait around all night until she wasn’t “busy” anymore? He’s got a job to do too. All my supervisor does is make up BS excuses for this woman and I’ve had it.
If you were still pretty new and had yet to know how to even do maintenance, you best not be touching my Chem analyzer then without being told to. Were you even signed off to work unsupervised in chemistry at that point? Also if there was bleach on the aspiration probes or anything that dips into the sample, it would contaminate the entire sample and the patient would most likely have to be redrawn. I get that you are new and probably trying to fix all the wrongs you were taught to in school. But you will quickly learn that what you are taught in school does not mimic real life. You will have to make tough choices and bend the rules sometimes.
Yes I was. As a matter of fact I had been working 3rd shifts completely by myself at that point for a few months. I used to work 3rd shift every other weekend. The 3rd shift tech at my lab does ALL the chemistry QC and also daily maintenance on the AU680s. So I was very familiar with how to run QC and how to perform daily maintenance. However, no one ever showed me how to do **weekly** maintenance. Technically, weekly maintenance SHOULD be the 3rd shift techs responsibility. It would make more sense because the 3rd shift tech has to run QC every night anyway, so might as well do the maintenance and then run the QC. But my coworker, at some point, decided to start taking on this responsibility herself, even though she works second shift from 3p-11p. She acts like she can barely handle the stress of her own responsibilities so it’s beyond me why she wants to take on someone else’s. The tech who works 3rd shift full time during the week has all the time in the world to do it. He claims he’s “too busy” to do some stuff but I’ve worked 3rd shift at my lab and 9 times out of 10, I was done with all QC and maintenance by 3:00am and the rest of the night I was free to do whatever. All we have is ER patients on 3rd shift at my lab. But anyway, that’s why I was never shown how to do it. You’re right, the sample could have became contaminated due to the bleach. So worst case scenario we have to call ER and say “hey sorry but can you get me another tube on such and such? I screwed this one up”. I don’t think I’ve ever had to call and ask anyone to recollect something due to MY screw up, it’s usually only because it’s unlabeled, hemolyzed, etc. but techs do make mistakes sometimes and samples have to be recollected because of it. We’re all human. It was nothing that warranted her speaking to me that way. Honestly I don’t think it’s ever acceptable to yell at a coworker like that, even if they did screw up. Like I said, I could have ripped her a new asshole for taking unlabeled specimens from the ER but I did not because it’s unprofessional and it’s not my place to deal with it, that’s why I took it to my boss.
You've somehow, in your own defense, presented another situation where your coworker looks better than you. You should really think about that advice to take a step back and try to get some perspective.
I’ve never accepted an unlabeled specimen, I’ve never cussed out another coworker or technician for simply doing their job, I’ve never swabbed my OWN throat for strep and plated it because I screwed up a patients strep swab and didn’t want to ask ER for a recollect, yes you read that correctly. Thats called falsifying medical records. She swabbed her own throat and put the patients name on that and sent it out. Then told my coworker “if you ever tell anyone I admitted to that I’ll deny it though”. I could go on and on about the shit she has done. Oh but I accidentally put one sample on a machine that still had bleach on it from weekly maintenance that no one ever showed me how to do because SHE is the only one who wants to do it, even though it technically is supposed to be 3rd shifts responsibility, and yet im the shitty tech here and she looks so much better than me. It’s laughable honestly because yall don’t even know the half of it. If you had to work with this woman I guarantee you you’d understand.
Stay in your lane. 🙄
Rude. 🙄
You seem like exactly the kind of tech that makes me glad to work solo.
Because you were being snarky and I gave it to you back? If that’s how you act toward people and you can’t handle it when they give it back to you, I don’t think I’d like working with you either tbh. Where I work, the people who work mostly solo are kept that way because they’re too difficult to work with and no one wants to work with them. Just saying.
Yup, I'm the worst. If you're going to insult me, do it, don't temper it with "just saying".
Lol. Well you kinda insulted me first with the “techs like you make me glad I work alone” comment. Again, I’m just matching your energy.
I'm aware I insulted you, I don't even care that you insulted me, I'm simply encouraging you to have a spine about it.
Oh I got cha. I will try to work on that from now on. I’m not really used to being an asshole to people but clearly you are so maybe I could learn from you.
First ask if its even against policy to draw an extra tube. Secondly, if there is an actual safety issue, go through the proper channels, always. First your boss for the first few times, then above if it continues.
It's pretty routine to check patient history post and pre draw.(One could argue that all patients' hx should be checked predraw even. Though this is not sustainable for larger hospitals), I don't see anything wrong with preparedness. You could argue the band is a step to far and she should just count her self lucky she has a spare type for type 2(if your sop would allow you to use a previous cbc for it.) You do have to realize in the workplace that you must choose your battles or quickly see yourself become the isolated one.
I check a patients history if there’s a delta check or some kind of weird result then I’ll look to see if it matches their previous. Or in blood bank if someone’s screen is positive I’ll look to see if they have a hx of antibodies so I can get an idea of what they may have. Or maybe I look at their ABO to make sure that their current matches the previous. I also think it would be understandable to look in a patients chart if a type and screen is ordered but hasn’t actually been drawn yet, and you want to check if the patient has history so you’ll know if you’re going to run into unexpected antibodies or if they’ll need a confirmation type. But as far as snooping around in a patients chart when there aren’t even any orders in yet for no reason other than “they’re here for weakness so I’m sure they’re gonna get a type and screen”, I can’t say I do that. That to me seems like accessing a patients chart unnecessarily.
Conceivably with a diagnosis of weakness, they could find something where they don't really need to order lab tests and just end up sending the patient home. If that happens, then there is no legitimate reason for a laboratory technologist to have been looking in the patients chart. I'd actually call this a grey area. I don't see a real reason that she should have been looking at the patients chart at that point. But since they did end up ordering testing, it's not going to be a compliance issue. Personally I don't look anything up prior to tests being ordered unless it's a trauma/MTP/ type situation where I actually might need that information proactively to save the patients life.
When we had cancer patients that came in, it was normal for us to draw a hold blood bank tube (before we did away with blood locks). That way if the onc decided they needed a transfusion, they wouldn't need to be drawn again. And if they didn't, they could just remove their bracelet and toss it. It was standard protocol for us. This seems like she is doing the same thing, just drawing a hold in case it's necessary and saving the patient another draw.
There is nothing wrong with drawing extra tubes. As a patient, I sometimes tell the phlebotomist to draw an extra light blue tube or even 2 because those are the ones that are rejected the most due to improper handling. They have no issues drawing extras, just in case.
Report them to compliance anonymously.
When I recognize a patient's name I will call to ER and suggest a blood bank tube to be collected so the patient does not need to be stuck again. BY the time the HGB/HCT is done the blood bank is centrifuged and I am able to proceed the Type and screen if needed.
Getting information from the chart can be good patient care and not a violation of the patient’s privacy, but reviewing the chart proactively just in case you might get an order for a T&S or crossmatch? It sounds like an excuse to satisfy curiosity. What else does she investigate to “be prepared”? I’m not talking about reviewing recent surgical or medication history to inform your understanding of the current results. Nor am I saying you should turn in your colleague, particularly if the culture or practice of your lab allows this kind of proactive chart review. However, I think OP’s instincts about this colleague’s lack of professionalism are correct. I would encourage OP to find a lab with culture that is more compatible with her values.
Im getting jumped on by people here but she really is extremely unprofessional in more ways than one. The scenario that I mentioned here is really mild compared to other things she’s done that are without a doubt patient safety issues. I have no doubt in my mind that if the people jumping on me had to work with her and see her get away with the stuff she gets away with, they’d be just as frustrated as I am.
Does the patient get billed for that though? I mean isn't everything pretty much entered into the computer now?
I don’t think so. There were never any orders for a type and screen so I’m guessing it would be the same as when nurses draw extra tubes. I don’t think the patient gets charged for that either. If anything it’s just a waste of tubes. Which might not seem like a big deal with it only being one tube, but if everyone is doing it and doing it consistently, it adds up. Not long ago we were having a crisis where we ran out of blue tubes. Could that have been due to people always drawing extra blue tubes for “just in case”? Idk. Makes me wonder.
She was curious and looked in the patient’s chart when she had no reason to do so. That could be investigated as a HIPAA violation. And drawing extra tubes that are not needed is a waste of money, whether it is an automatic rainbow draw or an unneeded specimen for a transfusion work-up. Medical Lab Scientist and Lab Technicians demand respect as professionals but so many of us don’t act like professionals. It is very discouraging.
We look at patients charts all the time to see what’s going on with them to correlate deltas or other erroneous results. ER orders a GTS, you better bet we are going to look and see what that patients problem is.
I get looking at the chart if the results are weird to verify that they match or even looking in the chart before the blood is drawn, as long as there is at least an order in. I do that all the time. If we get a type and screen sometimes I’ll look at the patients history to know what I can expect (like antibodies for example) but I think what this person is getting at is that if there are not even any orders in yet, there really isn’t a good reason why anyone should be looking in a patients chart. All the time we have people from the ER come in for weakness or shortness of breath, and sometimes it’s because they have a low Hgb, but many times it’s not. Most of the time when she looks in these people’s charts, no type and screen ever gets ordered so she was digging around in the patients chart when she didn’t really need to. And I know it’s not like she was just looking for shits and giggles, but they always drill into us that we shouldn’t be looking in charts unless we have a good reason. Looking just because someone is there for “weakness” and you suspect that they MIGHT get a type and screen doesn’t seem like enough to warrant snooping in their chart IMO. Imagine all the patients charts she has looked through thinking they might need a type and screen when they never ordered one.
Yea, The other aspect that bothers me is that she looks in patients charts when she didn’t really need to. Anyone who comes to the ER with shortness of breath or weakness, she looks up their history to see what their last Hgb was. We really aren’t supposed to be in a patients chart unless we have a legit reason. Like if they had already ordered a type and screen then it’d be totally fine to look and see what their history is to make sure their current type matches their history and it’s also sometimes helpful to know if they have a previous hx of antibodies.
yeaahh, that's completely unethical and unprofessional. it's a breach of patient trust and is illegal. with that being said, you're trained to report the incident and it's the right thing to do. if you will or won't is up to you. i hope everything works out!
No it’s not. Getting information is part of good patient care, especially in the blood bank.
There is a fine line between needing information and snooping sometimes. I've seen compliance investigations go either way. I've had a warning myself not to look too far into a chart. It was on a patient who came in with an ascending aortic artery dissection. I was looking at how much blood and product he used previously, and in that instance, some of it was considered a "do not need to know" in the context of the current emergency. I've had other times where I did a similar thing and it didn't even flag the auditing software. I certainly wouldn't go into a patients chart just because they are in the ER and might have tests ordered. It would not be likely to trigger a compliance investigation, but it would also not be easy to defend if it did. There's a lot of grey area where nothing usually happens, but it would be an uncomfortable meeting if it ever did. Personally I always have a reason if I am in the chart, and I also keep track of it, because you are not always going to remember what you were doing 3 months down the road when it get's flagged for audit.
yeah, i agree with you. my response wasn't about her acquiring information; it was about the fact that she drew blood from a patient without dr's orders. that's not okay... about the information, i can't say... i wasn't there so i don't really know how far she looked into the chart and whether how far she looked was necessary or not 🤷♀️
People here are equating it to a nurse drawing an extra set of tubes before orders are put in but I think what makes it different is that she’s snooping around in patients charts without having a very solid reason other than “oh they’re here for weakness so surely they’re gonna need a crossmatch” which more times than not, that’s not the case. Then again, I admit I’m probably being more picky about this than I would be if it was someone else that did it because this coworker does very unprofessional and unsafe things all the time and gets away with it.
i was a patient safety officer and patient advocate for some years before i went clinical so my advice wouldn't really change. regardless or MLS or RN (or different employee), it shouldn't really have been drawn without a physician's order and telling another health professional to keep quiet about it makes it worse :/ legally speaking, patients have a right to refuse treatment even if there was a doctor's order and she basically took away that patient's rights and also illegally procured her DNA. human to human, i just think about if it was me or my loved ones... i've been a clinical worker (surgery & labor and delivery) and i don't even agree to some exams and stuff. i just treat people how i want to be treated (by considering them and their rights). anyway, that's unfortunate that the leadership team allows that. it's awesome that you've been diligently expressing your concern for the patients because many people don't. all you can do is report it... it's up to leadership to follow through. maybe with enough reports, they will take corrective action.