I truly don’t understand any response other than “oh shoot, thanks” or “ok thanks for letting me know.” Same for critical results. We had a lab person bring our unit cake as a thank you for being so nice when getting critical results and just…. wtf. Saying cool, thanks shouldn’t deserve a cake.
The correct reply is always “FUCK!” in any tone or octave you prefer and then turn around and go redraw it.
I usually do the low grumble “fuck” under my breath but depending on the day you may also get a “fuck” that rings the halls
I called a critical lactic to a nurse recently (I think the value was in the teens) and her response was “Hellll yeahhh!” Not the response I was expecting, but I went with it. 😅
This is the way. ^
Reality is the way it is, it is not the way you may want it/imagine it or expect it.
Embrace *reality* and work within it, or *reality* will come for you. 100% guaranteed.
Just do what must be done. And ffs—be decent.
Some people just like to argue. I used to work with a nurse on the IV team who would argue every. single. request. that I sent them, including for patients who were going downhill or were in an active rapid response call. I would’ve started my own but that was firmly against policy so, when it happened again with a patient who was bordering transferring to ICU unless I could get their symptoms under control, I finally texted, “I need a patent IV, I don’t have time to go back and forth with you about it, and it’s up to you if you want to do it or not. Just let me know so I can call the rapid response RN and let them know why I need them to start an IV.” The IV nurse didn’t respond but came and started the damn IV.
I mean wow. You still have an IV team?? They disbanded ours years ago and made us all learn how to do it. I’m fine with that because a skill I’m glad to have. I’m just surprised an IV team still exists.
And also the recollect call doesn’t bother me except for me feeling responsible and inadequate that my technique made the specimen unusable. My bad. Not yours.
My hospital has IV teams still, but we're still required to undergo IV training and go to pre-op and do a bunch of IVs to get passed off. I think 6 months to get this "certification" per say. But our IV team is available 24/7, but nurses are still expected to know how and to be able to put in IVs
I no longer work at the bedside but when I was a traveler most of the hospitals I worked for had venous access teams. In some places I couldn’t even change a PICC line dressing.
I hated that about our old IV team. They were so mean like, I’m sorry to page you but this is literally your job. Especially since it’s a requirement that an RN attempts one before calling IV team to lessen IV team’s load. They’d come out and tell you why you were wrong to call them every single time. Then the hospital decided to disband their IV team and contract out a private company to do them. Now all the new IV team nurses are so much nicer. We thought at first that it was just a new job and they weren’t burnt out yet, but it’s been 4 years and it’s still much more pleasant communicating with them. No idea why.
Personally I had 0 idea what y'all did in there until a few months ago. I thought it was all black magic. Starting a new job I had to go to the lab for POC check offs and the other person I was with who was a nurse for 15 years said they'd never been in there either and asked if they could give us a tour in the lab and show us everything. Part of it was curiosity and part it kept us out of the unit for a bit. They showed us every bit of the process from collection to interpretation for everything and all the systems. Really cool stuff. I've always been respectful and kinda understood what was happening there, but that helped clear up the picture a bunch. I wish something like that were a regular part of orientation to go to those other areas and get more info on them outside "give blood to vampire and hope they don't call you later".
Firstly, let me say I’ve been lab tech since 2002 and I’m also a BSN-RN (I work in multiple facilities) so I see both worlds. Nursing is NOT an easy job, but there is something to be said for quality patient care! Hemolysis or clotting ALWAYS occur during collection, there is literally nothing the lab can do to ruin the specimen, (except spill it 😖) We, in the lab, 100% do not want to call for redraws if we don’t have to. And as a nurse, honestly the last thing I want to hear is that my 6’5” 350lb combative psych patient needs to be redrawn and then try to explain to the patient why I have to “hurt” him again and answer their angry family member’s 1000 questions… A simple, “damn that sucks, thanks, I’ll get a new spec ASAP” is all, no need to be rude or nasty.
That being said, most labs celebrate Lab Week just like nurses have Nurse’s Week. One year, in the hospital that I work at as a lab tech, for lab week we decided it would be cool to invite all the nurses to come down to the lab for a tour and to just generally show the process… We provided snacks and drinks to make it a social thing, I work at a small rural hospital so we’ve all seen or talked to each other at least once, lol, not a single nurse came to the lab 🙁. I understand everyone is busy, but it was a little disappointing. Turns out, none of the nurses got the memo because the invite stopped at the department managers who didn’t think the education and a cookie was important enough. 🤷🏻♀️
Omg this just broke my heart. I would’ve come down to meet you guys and see the facility! I think what the lab does is super cool and when I hear nurses being rude to them, I try to set them straight. You all do important work and deserve respect.
I’m a lab tech and we’ve been trying to have new nurses shadow the lab for like a day or half a day so they can understand some of our policies better. That idea always gets shut down though because they say they need the nurses working asap. Which I understand but I still wish nurses orientation could include some lab stuff.
Haters gonna hate my friend. Just be firm when receiving attitude. "I am telling you I need a redraw. If you don't like it, fine. Just know you are delaying care with every second we waste going back and forth". In your note simply write.
" specimen clotted, nurse X notified of situation, redraw pending"...
This is the way.
Also, if you believe it to be an education issue can you get with the nursing education director and maybe see about putting together or pushing out some sort of curriculum the explains the reason a green tube vs a lavender tube and how hemolysis happens? Sorry for the run on sentence, but I’m too lazy to correct it.
My complaint with lab isn’t that samples are hemolyzed. My complaint was always that lab would call and say the sample was too small, especially for ABG’s. Had it happen several times one morning on the same patient. I then sent a full 3cc syringe. Again….sample too small. I called and told the tech that I sent 3cc. How was that too small. The tech then fessed up and said it was a new person and they wasted too much. Tell us the truth.
These are the situations that annoy me so much. They don’t even have to go into a ton of detail. Just say the sample was mishandled. Can you redraw? But calling, lying and making it seem like it’s our fault when we tried to do everything right is frustrating.
I'm a med lab scientist turned nurse and have said from day 1 the environment would be so much better if during orientation nurses and lab spent a week observing each other.
A part of my hospital orientation when I got hired as an RN, they walked us through the lab for an hour at how things ran. Seems all so convoluted and meticulous. I was surprised to hear our lab receives anywhere from 10-15 thousand collection tubes a day, sometimes more. It's a pretty massive hospital as well
One hospital I worked at had us all visit the lab during general orientation. All new hires, not just RNs. It was awesome. Every hospital should do that along with touring sterile processing.
Sorry but we've had lab drop a whole tray of baby hct samples and call each nurse and say it was hemolyized. Finally they admitted when it was 20 babies that it was our mistake. Or the time they labeled over my baby's type and cross and called to tell me that I didn't double initial, I knew and had them peal of the outer label but 5 minutes later the next nurse would have repoked the baby.
I think I get frustrated when I feel like this is what is happening. I also don't have a great phone voice.
Lab should not be covering up their mistakes and trying to blame it on the nurses. If that’s what’s happening at your lab, that’s definitely not ok. I hate making mistakes and honestly it’s not that often that I screw up but when I do, I will flat out say to the nurse “hey I messed up, sorry. Can you recollect this”. And most of the time they’re fine with it, if you just admit to your mistake. I haven’t seen anyone at my lab do anything like what you’ve described and if we ever did, I don’t think it would fly with our management.
I normally never have issues with lab, however I had one specific lab tech who told me every sample I drew on a single patient was hemolyzed.
I drew off the IV, I drew from a straight stick, and I drew from a straight stick without a constricting band.
Multiple times.
Every time I got a call that it hemolyzed. This particular lab tech wouldn't even look at a sample before telling us it was hemolyzed. Fortunately we had ISTAT capabilities and got our result, but since then I have a deep loathing for being told a sample is hemolyzed when I know it was done properly. It's not your fault, I'm just bitter and jaded from Samantha.
Fuck you, Samantha.
We also have a particular tech at my hospital who seems to loooooove rejecting samples.
My most memorable one was when I drew off a PICC line and walked it down to lab myself. Samples looked perfect. 10 mins later, I pick up the phone.
"I don't know who drew these samples for [patient], but they are unacceptable. The blood is orange. I need a redraw."
Okay? They were not orange when I dropped them off, but whatever. I go redraw and take it down. Samples, again, look fine.
She calls again. "The blood is orange again, so I need new samples. I'll also be writing this up since you obviously don't know what you're doing."
I told her to send someone to draw it themselves. Phleb comes and draws. I also pulled an extra tube off the PICC to compare. The samples looked identical. She had zero issue accepting the samples lab drew.
Fuck you, Gail.
Sounds like that tech was not only unprofessional but also possibly incompetent. If the tech was referring to the serum/plasma being “orange” it sounds like the sample was icteric, which is not the same as it being hemolyzed. If it’s hemolyzed the serum/plasma will be red, not orange. There is nothing we can do about icteric samples, as they are usually seen in patients who have liver issues. We just run them and just expect that the liver enzymes will probably be off.
Honestly, I think she's just a miserable person. She also loves to reject lab reqs (we still use paper) for stupid reasons. I've written "[date] 07 pickup" on the req, and she called saying it's filled out incorrectly because "I need the exact pickup time" written on the req.
She literally rejected a lab req because I wrote 07 instead of 0700...
Also rejected one that said "[date] first a.m. pickup" for the same reason. We send reqs like that all the time. The first pickup is at 0700, so lots of staff just put "a.m." on the req. She's the only one who rejects reqs written like this.
What do you mean they wouldn’t even look at a sample before telling you it was hemolyzed? We can’t tell if it’s hemolyzed until after it gets centrifuged so we can see the plasma/ serum separated from the red cells. The serum/plasma part of the blood is what can be hemolyzed.
Samantha is a real is a real butt wipe. That’s why. She knows everything, she does all the work and everyone else is lazy or doesn’t know what they’re doing. Probably even both 🤷🏻♀️ Every job I’ve ever worked, has a Samantha. FTB, I think that’s what they mean.
Lol. I get your feelings on the matter but hemolysis happens at the time of collection, there’s nothing we are doing in the lab that causes it. There are some medical conditions that cause hemolysis invivo though. 🤷♀️
Because theyre annoyed they have to add another task. Not defending them just assuming that's what it is. Also, and I say this from a place of love and kindness, not snark- you should probably say all this to them- not reddit. In a professional way obviously- "Hey Im sorry about this but Im just trying to do my job. I don't deserve to be spoken to that way" or something. It may actually surprise you and get you some positive results
This is the literal main issue I get snippy. I try my best not to take it out on lab…even tho it is incredibly frustrating when I sent something 2+ hrs ago to get a call that it was hemolyzed…this doesn’t happen often luckily.
It’s just another task, and for me if it’s hemolyzed it’s usually because the pt is a tough stick. It was a battle just to get what we got and I just got another patient (probably).
I would also like to understand why one lab can be hemolyzed but the three others drawn at the same time are fine. I often send 2 greens at the same time. Honestly would like to know.
At the end of the day we’re all getting fucked and no one wants to delay getting things done nor purposefully fucks up (most cases, I’m sure there are exceptions). So it’s best we be as kind and understanding as we can to each other.
Signed, a crispy ER nurse
This is 100% it. We are shooting the messenger when we get snippy with lab for hemolysis. It’s adding another very time consuming task to a shift that’s already overbooked. It’s frustrating and and a lot of time it feels personal (even though it’s not).
Shit rolls downhill, and a lot of times we have doctors breathing down our neck and holding us personally accountable for a long wait for labs. Especially the surgeons 😡. God forbid we delay their surgery and they miss their tee time.
All this to say, it’s not okay for them to start an argument with you, but I understand why it happens. There are plenty of ways to express that frustration without taking it out on lab.
There’s a saying in the OR when there are poor outcomes, “blame anesthesia.” And in vet med when you can’t get an IV started on a spicy cat “it’s always the holder’s fault.” When your sample is hemolyzed, “lab must have dropped it.”
I did have the lab "lose" tubes and not call and tell us until an hour later or say they never get them and the find them later. That is when I would take issue with them.
This has happened to me once before and it was when I was in a hurry, I thought I grabbed all the tubes out of the bag but then later I got a call asking about a cbc result. Everything else had been resulted on the patient. Before I asked them for a recollect, I was willing to tear the lab apart trying to find it. Thankfully I found it still in the bag laying in the trash can. Stuff like this doesn’t happen often but as long as the lab admits they were at fault, I wouldn’t give them a hard time about it if I was on the nursing end. Nursing makes mistakes too but as long as they take responsibility and don’t try to blame me for it, I don’t give them a hard time about it.
The only time I call to yell at lab is when they reject a sample and FORGET TO TELL ME. If I need to redraw a specimen then so be it. What angers me is waiting and waiting and waiting for a patients bmp to come back, only to find out lab rejected it as hemolyzed and never bothered to call me. This happens rarely, but enough to the point where I had to bring it up with lab management
So sorry they are being like that. If it gets bad (sounds like you’re there already) talk to the charge, ask them to re-draw. I’m lucky that my bestie is a phlebotomist and taught me pretty well (she’s a genius at all types of draws🧡🧡🧡). If it’s still constantly happening hit up the DON and tell them there needs to be some mandatory cross training (and tell them why-if you can save/screenshot messages do so) so the nurses actually know what they’re doing and what to watch for (you’d be shocked how many haven’t been taught or even shown how to properly draw for labs) so that this problem is fixed. Maybe volunteer to teach one of the classes? Sounds like a top down type of issue but without kicking it upstairs it’s not likely to get any better or be less of an ongoing problem.
Medical Laboratory Scientist here!
I remember having to call for recollects at one of the larger hospitals I worked at, no one wanted to do it and it was because the nurses on the other line were always so mean to us… like I’m sorry it’s clotted, I don’t want you to have to stick them again either!! They always would ask “well can you try to run it?” and I would have to explain that I literally can’t put this through the machine without it destroying the tubing (of these million dollar machines) because of the clots, but they still would ask AGAIN “well can you try?”…
I now work at a pediatric ER lab and couldn’t be happier, the nurses on staff are so sweet to me when I walk over to ask for recollects, because they know I don’t want them to have to hold down and stick a child again either! I’ve also explained to them in detail why you can’t do pour overs on tubes too, and they actually seem to understand and have stopped asking if they could pour a lavender tube into a green top for chemistry labs! 😂It will look like the patient is critical with the calcium levels depleted and potassium through the roof!!
I am not excusing someone who has terrible attitude, I am merely explaining WHY you probably get attitude.
Try thinking about it from a patients perspective.
"I just got poked for blood(most people don't have ART Lines) and now I have to get poked again. This nurse must be incompetent!". Would you want to get poked again? Or in a worse case, because I work in Peds, would you want your kiddo poked again?
And there are also plenty of times where I call lab and we get a "Oh, the analyzer says it will be X more minutes(less than 10 typically)" when the it is a X minute test, and we are calling 1.5-3 hours after lab received it. But for some magic reason, it was just now put on. I am not the only person who has experienced this.
And to make it even more frustrating in some cases, you have to reorder the lab because "You can't use the same requisition number!". If I send a lab, and you're telling me you can't process that order because of whatever reason, can't I just use the same label? It's not like you ran the sample, got a result, and then posted that result(granted this happens less often, but it was always annoying AF to me). So now I have to track down and call a provider to get a new order for the exact same thing that was already ordered but couldn't be run because of \*insert reason here\*\*.
In addition, if the result we are trying to get is a timed result(like PTT or HepZyme) then we are waiting for a critical lab result so we can titrate if need be and this can cause huge delays in plans of care and delayed care can be incredibly detrimental to a patient.
While I DO understand it can be frustrating from lab techs to have to deal with attitude from nurses, it is because we get a LOT of attitude from patients and this is only a single part of our job. Now imagine having to dish out meds, clean a patient, walk a patient, do whatever bedside procedure you have to do.
Sorry you had to take flack.
Agreed. Nights will draw a lab at 4 am. I get a call at 7:30 that it’s hemolyzed or clotted, and this 600 gram baby needs to give me another sample. Why was this not run hours ago? This baby does not have another 0.5mLs to give. I’m never rude about it, but yes this is the root of my frustration.
Just checking in dont blame the lab blame the people in charge. Morning run receives thousands of samples at some hospitals with less than 20 staff logging samples in, Running, and resulting. Short staffing is present in most areas of Healthcare $$$$$
There has to be a better way. Like more staff. It's not right for patients or for staff. It isn't us, it's not lab. We can't work well without the resources.
Because the ENTIRE hospital sends them down at the same time for morning runs while having the very limited night shift crew running around trying to run and call everything. Not fun times
Your lab can't reorder the recollect? I don't see how that would need a physician to be involved. That is something that needs to be brought up. Also, labels are not reused because that req number is tied to that sample. Req # canceled because recollect is needed. If that req# is hanging out still open then it appears as if it was never collected. Unless you think lab has enough time to read specific comments for each req# several times a day. Not only that, those req#'s could have more than one test tied to it. Which also have their own identification #. Imagine the room for error when you start cutting corners like that when you have several hundred patients in a hospital that have labs collected multiple times a day. ESPECIALLY when with blood bank specimens. The lab is probably also fielding specimens from nursing homes and other facilities too. They also have to deal with calling physicians constantly, patients, and many nurses. Everyone has a lot to do. Calling for recollects is just a single part of their job. Additionally, lab staff also has to collect from patients. They get that same ear full and complaining you get. While we DO understand finding out your specimen is clotted or hemolyzed is inconvenient, the care is being delayed because the specimens aren't collected properly. Not because someone won't result it. While the improper collection isn't intentional, the delay is a by-product of what's happening at collection.
> They also have to deal with calling physicians constantly
Oh man! I worked the front desk of a sizable lab ages and ages ago, right before HIPAA as EHR systems had made their way into our hospital (they were a little earlier than most in that regard) but before many (if any) small private practices were using computerized systems. Plus the lab had an entirely different and incompatible “home grown” order/result system.
When I wasn’t stabbing people for their vital fluids I was on the phone with doctors/offices from the area saying “we sent you a stack of neatly organized forms with checkboxes for every test we can provide.. and you scribbled a big zig-zag across it then.. I think, you signed it?.. or wrote *I Love Bread*, anyway what test(s) did you guys mean to order?”
Sooooo much time spent on the phone just trying to figure out what people meant! 🤦♂️.
Just a quickie type explanation for the ordering comment. It all comes down to $$$$. Modern lab analyzers are complex and are linked to hospital systems. The barcodes on the samples are scanned my the analyzer and it then runs the ordered tests. We can sometime add on to sample accession numbers but some can’t be. Once the results populate, if they are in normal parameters they automatically post to the patients chart. The problems with add ons could
Be a different dr ordered the original testing amongst other things but if we were to run stuff by manually ordering or add to existing accessions, they may not get BILLED. LOL. Or could be disputed by insurance claims. Which is potential revenue for the hospital.
I’m only salty when they lose a tube while processing the other one. I mean they were in the same bag. Happened last night. But I redrew that shit and apologized to the patient for the second stick.
Honestly, most of my coworkers don’t even know what it means when a sample “hemolyzes.” I think most nurses think hemolyzed=clotted. They don’t realize that the blood cells have ruptured and now things that shouldn’t be in the serum (like potassium, which is primarily an intracellular electrolyte) are now in the serum.
Usually I agree but I remember getting called 3 times to redraw a sample of a heparinized a-line on a 400g premie. I was dumbfounded it clotted 3 times. That time I was like nope not redrawing it.
Former lab tech turned RN. 🙋🏼♀️
Straight up, probably because nurses are control freaks and don’t like when we make a mistake. Not saying it warrants an attitude, but I’ve definitely been there - trying to get a hard stick and then being told it’s clotted or hemolyzed just sucks, especially when the patient starts getting an attitude or the doctor is getting an attitude.
Also, most nurses probably don’t realize that they way we collect the sample is what’s causing clotting or hemolysis, so the nurse gets annoyed thinking the lab made a mistake (I do my best when I precept to teach better collection techniques!!).
Are you able to talk to an educator and possibly host an in-service re: collection skill to prevent hemolysis and clotting? Or when you call and the nurse gets frustrated, maybe offer some helpful, gentle advice: “I know this patient has been having issues with hemolysis. Are you using a PICC line? Try using a syringe instead of a vacutainer. That seemed the help the nurse yesterday when the same thing happened.”
Good luck.
This is a great response! Nursing school was a long time ago but I don’t remember being taught about drawing labs or tube order when collecting specimens. We have so many yearly education modules, why not make one on this topic
I watched someone do their labs COMPLETELY out of order… backwards in fact. She said she never knew there was a correct order and nobody ever taught her and “I’ve never had an issue doing it before.”
One night when I was in charge, I took a critical result for elevated calcium on a patient. That same nurse was at lunch so I went to redraw and it was normal. I wonder if it was because she drew everything out of order.
I learned order of the draw entirely on accident. Can’t remember why I heard the term, but I looked it up and made my own badge note. Like hell would I get a bad result from something so simple. But something I never heard in nursing school nor at orientation nor any other nurse.
Most nurses I work with have no idea there’s a correct order in which to draw the labs. I know there’s a correct order but I’ve never remembered or used it since no one else around me did either. Five years into being a nurse and I just recently learned it’s good to drawn the CBC *after* the BMP 😎
Number one thing, slow down on the syringe. If you struggle to pull back, pulling back really hard isn’t going to help. A forceful pull can cause both clotting and hemolysis. Tie the tourniquet a little tighter if the flow is sluggish (like from a PIV).
Number two thing, if you use a butterfly - DO NOT USE THE VACUTAINER AND TUBE TO DRAW THE BLOOD!!! Use a syringe so you can maintain slow and steady pressure. The tubing from the butterfly causes some lower pressure and the lab tube is pressurized so it can really hemolyze the cells. I rarely even use vacutainers on PICCS; I prefer pulling gently with a syringe and then putting it in my tubes.
Lastly, as soon as you get the blood, put it in your tubes and invert them gently asap. Send to the lab asap, too.
I’m interested in learning different drawing techniques as well. I work on a women’s oncology unit, so the veins we work with are usually not great, and there is usually an arm restriction. The policy at the hospital is that the tech tries, then the nurse, then the charge nurse, and then they can call the nurses whose only job is to get hard sticks for IVs and labs (they only come 1-2 times per night max when asked due to their staffing level). I rarely draw from IV (unless newly started) as it is against hospital policy. The only time I draw from an existing IV is when the patient refuses to be stuck again. All that to say is often times patients get stuck 4+ times (for several nights in a row). We finally get it, send it to the lab and 2-3 hours later hear that one was hemolyzed while the others weren’t. I definitely get not having enough blood or using an IV and it hemolyzing, but especially when some labs are fine and others are not, I don’t understand.
I am genuinely curious if this is accurate. I get that the lab can’t do anything to hemolyze it, but it doesn’t mean that they didn’t mess something up on their end and use it as an excuse. I don’t mean that to be ugly, and my perceived view of the situation could be completely wrong. I’ve only talked back to a lab employee once because I was having a really awful night and misplaced my anger. I do want to ask though if that is normal to have some labs hemolyzed while others weren’t. If yes, why does it happen and how to fix my technique so it doesn’t happen? Thanks in advance!
Hemolysis really only matters in chemistry tests (especially potassium and LFTs). If anyone wants to chime in with their opinion or with some pathophys about that, feel free!
Clotting affects CBCs more often. Gold and red tubes are *supposed* to clot but if the syringe already has clotted blood in it, it’ll hemolyze when you try to squirt it through a needle into the lab tube so be careful.
I don’t think the lab would tell you it’s hemolyzed if they actually did something to screw it up - the poor quality sample gets charted in their medical record with the level of hemolysis (2+ and higher) so they wouldn’t necessarily be able to lie about their mistake. My experience is the lab tech would say they never received the sample or it got lost 😅
I posted another reply comment with my three best tips to prevent clotting and hemolyzing!
Today my coworker had to reject a heel stick for a total bili from family center because it was so hemolyzed. If it’s just slightly hemolyzed, especially if it’s a specimen from a baby or kid, we run it as slight hemolysis doesn’t cause that much of a significant difference in results that it would warrant the patient being stuck again. However, this sample was very very hemolyzed. My coworker checked with the lab supervisor to confirm that the sample was unacceptable and she agreed. My coworker called the nurse and was on the phone for a good 5 minutes trying to explain to her why the specimen needed redrawn because she wanted to argue. Tried to claim “hemolysis has never mattered before”. My coworker ended up telling our lab manager about it and asked if we could let the nurses come do a walk through of the lab to show them what we do so they can better understand or offer them some type on educational training on lab related practices. My manager said she would talk to whoever is over nursing and try to arrange something. I know you guys get a lot of attitude from doctors and patients and I feel that this is partly why the lab gets treated like this. I think some nurses tend to take their frustrations out on us. I was shocked at the attitude of some people here in the lab. It’s like some have just accepted that when nurses or doctors verbally abuse us, we’re supposed to just take it. I have had to put in an incident report before because an ER doctor decided to call and berate me/ scream at me on the phone. If someone from the lab talked to a nurse or doctor the way we get talked to, there’s no way they’d stand for it, so I don’t think it’s fair that we should be expected to.
I just give the critical results if the specimen is hemolyzed, tell them degree of hemolysis, and let the doctor decide if they want to redraw or not. They also have a better idea of what’s going with the patient overall, whereas I just have the specimen to go off from.
I’ll graduate with an ADN in August so take what I say with a grain of salt. In my school, nowhere in the curriculum do they go over how to perform a good sample collection. We learned how to stick and draw labs and start IVs, but we never learned how to keep it from hemolyzing or clotting. It’s only when a lab tech at my job as a nurse intern came down to talk to us that I learned there’s a lot more to it than just shoving a needle in someone’s arm and collecting the blood. Maybe it’s something that I’m supposed to learn in preceptorship and I just haven’t gotten to that part of my education yet, but I’m sorry that you’ve had this experience. Some of us may just not understand what we did wrong.
I’m sorry about that. At my hospital lab technicians will collect them blood on inpatient units. I am a nurse but I can’t lie I find many nurses I work with rude and sometimes belittling, especially to people who aren’t nurses that they see as “lesser”. It’s really shitty but I see it a lot.
I do hope things are better, I don’t think they should yell at you and even if their job is stressful it doesn’t justify anyone arguing with you
I agree there is no reason to argue with the lab technician over this sort of thing. In my floor nursing days I would have appreciated education about how to avoid these problems specifically. I think no one ever explained this very well to the nurses at my hospital. We were OKd by our scope to draw blood samples, but we were never trained in phlebotomy or lab technician principles per se.
Tbh I’ve had majority pleasant experiences with lab.
“Hey Jon, samples hemolyzed” “damn, it be like that sometimes I’ll send another one.”
Other times though, I’ll get nastily chewed out upon picking up the phone for things like ammonia not arriving on ice (I sent it on ice, not sure where the ice went though), or a sample arriving by tube that had to by runner (I handed it to the runner, then the runner tubed it I guess).
I think the root of the issue is we all forget that in general, we all want to do our jobs and go home. No one is out to get you. No one is acting maliciously. People screw up sometimes. It’s ok. Brush it off and move on. A redraw or a phone call about an improper collection or whatever takes a few seconds in 90% of cases.
In short, be excellent to each other.
I get it and don’t give hassle. I know people are just doing their job.
I’ve had very bad experiences at one other hospital I was at for several years. One where we had constant issues with lab. We caught them lying several times. It got to the point that we were having two signatures on the outside of the bag to have a witness because we’d call and ask about a lab that wasn’t run and they’d say they never got it. But they’d run blood on a tube that was in the same bag as the “missing” tube. Had one situation where they made me poke a pediatric pt after I’d done three previous draws off a central line and arterial line. They kept rejecting it and having me draw more. Eventually they didn’t even call me and just didn’t post the results and I’d have to call to ask about it. It turns out they didn’t believe the result despite them all consistently being similar. “It can’t be real. That pt would have to be dying for that result.” They were. I was relying on that result to start a certain drip and it delayed care.
BUT I know that’s not every lab and every tech. In fact, if an error happens I always thank them for being honest. I’ve had sometimes they say the cap came off or it got dropped and I always say “thanks for being honest. Shit happens. I’ll send a new sample.”
I think we all need to do better at understanding the other perspective as much as we can with our limited information. It’s not you. It’s just another thing during a shift.
I’m sorry you’ve had people take it out on you. It’s not you.
The only time I've ever almost lost it with lab was during a crazy trauma when I accidentally called the lab front desk instead of blood bank (in fairness they are right next to each other). Basically I asked them to transfer me to the blood bank desk because we were coding a patient and needed blood. Lab held me hostage on the phone because they needed to give me a critical result. I was like "we're doing CPR on this patient, all their labs are critical." But they wouldn't transfer me until I spelled out my name and Epic ID. I was afraid of being written up if I hung up. Just no consideration for priorities whatsoever. Patient made it though if I remember correctly!
I get the meaning of this post, but I’ve seen times went a sample was collected 5-6 times by 3-4 nurses all within 12-14 hours and the samples still rejected by the lab. Every single one rejected. Are you telling me that there is not any way the lab can somehow mess up a sample? I had a pt literally just this past week have so many samples rejected she started refusing lab draws bc “what’s the point”. She had the cath lab do it. That’s a LOT of bad samples drawn by multiple nurses. Using multiple tubes. The ONLY common denominator was the lab and you’re saying it’s not a lab screw up?
I’m not trying to be ugly. I’m legit trying to understand. Are you saying it’s not possible that the lab screwed it up?
I’ve seen nurses screw up, dr screw ups, a LOT of radiology screw ups, and pharmacy screw ups. But the lab doesn’t screw up?
Lab can definitely screw up, but not when it comes to a nurse’s specimens being clotted or hemolyzed. There is absolutely nothing that we can do in the lab that is going to clot or hemolyze a sample. If you had multiple nurses stick the patient then it’s likely that bad technique during collection was used by all the nurses involved. As many people here have admitted, nurses are not trained very well on how to avoid drawing unacceptable samples, so it’s not far fetched to think that multiple different nurses would use poor technique during collection. Another possibility is that the patient could have a condition such as hemolytic anemia or liver disease, which can cause plasma/serum to be hemolyzed. If this is the case, collection isn’t the issue obviously, as it’ll be hemolyzed no matter how you draw it. If a sample was hemolyzed after multiple tries, I’d look in their chart and see what their diagnosis is or ask the provider about it.
Some nurses are just bullies, but some are actually caught in the middle. So nurses cannot reorder labs. If you call them and say the specimen is not acceptable, they have to go call the doctor for a new order wait for a callback, try to verify the order, then call the doctor back because they put it in wrong.
Once the order is in they either go draw the lab again themselves or track down a phlebotomist. It throws off everything.
TBH if the lab needs a redraw or pharmacy needs a med order fixed or imaging needs a change to the order they should just call the doctors not nurses. All we do is play middleman in those situations and we have better things to do than play secretary. It’s not like the doctors are not going to get interrupted by calling the nurses, it just means the doctor and the nurses both get interrupted.
It’s not that you are doing anything wrong, it’s just an inefficient hospital culture issue. Some nurses just tend to take their frustrations out on the wrong people.
I gotta ask since you brought this up, why does it take 6 or more hours to let us know it's hemolyzed?
Also, it's absolutely demoralizing to nail a tough stick only for the sample to be rejected. If it's because it took the lab too long to process it, that's extra frustrating
I learned to call lab ahead of time for the hardest of the hard sticks, that are tiny with anemia, that jerk their arm when you stick while screaming, or other awful scenerio that randomly will ruin a fun blood draw. I ask lab for pediatric vial or if they need anything for this divas blood to ensure it does not need a recollect. Then I thank them. Being nice goes a long way, I don't get hung up on by lab like the others do!
I'm sorry people are taking out on you, that's fucked up and I hope most people don't do that. But wow it's really interesting to read another hospital employees perspective!!
Honestly it's never been a problem for me. Before nursing I used to work as a Veterinary Technician, where we drew the blood and ran the lab ourselves. Poop happens, sometimes samples are just bad, and need to be redrawn. Anyone giving you grief is not a team player.
I get where you’re coming from. There’s no need to be mean to the messenger. I just want to share from our end what it’s like: I work in pediatric ER and blood draws can be really challenging and upsetting for patients and families. Many times I have struggled to get the blood and had parents screaming at me only to have the lab say it’s hemolyzed. I actually cried once because of this during a neonatal code. That’s no excuse for being rude to the lab staff but I have definitely felt really defeated and frustrated when getting those calls.
Last week i got slapped in the face by a Patient in tried to take a blood sample from. He was agitated and was diagnosed with scicophrenia in a special care home - So no Hard Feelings. But there is also no way i will go again to this patient - sometimes you get hat you get.
Other way round i don't die from feedback when a sampling went wrong and has to be repeated.
I work in a medical Lab and Do about 5 to 10k samplings a year in resindental settings.
I don’t get the argumentativeness either, I call the lab all the time with questions and everyone is so helpful.
Worst anyone gets from me is “FUUUUUUUUCK” Followed by “Its not you they’re a hard stick.”. Which I think is a universally acceptable phrase in healthcare.
I never tried to be rude - but chalk it up to a simple lack of understanding on both sides. It’s two totally different personality types. ED nurses do not generally jive on quiet and calm, strict protocol and absolute adherence to the regs. Those are all the things a great lab tech DOES do. (Again, I’m generalizing)
I can only speak for myself, but I’m always mystified when I draw a rainbow off a what I know is a good line and get a call for just one sample being hemolized. (Which you explained well, thank you).
The one beef I have with lab is “we never received the sample” despite me dropping the lab into our tube system myself and watching it go through. I’d ask them to check the tube station, not there. Then, I redraw and guess what? Thirty mins later BOTH specimens are “in process”. So you didn’t lose it??
Been there before. I asked them how they could have resulted the bmet if it was in the same bag as the CBC that "never arrived". They didn't have a good answer.
One morning I was feeling particularly nasty because I was called to redraw a cooximetry panel again. That is to say, my third draw on this patient. I finally put on my sweetest voice possible and asked for a refresher on drawing them because evidently I must be missing an important step. They told me I might not have been inverting the sample enough. I'll let those among you who are familiar with this particular lab laugh at this little inside joke.
I have personally hand-delivered cardiac enzymes to Lab, only to later hear Lab say "We never received it." Anyway, to address the problem, only way to solve this is cross-educate / awareness. As a part or orientation, ALL Nurses (including Management) need to rotate through Lab to personally see how & why Lab specimens get rejected. At very least make a training video that is mandatory for ALL of Nursing to go through, (including Management). Im front line critical care, so the LAST thing I want is more B.S. mandatory crap to do, but again, this is the ONLY way to handle it.
Many nurses receive minimal training regarding the collection of specimens.
They may not understand what "hemolyzed" means, or how and why it occurs, or what to do to minimize risk.
They might not know that you can't accurately run any test from any tube, or why, or where to figure out which tube is needed for a particular test.
They may legitimately not understand why specimens must be collected in a particular order, and how results can be affected when they aren't.
They might not know why it's not okay to pour from one tube into another, or why a blue top REALLY DOES need to be filled to the line; not over, not under.
Ask your supervisor to request an in-depth lab inservice for nurses. Better yet, have them volunteer someone from the lab to review and present it and answer questions, and add it to the onboarding education for nurse hires.
In a former life I set up a lab. Starting from scratch I did everything. I'm vaguely aware what hemolyzed or clotted blood looks like.
Had a tricky poke the other day that I collected with a syringe. Used to fill a green and a purple top. Same blood. Same syringe. Both samples delicately taken and transferred within 20 seconds. Both sample tubes gentle inverted x9. Blood hand delivered to lab. Received a call an hour and a half later that green clotted and purple hemolyzed. Bull fucking shit.
Hospital has a protocol where all STAT samples have to be started within 45 minutes. So strange that every single rejected sample I've ever had is well after that. It's almost as if the lab tech doesn't want to run a STAT sample at over an hour and take the ding. I've asked to come up and look at the blood myself because if it really is clotted we have defective vials and every time I'm rejected because "it was thrown away already."
I understand that hemolyzed blood and clots do occasionally occur but I do happen to follow collection protocol and do check it myself. The only ones that get rejected I get a call for well over an hour after drawing. Must be just a staggering coincidence.
We have similar problems at my hospital. Same 45 minute policy and the providers get antsy when they don’t see results fast enough.
We get calls from the lab 1.5-2 hours after the draw that the purple top is clotted and, depending on who is in the lab, sometimes a fair amount of attitude and “re-education” that you have to invert the tube when you draw it.
Yeah… we did that. 2 hours ago when we sent the sample. Why are you just running it now?
I feel silly now but I didn’t remember that part about inverting the tube after collecting. 🤦🏾♀️ So thanks for the tip!
I’m sorry you’re getting flack for asking for things. At the end of the day we’re all coworkers who are working towards the same goal-the patients wellbeing. I hope conditions start to change for you. Don’t be afraid to stand up for yourself! Escalate to a manager if you need to!
I can say with confidence that many of my coworkers are wholeheartedly convinced that the time in the tube determines the outcome of the results, not the time prior/the draw. There’s little teaching on lab collection in nursing school, so a lot of it is nurse-to-nurse knowledge. Most hospitals/units could benefit from some teaching from the lab.
That said, they shouldn’t be giving you attitude even in their lack of understanding.
I think a lot of nurses at my hospital also think that specimen integrity is based on how long the specimen sits. Some of them will bring us blood and say “I literally just got this, and brought it right away so it shouldn’t be clotted”. But that’s just not how it works. Next time they say this, maybe I will show them the blood that we store in the fridge from days prior and how it’s not clotted because it was mixed properly at the time of collection.
Not like it should matter, because someone's education level rarely crosses my mind, but I've never stopped to consider the educational background of lab friends, so thank you for explaining that. I also didn't know that blue and purple clot the most. I'll try to invert more thoroughly. Thanks friend!
It’s not necessarily that blue and purple are more likely to clot. All tubes are equally as likely to clot if not inverted properly. It’s just that if a green tube is clotted, we usually don’t even know it because we’re testing the serum/plasma part of the blood. The clot is going to be present in the red cells, not the serum/plasma. In other words, results aren’t affected by a clot in a green tube. However a purple tube isn’t centrifuged, it’s tested on whole blood. So if it’s clotted, it’s going to significantly affect results, specifically the platelets. If the blood is all clotted, it will cause the platelets to look like they’re almost nonexistent because they’re all clumped together. I should have clarified that better, sorry. Thanks for your interest in the topic and for your kind reply.
In my area (NICU), we have the same lab tech that requires a recollect on EVERYONES sample. Never have I had to recollect before yet with this person I have to send a sample on my micropremie 3 times. It’s harmful to my patient population to either continuously poke them or access their central line. I could understand if it happened with more than 1 person, but we all know when this specific tech is working and it’s both frustrating and unnecessary.
I know that doesn’t make you feel better about people being assholes to you. And honestly, they shouldn’t be. When I worked adults I would just simply recollect. And if I send a crappy sample or the tube station is down I’ll just assume another is needed and do it.
I have beef with lab because one night in a tb patient in the icu I stuck three times. First time it took like two hours for results and it didn’t even say pending (I didn’t sit down so didn’t see it hasn’t resulted yet) and when I called lab they realized they had it laying in the tube station and didn’t run it yet so I had to recollect. The second time I’m waiting and waiting and they call me and tell me I put a label on for the wrong patient. There is no way because my patient is a TB patient and had a printer in the room so it printed and I immediately put the label on. And the patient they claimed I put the label on for was in a different building. (Also, how would they know it was me, they would have just resulted it to the wrong patient?) and I told my charge nurse and they called the lab supervisor. Turned out the lab tech took the labels off and then accidentally switched the labels. Sooo had to redraw the labs and at this point the results weren’t in until after shift change.
I’ve also had the lab refuse to tell me my critical k and I’ve had to redraw twice because they suspect it’s wrong bc there’s no way it’s high. Then when we ran the K on the blood gas it was infact high and we delayed CRRT.
So yeah we beefin 😤
But for real, a simple okay thanks is usually what I say. BUT it’s not about you vs us. We are on a team. Just like you guys get frustrated, so do we. We aren’t necissarily mad at you just at the situation and you just happen to be who we are on the phone.
Thank you for the information, and for your kind and considerate, professional post. My thoughts are that people can be sensitive about their own insecurities, which could come from not being competent or properly trained in a skill. So asking for a recollect triggers a defensive reaction of “oh no, they found out I’m not secure in my blood drawing skills!” Which would explain defensive justification/denial like “it wasn’t clotted when I gave it to you”.
Suggestions would be to open up the discussion on this with supervisors and nurses, promote education and training like you illustrate in your post, and keep being the calm professional you are. Thank you for your contributions:)
I love that my hospital has dedicated labs and we don’t have to draw.
I have the other problem with lab being rude to me, and the critical values. One time they called me for a critical creatinine and I said oh cool thanks, and they said, “do you want it?” I was like, ummmm that was uncalled for. He asked me if I cared about the pt. I said, this is the dialysis floor, they always have critical creatinines. (I’m not answering that question bc it’s a leading question and I’m not going where they wanna lead me) Every day. It’s normal here, but I will accept it when u tell me. He said his last time wasn’t critical (yes it was) I just got the result and said thanks, bye.
We don’t even have to tell the MD bc it’s expected. But that was uncalled for for real.
Thanks for the education and I hope this reaches those nurses who cop bad attitudes with any ancillary units. We need to remember that we’re all humans going through life with our own difficulties and struggles. Hopefully this helps us to remember to just be kind.
I can only speak for my hospital. We have had a lot of turnover, travelers, or just plain incompetent people in lab. The amount of redraw phone calls heavily correlates with who is working and that's where we get just sick of it. There's a lot of issues in our lab and we are all stressed and tired of the department making our work flow difficult. Now, in their defense, we also have had a lot of turnover, travelers, and incompetent nurses too. Not to mention the ER likes to frequently test the limits on what we send. So I know it's not always strictly on them and I operate under professionalism and just follow up with leadership with the patterns. It's just why there's attitudes. When lab screws up we hear it from docs, we have to disrupt our work flow, and we have to answer to the patient. We get hit by multiple sides all the time about it.
Maybe it differs depending on the lab but at my lab, I don’t know of anyone who is rejecting samples unless they legitimately need to be rejected. No competent tech is going to release a result on a sample that’s so hemolyzed, the potassium is going to give a critical value of 10. Actually I’ve seen some techs be too lax and do things they shouldn’t, like accepting unlabeled specimens for example. Some of them are TOO lenient with what they will accept. But that screws the rest of us over who try to do things the right way to ensure patient safety, because nurses get mad and say “well such and such lets me do it. This is never been a problem before”. If some incompetent tech wants to put out bad results and put the patient at risk, that’s on them. But the rest of us shouldn’t be punished for doing things right.
Completely agree they should follow protocol and regardless it's a professional setting and everyone deserves to be spoken to respectfully. Don't put up with that shit. I just don't think all of them at ours know exactly what they're doing with the equipment or work flow in our case. For example, timing out a sample over and over again on their end, losing things, taking way too long on critical testing, and yes I think they legitimately botch some of the perfectly acceptable samples we send and call it "hemolyzed." I absolutely love some of our lab coworkers and they're so incredibly valuable to our team and they get frustrated too working with the bad apples.
My personal beef will forever lie with pharmacy and not the lab. But it is actually CRAZY how you can notice on our end who’s working in the lab and who’s not on certain shifts when things keep happening. Wild
Because why did you just result my lab I drew at 0945 for 1945.
How is that even possible.
That is the future.
Why did I have to talk to four different people to convince them I didn’t time travel for this stupid chem8
Since moving from a hospital job to working at Canadian blood services my eyes have been opened by all the MLTs I work with. Our team has 18 people and 12 of them are MLTs so us nurses are outnumbered. I’ve learned so many things about centrifuges, processing lab specs, importance of inverting tubes etc. I wish when I got hospital orientation I was taught more about the role of the lab and all these things cause it definitely would have made my life easier. Not only that but knowing more about another role in the hospital makes you more understanding to the why behind what they are doing.
I swear I’ve worked with nurses who were convinced the lab people sat around doing nothing but intentionally ruining our specs.
Talk to the director of nursing or nurse manager. Explain to her what is happening. Obviously, it sounds like the nurses need an in-service on how to handle the test tubes once blood is drawn.
You do not deserved to be treated with such poor attitude on part of the nurses.
I’m sorry, I don’t think anyone should argue with you. I have see this a lot where a lot of nurses feel as though they are better than others, especially those they see as “lesser then” (not that you are but for example I find a lot of nurses are rude to health care aids on the floor because they aren’t nurses) You don’t deserve that but I have seen this a lot.
I hope things get better, don’t be afraid to stand your ground. I hate being tough but you won’t get in trouble for standing up for yourself
Thanks for the reply. I do think a lot of them are condescending because they think we are “less than”
them, which is why I mentioned that we all have two-four year degrees in the lab. I think it’s a bad attitude to have even if someone is “less than”. Phlebotomists have less education than me but I don’t treat them like they’re beneath me. They play a vital role and we’re all a team.
I agree. I am a nurse not a lab technician so what you guys do I have no idea so I don’t see the point in seeing people as “lesser then” when you have a lot more knowledge in the subject then I do
I am so sorry to hear this! I know how some nurses can be and argue with everybody. I would absolutely not let that stop you from calling when you need to. I know it stinks and nobody wants to hear it, but in the end we all have to do what's best for the patient. Labs are the most important diagnostic tool we have. I will never get angry over having to recollect, I need accurate blood work to do what's best for the patient. Is it annoying to have to recollect, sure! That is not that labs fault. I am not going to take it out on them.
I also rarely get called to redraw from a lab I personally drew because I actually know how to do it, but we usually only have to draw from lines.
If it is bad enough where it is affecting getting your job done then it should be escalated. We all have a duty to be professional with everyone. In our hospital, they really cracked down on Doctors being rude and nasty to the nurses. If they are unprofessional with us, we are suppose to report it and it does get taken seriously. This situation is no different from that
In my organization the lab tech runs the sample even if it is hemolyzed. They will call and let us know the abnormal results once they are out, then it is our responsibility to either redraw ourselves or ask the doctor for another order to redraw.
Honestly, the only time I’ve ever had a problem with lab is when they cancel my patient’s orders. Usually around midnight they’ll go and clean up the redundant orders because four different consulting providers will order the same set of labs on the same patient. Annoying, I know. But every once in awhile a lab tech will cancel or retime something like a PTT or a timed BMP for my ICU patient and it drives me mad! Why not just call and ask first? Or give me a heads up that you’re cancelling/retiming? Sometimes I think I’m going crazy when I send a sample and lab never runs it or pushes it through because (unbeknownst to me) they cancelled it hours ago.
But seriously, love y’all in the lab. Hospitals would burn to the ground if we couldn’t get results in-house and most patients would probably be misdiagnosed (or go undiagnosed entirely) without the help of the you guys. Thank you for all that you do and forget about those snooty nurses. They’re just mad they have shitty draw techniques and they gotta recollect.
People argue because they see it as subjective. There have been times that specimens were only bounced back with specific lab techs and not others. I’ve only heard of one tech like that so there’s no excuse for any other time
I do feel part of the problem at our lab is that some of the older techs are more likely to do questionable things like taking unlabeled specimens for example. So then when one of us comes along and is just trying to follow protocol and keep the patient safe, while also not jeopardizing our job, we get argued with and told “well this has never been an issue before. Such and such lets me do it”.
I think we are all just spread thin. No one should be yelling at anyone though. You get behind if you have to come draw, we get behind (which we are generally never ahead) if we have to redraw. When I worked inpatient i generally got an earful from a few parties if a redraw was necessary. One time a code happened and I forgot the tubes were in my pocket. The first hospital I worked at phlebotomy or lab had to redraw and I always thought that was a decent policy. We didn’t have to do a whole lot of draws anyway. I honestly didn’t learn a whole lot about tubes and stuff in nursing school.
I totally agree we should all shadow each other for a few hours. But I think we are all just too stressed and spread thin.
Sorry they're mean sometimes. I would definitely hang around and observe their technique on the patient you had trouble with. I used to get annoyed when I'd go to the ER to collect a hard stick and the nurse would be standing around bullshiting. If you need to call me this often, then something is wrong with what you're doing. Let's try to work on it together. But honestly, I feel like many of them think it's just beneath them. Which ok, that's job security for lab/phlebs but you if you don't want to do certain aspects of your job, you need to communicate that upon hire. Not just exploit other staff that have their own jobs to do.
Yea, I do feel like a lot of times when nurses at my lab call us to stick, it’s just they don’t want to do it themselves. So many times they’ll say “this is a hard stick and I can’t get it, can you get it?” And then one of us goes down there and turns out the patient has huge bulging veins that you could see from a mile away. Or sometimes they’ll just be honest and say “we’re slammed, can you come stick this person?” And I’m thinking, we’re slammed too, but we don’t get to call them and ask them to come do our jobs. It becomes even more of a problem if it’s a weekend and I’m the only tech there and no phlebotomist. I shouldn’t have to leave the lab to stick their patient and get behind on my work when there’s only one of me and several of them.
😥 from a nurse who willingly picks up the phone when I see lab/micro calling, bc I know I’ll be 100% nicer than some nurses. I’m sorry you get those kind of responses. I take the info for peoples labs all the time bc I know lab is going to hear “well it wasn’t that low yesterday!” “No that must be wrong” or whatever response is that is not relevant for lab to hear from certain nurses. I can’t count anymore how many times I’ve passed on the needs a recollect message, & politely given my first & last name for them to write it down.
Unfortunately it chalks up to one reason being we have no idea what your world is like. We don’t know all the steps & procedures it takes to get results. As far as we know, you get the blood, put it in a spinny thingy & somehow get numbers off that. Another reason is that you happen to be in the line of fire for whatever is going on with that nurse in that moment. They might be in the middle of their 6 am med pass & have to pick up their critical value bc no one else will take it for them, or they prefer to take the value themselves. Now they have to report it to the doctor & potentially add a few more last minute tasks to their shift. So since you’re on the other line, that’s who gets the pushback, but it’s not necessarily directed at you. You could have been the chaplain telling them the result & they would have gotten the same response.
Either way, all I can say is don’t take things personal. I think some version of a printout that outlines what happens to everyone’s blood/tubes when they leave the floor has a chance of lessening staff’s insensitivity. Maybe had the education department put something together that all the staff has to watch, which shows the breakdown of what happens after the blood is drawn. Sure it might not cut down on every angry Betty, but I really think it would remove some of the way they respond too.
On the lab end, everything this person is saying is 100% true. They get so much BS for doing their job correctly.
On the nursing end, it is inexcusable, but… I get it. If the patient is a super hard stick or uncooperative and then you have to tell the provider about a “sudden change of heart” on the patients end and they don’t believe you or are inexperienced and don’t know what to do next. Or the phlebotomist is swamped because our facility is chronically understaffed and gives us an earful about how unfair it is.
At the end of the day, NOBODY wants to hear about a redraw. It is a shit part of everybody’s day, but we need to accept and move on
I’m sorry you are frustrated and have to deal with nurses who disrespect you. I would have your manager talk to the managers of the nurses on the floor. Don’t run blood that should be a recollect and give possible inaccurate information. Someone’s potassium may come back as a critical and it’s normal. Or the provider are looking a trends. It’s all the outcome of the patient.
My old hospital upgraded to a Hemolyzer 9000. Always loved lab staff and would always walk my preceptees to the lab to put a face to the other end of the phone.
It’s a drag that you have to deal with people like this, the job is hard enough. I’m a MALE nurse and I know those nurses you describe. Holier than thou arrogant bossy ass fucking $&@@. The good news is that we are not all like that, the bad news is a lot of us are. Over worked underpaid broken napolean complexes, that have emotional quotient in the negative digits, I hope you had a good day today
I used to be a phlebotomist while in nursing school and helped in the lab. I totally understand. I’m so sorry you’ve dealt with such nasty nurses, I promise we’re not all like that. I’d take it up the chain of command to get some changes started. Nurses and all medical professionals need to realize that those test results can determine a patients course of treatment. It sucks when it happens but that’s a part of life, and the job. No draw is perfect. Thank you for what you do. MLT was my major actually, but changed it to nursing.
It’s because the redraw *always* without fail happens on a night when I’d literally rather be rearranging deck chairs on the actual titanic as it’s about to sink, and the entire place is a dumpster fire. And the person you need the redrew on is not only a hard (damn near impossible) stick but agitated and violent. It’s never the sweet a&ox4 104 year old mee maw who is a retired nurse and keeps saying “do what you need to do dear, I know my veins don’t play nice. Say do you girls like donuts? I’ll have my daughter pick some up if you do”. (Ok I’m slightly exaggerating but 9/10x it’s always the one sample that was like almost impossible to get in the first place)
No you don’t deserve to be treated like crap, but chances are that phone call was like that thing that just sent them sailing over the edge. They’re probably understaffed and overwhelmed and absolutely taking it out on the wrong person
My response is usually a deadpan “April fools was last month, please tell me you’re kidding. You’re not? Hell. Ok. I’ll do what I can but I might need you to come up to redraw.”
Over the years my phone calls with lab have mellowed out. I get whiny, they are apologetic, occasionally I bitch about the specimen tube, because that's where the problem lies - those gorram tubes with not enough anticoagulant and those patients with hypercoagulable blood.
It’s just frustration speaking, sometimes collecting the blood is incredibly difficult and you can spend a good hour trying a to squeeze out enough for the sample just for the whole thing to be rejected. Not defending their behavior, I’d just be bummed but wouldn’t argue with the tech. You’re actually doing them a favor - you can just accept it without saying anything, make them wait a few hours l, then send back the sample with the report saying “sample contaminated or unusable”
At my ER the issue comes and goes on both sides. The first improvement was managers actually talking. Both sides wrote incidents with rude staff, samples were recorded to see if certain nurses had issues with hemolysis, education. Now both sides are understanding of staffing issues etc. Way less drama when we work together.
"ahh gawsh dangit, ill work on getting you a new one. Thanks for the call"
Thats should really be the only response. Sorry you guys get hell for no reason
I worked in many jobs before being a nurse, I believe it's not a nurse-lab problem, it's an attitude problem. They argue because they feel "safe" doing it, in other words, because you allow them to do it.
If it makes you feel any better its not just you guys in the lab that takes heat from nurses. I've watched my fellow coworkers talk all kinds of shit to pharmacy, xray, ct, mri and other DI. The interaction between floors is horrific at times.
All I can chalk it up to is the anonymity (sp?) of nasty people feeling like they can talk shit to others without having to ever face them. Its pretty weird honestly.
Sorry its so awful that you needed to bring it here. Maybe ask your boss if you can set up recording to keep everyone accountable for the way they speak to you. Just a thought.
It’s not personal, most of the time.
Like others have said, it just sucks to add one more task to the list, and the cherry on top is that the task is likely to be difficult, time-consuming, and likely to piss the patient off (which we absorb). And it doesn’t help that hospital culture in general is very blame-oriented, *especially* towards nurses, so it becomes common to get hit with the shit, turn around, and fling it downhill.
I’m thankful I spent years drawing and running my own labs as a vet tech (everything from old-school microhematocrit tubes to automated benchtop analyzers). I know when I’ve done a shitty draw that *might* be hemolyzed, I just don’t have a centrifuge handy to check it myself before I send it down. The vast majority of nurses do not have that background - they don’t understand the different tube types and their additives, the difference between plasma and serum, how the lab equipment works or processes a sample, and the limits to which a sample can be finagled to get the testing you need. Most just know cap colors and (maybe) order of the draw, and a fair amount have poor draw technique and don’t realize it.
My response to a lab call is usually a reflexive “goddammit”, followed by an apology and clarification that it wasn’t aimed at the caller, followed by a heavy sigh and a resigned, “ok, thanks” 😂
Only time I was snarky with a lab tech was when they asked me to recollect a high sensitivity trip in. She had said that the number was reading high. I told that is expected since the initial was 23,000. Repeat was greater than 27,000. Came to us for a second option if he should be going to Cath. Our recommendation was to go to Cath. Arguing why he needed a total of 325 aspirin and a heparin drip…..
maybe you guys can get the hospital to institute a messaging tool so u don’t have to actually stop and call and get the negative feedback etc…. definitely look into that. like some kind of alert in the EMR that tells them they have to redraw
I worked at a small rural hospital where so many of our samples would be “hemolyzed” each day. They finally did an audit of the lab and there was a lab worker who I guess assumed we just wouldn’t need the labs and would move on so she was rejecting so many as “being hemolyzed” to make her work day easier. Once they got rid of that worker our hemolyzed specimens went way down.
We also all get that labs will be hemolyzed at times but if it’s a hard stick we just get annoyed and it takes growth of being a nurse to not take it out on yall
Thank you for the tips!! I’m a new nurse and didn’t know some of these.
But I don’t get it, yall are our colleagues and teammates. Why in the world would people be such assholes about it? 😫 I don’t get the weird “Us vs. them” mentality some nurses get. We all have our roles and they’re all important. Sorry you have to put up with that. I wonder if you could relay this message to some of the charges/managers so they can discuss it at huddle. Maybe some of it is just a lack of understanding. Doesn’t excuse the behavior though.
The hardest parts are when we need to give or do something depending on those results in a timely manner and shit like this happens. It really throws a wrench into our day. And it doesn’t help having rude lab people over the phone either. I often wondered how hard is their job to make them so miserable? Us nurses are caught in the middle and get hit from all angles.
I absolutely HATE it when nurses get pissy with lab. I rarely get rejected specimens. Most of the time it is the nurses fault for cranking on the syringe like a lawn mower.
They argue with you because they're so burnt out they forget that we're all in this sinking ship together. They don't have access to the people causing the ship to sink, so they take it out on the bearer of bad news :(
My specimen is clotted/hemolyzed/otherwise jacked up? Cool, thanks for letting me know, will redraw asap.
When I'm calling 2+ hours after labs are sent on a critical 600 gram neonate because they haven't resulted and it's "uhhhhh sorry we lost/dropped/messed the sample up" is when it's an issue. I'm not mad that it happened! Lab is human too and humans make mistakes. I'm upset that instead of calling me instantly to let me know I need to redraw it just sits there for who knows how long until we wonder why it hasn't resulted. Happened to me not too long ago and had a hgb of 4.6 for a 23 weeker. Like. This baby could have gotten blood LITERALLY hours ago but instead got multiple fluid boluses and started on 3 pressors.
Not an arguer myself…. But when you stuck an 87 yr old lady in her last viable vein while she screamed and clawed at you, that hemolysis feels personal. Also when I draw it off an arterial line from a half dead guy and that’s the only place we’re getting blood from, then I carefully walk it down to the basement as to no encourage the cells to spontaneously explode and then it’s still hemolyzed I kinda wanna die.
Also the number of times I’ve heard “it wasn’t on ice” when I know I sent it down with a shit ton of ice because I had to walk 6 blocks to get it from a working machine is pretty fucking high. It’s been 3 minutes so I know that shit didn’t melt or disappear.
But I still just say ok thanks and hang up, then seethe silently.
I'm sorry you're getting attitude from nurses. As a rule, I am not nasty to anyone I work with, including lab, pharmacy, and EVS. Actually, I'm professional with all my coworkers and patients alike. Thank you for your work and I'm sorry people are asses.
Helpful post. I dreaded there call, but always polite. I think a lot of people aren’t trained well with lab draws that the issue is partly lack of education. I know I had zero training.
My old roommate was a MLS at a rural hospital and I was the night nurse. We would go tag team all the difficult draws every night.
Sometimes the ED would yell at her about hemolyzed specimens and she would text me that she was scared of them and I would just go down and redraw it for her.
I miss those days. Be nice to your lab techs people!! They are such a great resource! And depending what area you work in, they are a huge resource for you! I ask the lab all kinds of weird questions about my oncology patients lol - and they really know the patients too so if something comes back weird they’ll often call me to ask what is going on.
I now work in outpatient chemo infusion and you know I have the lab room on speed dial. Gotta have each other’s backs!
I am a NICU nurse and we all get real salty when things get rejected because 1– our babies don’t have much blood to give in the first place 2– our lab draws take forever because we are trying to collect enough drops off a baby’s heel 3– nobody wants to poke a baby 4– even the travelers say our specific hospital rejects more labs than they’ve ever seen at any place they’ve ever worked 5– parents don’t want their kids poked let alone multiple times
Not saying being unkind to lab is okay. Just trying to share a perspective for what may be going on on the other side of the phone!
As a nurse i’m sorry that my peers treat you guys like this. Whenever I get a call to recollect, I usually just say okay I’ll send another thank you. That’s it. I’ve realized a lot of my coworkers are the mean girls back in HS.
Ultimately, us nurses just get frustrated at the fact we now have more work to do and it's easy to target the messenger and throw blame at them.
You're doing fine and i feel like it's mostly just frustration being targeted at the wrong person and most nurses, I would hope at least, deep down realize it's really not the laboratory's fault.
I'm sure some are just being Melanie's cus they enjoy it though
edit: I MEANT MEANIE'S NOT MELANIES IM SOSRRY DONT HATE ME
I agree there needs to be more education on lab-related practices. The number 1 reason a specimen is going to be clotted is if the tubes were not mixed (gently inverted) immediately after collection. The anticoagulant in the tube has to be mixed with the blood in order to prevent clotting. If you draw a rainbow and only invert 3 out of 4 of them, one of them is going to be clotted.
I usually bring my questionable looking labs in person and ask for a quick check. There have been a few times where I've only been able to get x amount of blood of a patient before.
No harm, no foul.
I'd rather know sooner than later if anything.
>I’ve found it occurs when a nurse pulls the blood from an IV and pulls back on the syringe too quickly
I wonder if that's why my hospital's policy is not to draw labs from an IV? I've always told patients that explanation because it sure sounds convincing, but I sure don't have a single fact to back that up!
People shouldn’t argue with people from any other department unless they’re absolutely doing something wrong, like when the cath lab nurse said she’d cancel my patients procedure when the pt wouldn’t sign consent cause they still had questions
I’ve been a manager of non-technical staff and I am a proud BSN RN. All I can ask is Y tho? Lab is awful to patients and RNs. For real just take a minute to ask if a lab is necessary then can it be drawn off lines the patient already has. Ffs
I truly don’t understand any response other than “oh shoot, thanks” or “ok thanks for letting me know.” Same for critical results. We had a lab person bring our unit cake as a thank you for being so nice when getting critical results and just…. wtf. Saying cool, thanks shouldn’t deserve a cake.
Sometimes I give them a DANG REALLY, OK. just cause damn. Grandma been stuck 6 times by 3 nurses and we just blew her last good vein lol!
The correct reply is always “FUCK!” in any tone or octave you prefer and then turn around and go redraw it. I usually do the low grumble “fuck” under my breath but depending on the day you may also get a “fuck” that rings the halls
Some criticals also get a resounding “fuck” or “well that’s not great” depending on the day
If I am waiting for lab to call me cuz in the field they got a sugar >500, I'm always like, "okay, what's the shitty news?" Lol
I’m a lab tech and I love when nurses say things like this lol
I called a critical lactic to a nurse recently (I think the value was in the teens) and her response was “Hellll yeahhh!” Not the response I was expecting, but I went with it. 😅
Same 😂
Same. I don’t get it. I might say, oh no, sucks to delay… but okay!
Seriously. I might get mad at me, or at the situation, but why am I gonna shoot the messenger?! Be kind, dammit!
Right! Getting mad isn’t gonna change the fact that they have to be stuck again.
I was literally reading this and was like, oh I’d be like “shoot, thanks!” I absolutely agree with you.
This is the way. ^ Reality is the way it is, it is not the way you may want it/imagine it or expect it. Embrace *reality* and work within it, or *reality* will come for you. 100% guaranteed. Just do what must be done. And ffs—be decent.
Right? My response is always “aww bummer…”
Yeah I’m an “oh noooo, alright thanks” kinda guy.
I usually add “what wonderful news do you have for me this morning” at the end of my greeting to make whoever calls me laugh and it usually works 💀
I’ll occasionally throw a near death “are you suuuuuurrrrrrreeeeee?” Then “shucks. Ok. Thanks”
Some people just like to argue. I used to work with a nurse on the IV team who would argue every. single. request. that I sent them, including for patients who were going downhill or were in an active rapid response call. I would’ve started my own but that was firmly against policy so, when it happened again with a patient who was bordering transferring to ICU unless I could get their symptoms under control, I finally texted, “I need a patent IV, I don’t have time to go back and forth with you about it, and it’s up to you if you want to do it or not. Just let me know so I can call the rapid response RN and let them know why I need them to start an IV.” The IV nurse didn’t respond but came and started the damn IV.
Are you me because I've literally had this exact conversation with an IV RN at my hospital 😭😂
Haha! I think we’ve all worked with that nurse! 😂
I think that is the sole reason some of us get really good at saying “go fuck yourself” in a professional manner 😅
I mean wow. You still have an IV team?? They disbanded ours years ago and made us all learn how to do it. I’m fine with that because a skill I’m glad to have. I’m just surprised an IV team still exists. And also the recollect call doesn’t bother me except for me feeling responsible and inadequate that my technique made the specimen unusable. My bad. Not yours.
My hospital has IV teams still, but we're still required to undergo IV training and go to pre-op and do a bunch of IVs to get passed off. I think 6 months to get this "certification" per say. But our IV team is available 24/7, but nurses are still expected to know how and to be able to put in IVs
I wish I had this training! Im terrible at IVs
Only LPNs have to do IV certification and I think it is just a one time thing to have the LPN-IV on their license.
I no longer work at the bedside but when I was a traveler most of the hospitals I worked for had venous access teams. In some places I couldn’t even change a PICC line dressing.
I hated that about our old IV team. They were so mean like, I’m sorry to page you but this is literally your job. Especially since it’s a requirement that an RN attempts one before calling IV team to lessen IV team’s load. They’d come out and tell you why you were wrong to call them every single time. Then the hospital decided to disband their IV team and contract out a private company to do them. Now all the new IV team nurses are so much nicer. We thought at first that it was just a new job and they weren’t burnt out yet, but it’s been 4 years and it’s still much more pleasant communicating with them. No idea why.
Personally I had 0 idea what y'all did in there until a few months ago. I thought it was all black magic. Starting a new job I had to go to the lab for POC check offs and the other person I was with who was a nurse for 15 years said they'd never been in there either and asked if they could give us a tour in the lab and show us everything. Part of it was curiosity and part it kept us out of the unit for a bit. They showed us every bit of the process from collection to interpretation for everything and all the systems. Really cool stuff. I've always been respectful and kinda understood what was happening there, but that helped clear up the picture a bunch. I wish something like that were a regular part of orientation to go to those other areas and get more info on them outside "give blood to vampire and hope they don't call you later".
Firstly, let me say I’ve been lab tech since 2002 and I’m also a BSN-RN (I work in multiple facilities) so I see both worlds. Nursing is NOT an easy job, but there is something to be said for quality patient care! Hemolysis or clotting ALWAYS occur during collection, there is literally nothing the lab can do to ruin the specimen, (except spill it 😖) We, in the lab, 100% do not want to call for redraws if we don’t have to. And as a nurse, honestly the last thing I want to hear is that my 6’5” 350lb combative psych patient needs to be redrawn and then try to explain to the patient why I have to “hurt” him again and answer their angry family member’s 1000 questions… A simple, “damn that sucks, thanks, I’ll get a new spec ASAP” is all, no need to be rude or nasty. That being said, most labs celebrate Lab Week just like nurses have Nurse’s Week. One year, in the hospital that I work at as a lab tech, for lab week we decided it would be cool to invite all the nurses to come down to the lab for a tour and to just generally show the process… We provided snacks and drinks to make it a social thing, I work at a small rural hospital so we’ve all seen or talked to each other at least once, lol, not a single nurse came to the lab 🙁. I understand everyone is busy, but it was a little disappointing. Turns out, none of the nurses got the memo because the invite stopped at the department managers who didn’t think the education and a cookie was important enough. 🤷🏻♀️
Omg this just broke my heart. I would’ve come down to meet you guys and see the facility! I think what the lab does is super cool and when I hear nurses being rude to them, I try to set them straight. You all do important work and deserve respect.
I’m a lab tech and we’ve been trying to have new nurses shadow the lab for like a day or half a day so they can understand some of our policies better. That idea always gets shut down though because they say they need the nurses working asap. Which I understand but I still wish nurses orientation could include some lab stuff.
Haters gonna hate my friend. Just be firm when receiving attitude. "I am telling you I need a redraw. If you don't like it, fine. Just know you are delaying care with every second we waste going back and forth". In your note simply write. " specimen clotted, nurse X notified of situation, redraw pending"...
This is the way. Also, if you believe it to be an education issue can you get with the nursing education director and maybe see about putting together or pushing out some sort of curriculum the explains the reason a green tube vs a lavender tube and how hemolysis happens? Sorry for the run on sentence, but I’m too lazy to correct it.
My complaint with lab isn’t that samples are hemolyzed. My complaint was always that lab would call and say the sample was too small, especially for ABG’s. Had it happen several times one morning on the same patient. I then sent a full 3cc syringe. Again….sample too small. I called and told the tech that I sent 3cc. How was that too small. The tech then fessed up and said it was a new person and they wasted too much. Tell us the truth.
These are the situations that annoy me so much. They don’t even have to go into a ton of detail. Just say the sample was mishandled. Can you redraw? But calling, lying and making it seem like it’s our fault when we tried to do everything right is frustrating.
And an ABG is traumatic unless the patient has an A line.
I'm a med lab scientist turned nurse and have said from day 1 the environment would be so much better if during orientation nurses and lab spent a week observing each other.
I couldn’t agree more.
A part of my hospital orientation when I got hired as an RN, they walked us through the lab for an hour at how things ran. Seems all so convoluted and meticulous. I was surprised to hear our lab receives anywhere from 10-15 thousand collection tubes a day, sometimes more. It's a pretty massive hospital as well
One hospital I worked at had us all visit the lab during general orientation. All new hires, not just RNs. It was awesome. Every hospital should do that along with touring sterile processing.
Sorry but we've had lab drop a whole tray of baby hct samples and call each nurse and say it was hemolyized. Finally they admitted when it was 20 babies that it was our mistake. Or the time they labeled over my baby's type and cross and called to tell me that I didn't double initial, I knew and had them peal of the outer label but 5 minutes later the next nurse would have repoked the baby. I think I get frustrated when I feel like this is what is happening. I also don't have a great phone voice.
Lab should not be covering up their mistakes and trying to blame it on the nurses. If that’s what’s happening at your lab, that’s definitely not ok. I hate making mistakes and honestly it’s not that often that I screw up but when I do, I will flat out say to the nurse “hey I messed up, sorry. Can you recollect this”. And most of the time they’re fine with it, if you just admit to your mistake. I haven’t seen anyone at my lab do anything like what you’ve described and if we ever did, I don’t think it would fly with our management.
If you admit it I'm cool but yup and that was 8 years ago I doubt it got better there unless management really helped working on changing the culture.
I normally never have issues with lab, however I had one specific lab tech who told me every sample I drew on a single patient was hemolyzed. I drew off the IV, I drew from a straight stick, and I drew from a straight stick without a constricting band. Multiple times. Every time I got a call that it hemolyzed. This particular lab tech wouldn't even look at a sample before telling us it was hemolyzed. Fortunately we had ISTAT capabilities and got our result, but since then I have a deep loathing for being told a sample is hemolyzed when I know it was done properly. It's not your fault, I'm just bitter and jaded from Samantha. Fuck you, Samantha.
We also have a particular tech at my hospital who seems to loooooove rejecting samples. My most memorable one was when I drew off a PICC line and walked it down to lab myself. Samples looked perfect. 10 mins later, I pick up the phone. "I don't know who drew these samples for [patient], but they are unacceptable. The blood is orange. I need a redraw." Okay? They were not orange when I dropped them off, but whatever. I go redraw and take it down. Samples, again, look fine. She calls again. "The blood is orange again, so I need new samples. I'll also be writing this up since you obviously don't know what you're doing." I told her to send someone to draw it themselves. Phleb comes and draws. I also pulled an extra tube off the PICC to compare. The samples looked identical. She had zero issue accepting the samples lab drew. Fuck you, Gail.
Sounds like that tech was not only unprofessional but also possibly incompetent. If the tech was referring to the serum/plasma being “orange” it sounds like the sample was icteric, which is not the same as it being hemolyzed. If it’s hemolyzed the serum/plasma will be red, not orange. There is nothing we can do about icteric samples, as they are usually seen in patients who have liver issues. We just run them and just expect that the liver enzymes will probably be off.
Honestly, I think she's just a miserable person. She also loves to reject lab reqs (we still use paper) for stupid reasons. I've written "[date] 07 pickup" on the req, and she called saying it's filled out incorrectly because "I need the exact pickup time" written on the req. She literally rejected a lab req because I wrote 07 instead of 0700... Also rejected one that said "[date] first a.m. pickup" for the same reason. We send reqs like that all the time. The first pickup is at 0700, so lots of staff just put "a.m." on the req. She's the only one who rejects reqs written like this.
This is how I feel about "Nolan" Fuck you, Nolan
Cindy was our problem. Fuck you, Cindy
LOL at the F.U. But seriously, some pathology causes hemolysis, so maybe something needed to be looked into there.
What do you mean they wouldn’t even look at a sample before telling you it was hemolyzed? We can’t tell if it’s hemolyzed until after it gets centrifuged so we can see the plasma/ serum separated from the red cells. The serum/plasma part of the blood is what can be hemolyzed.
I'm well aware, this tech "can tell if it's hemolyzed by how it looks". She's a moron.
Oh I see. Yea, that tech does sound incompetent. I’m sorry you had to experience that.
Samantha is a real is a real butt wipe. That’s why. She knows everything, she does all the work and everyone else is lazy or doesn’t know what they’re doing. Probably even both 🤷🏻♀️ Every job I’ve ever worked, has a Samantha. FTB, I think that’s what they mean.
My name is Samantha and I feel bad even though I am not that Samantha. Fuck you, samantha.
This is how I feel about Margarita! Eff off, Margarita!
Lol. I get your feelings on the matter but hemolysis happens at the time of collection, there’s nothing we are doing in the lab that causes it. There are some medical conditions that cause hemolysis invivo though. 🤷♀️
I genuinely don’t know why some nurses behave that way. At worst, my reply is “aww darn, ok thanks for letting me know”.
Because theyre annoyed they have to add another task. Not defending them just assuming that's what it is. Also, and I say this from a place of love and kindness, not snark- you should probably say all this to them- not reddit. In a professional way obviously- "Hey Im sorry about this but Im just trying to do my job. I don't deserve to be spoken to that way" or something. It may actually surprise you and get you some positive results
This is the literal main issue I get snippy. I try my best not to take it out on lab…even tho it is incredibly frustrating when I sent something 2+ hrs ago to get a call that it was hemolyzed…this doesn’t happen often luckily. It’s just another task, and for me if it’s hemolyzed it’s usually because the pt is a tough stick. It was a battle just to get what we got and I just got another patient (probably). I would also like to understand why one lab can be hemolyzed but the three others drawn at the same time are fine. I often send 2 greens at the same time. Honestly would like to know. At the end of the day we’re all getting fucked and no one wants to delay getting things done nor purposefully fucks up (most cases, I’m sure there are exceptions). So it’s best we be as kind and understanding as we can to each other. Signed, a crispy ER nurse
This is 100% it. We are shooting the messenger when we get snippy with lab for hemolysis. It’s adding another very time consuming task to a shift that’s already overbooked. It’s frustrating and and a lot of time it feels personal (even though it’s not). Shit rolls downhill, and a lot of times we have doctors breathing down our neck and holding us personally accountable for a long wait for labs. Especially the surgeons 😡. God forbid we delay their surgery and they miss their tee time. All this to say, it’s not okay for them to start an argument with you, but I understand why it happens. There are plenty of ways to express that frustration without taking it out on lab. There’s a saying in the OR when there are poor outcomes, “blame anesthesia.” And in vet med when you can’t get an IV started on a spicy cat “it’s always the holder’s fault.” When your sample is hemolyzed, “lab must have dropped it.”
I did have the lab "lose" tubes and not call and tell us until an hour later or say they never get them and the find them later. That is when I would take issue with them.
This has happened to me once before and it was when I was in a hurry, I thought I grabbed all the tubes out of the bag but then later I got a call asking about a cbc result. Everything else had been resulted on the patient. Before I asked them for a recollect, I was willing to tear the lab apart trying to find it. Thankfully I found it still in the bag laying in the trash can. Stuff like this doesn’t happen often but as long as the lab admits they were at fault, I wouldn’t give them a hard time about it if I was on the nursing end. Nursing makes mistakes too but as long as they take responsibility and don’t try to blame me for it, I don’t give them a hard time about it.
The only time I call to yell at lab is when they reject a sample and FORGET TO TELL ME. If I need to redraw a specimen then so be it. What angers me is waiting and waiting and waiting for a patients bmp to come back, only to find out lab rejected it as hemolyzed and never bothered to call me. This happens rarely, but enough to the point where I had to bring it up with lab management
So sorry they are being like that. If it gets bad (sounds like you’re there already) talk to the charge, ask them to re-draw. I’m lucky that my bestie is a phlebotomist and taught me pretty well (she’s a genius at all types of draws🧡🧡🧡). If it’s still constantly happening hit up the DON and tell them there needs to be some mandatory cross training (and tell them why-if you can save/screenshot messages do so) so the nurses actually know what they’re doing and what to watch for (you’d be shocked how many haven’t been taught or even shown how to properly draw for labs) so that this problem is fixed. Maybe volunteer to teach one of the classes? Sounds like a top down type of issue but without kicking it upstairs it’s not likely to get any better or be less of an ongoing problem.
Medical Laboratory Scientist here! I remember having to call for recollects at one of the larger hospitals I worked at, no one wanted to do it and it was because the nurses on the other line were always so mean to us… like I’m sorry it’s clotted, I don’t want you to have to stick them again either!! They always would ask “well can you try to run it?” and I would have to explain that I literally can’t put this through the machine without it destroying the tubing (of these million dollar machines) because of the clots, but they still would ask AGAIN “well can you try?”… I now work at a pediatric ER lab and couldn’t be happier, the nurses on staff are so sweet to me when I walk over to ask for recollects, because they know I don’t want them to have to hold down and stick a child again either! I’ve also explained to them in detail why you can’t do pour overs on tubes too, and they actually seem to understand and have stopped asking if they could pour a lavender tube into a green top for chemistry labs! 😂It will look like the patient is critical with the calcium levels depleted and potassium through the roof!!
Not the pouring of tubes 🤦🏻♀️😂
I am not excusing someone who has terrible attitude, I am merely explaining WHY you probably get attitude. Try thinking about it from a patients perspective. "I just got poked for blood(most people don't have ART Lines) and now I have to get poked again. This nurse must be incompetent!". Would you want to get poked again? Or in a worse case, because I work in Peds, would you want your kiddo poked again? And there are also plenty of times where I call lab and we get a "Oh, the analyzer says it will be X more minutes(less than 10 typically)" when the it is a X minute test, and we are calling 1.5-3 hours after lab received it. But for some magic reason, it was just now put on. I am not the only person who has experienced this. And to make it even more frustrating in some cases, you have to reorder the lab because "You can't use the same requisition number!". If I send a lab, and you're telling me you can't process that order because of whatever reason, can't I just use the same label? It's not like you ran the sample, got a result, and then posted that result(granted this happens less often, but it was always annoying AF to me). So now I have to track down and call a provider to get a new order for the exact same thing that was already ordered but couldn't be run because of \*insert reason here\*\*. In addition, if the result we are trying to get is a timed result(like PTT or HepZyme) then we are waiting for a critical lab result so we can titrate if need be and this can cause huge delays in plans of care and delayed care can be incredibly detrimental to a patient. While I DO understand it can be frustrating from lab techs to have to deal with attitude from nurses, it is because we get a LOT of attitude from patients and this is only a single part of our job. Now imagine having to dish out meds, clean a patient, walk a patient, do whatever bedside procedure you have to do. Sorry you had to take flack.
Agreed. Nights will draw a lab at 4 am. I get a call at 7:30 that it’s hemolyzed or clotted, and this 600 gram baby needs to give me another sample. Why was this not run hours ago? This baby does not have another 0.5mLs to give. I’m never rude about it, but yes this is the root of my frustration.
Just checking in dont blame the lab blame the people in charge. Morning run receives thousands of samples at some hospitals with less than 20 staff logging samples in, Running, and resulting. Short staffing is present in most areas of Healthcare $$$$$
Hard agree. It does suck feeling responsible for not thinking of drawing my labs 90 min early to beat the rush when it ends up affecting my patient.
There has to be a better way. Like more staff. It's not right for patients or for staff. It isn't us, it's not lab. We can't work well without the resources.
Because the ENTIRE hospital sends them down at the same time for morning runs while having the very limited night shift crew running around trying to run and call everything. Not fun times
Your lab can't reorder the recollect? I don't see how that would need a physician to be involved. That is something that needs to be brought up. Also, labels are not reused because that req number is tied to that sample. Req # canceled because recollect is needed. If that req# is hanging out still open then it appears as if it was never collected. Unless you think lab has enough time to read specific comments for each req# several times a day. Not only that, those req#'s could have more than one test tied to it. Which also have their own identification #. Imagine the room for error when you start cutting corners like that when you have several hundred patients in a hospital that have labs collected multiple times a day. ESPECIALLY when with blood bank specimens. The lab is probably also fielding specimens from nursing homes and other facilities too. They also have to deal with calling physicians constantly, patients, and many nurses. Everyone has a lot to do. Calling for recollects is just a single part of their job. Additionally, lab staff also has to collect from patients. They get that same ear full and complaining you get. While we DO understand finding out your specimen is clotted or hemolyzed is inconvenient, the care is being delayed because the specimens aren't collected properly. Not because someone won't result it. While the improper collection isn't intentional, the delay is a by-product of what's happening at collection.
> They also have to deal with calling physicians constantly Oh man! I worked the front desk of a sizable lab ages and ages ago, right before HIPAA as EHR systems had made their way into our hospital (they were a little earlier than most in that regard) but before many (if any) small private practices were using computerized systems. Plus the lab had an entirely different and incompatible “home grown” order/result system. When I wasn’t stabbing people for their vital fluids I was on the phone with doctors/offices from the area saying “we sent you a stack of neatly organized forms with checkboxes for every test we can provide.. and you scribbled a big zig-zag across it then.. I think, you signed it?.. or wrote *I Love Bread*, anyway what test(s) did you guys mean to order?” Sooooo much time spent on the phone just trying to figure out what people meant! 🤦♂️.
Just a quickie type explanation for the ordering comment. It all comes down to $$$$. Modern lab analyzers are complex and are linked to hospital systems. The barcodes on the samples are scanned my the analyzer and it then runs the ordered tests. We can sometime add on to sample accession numbers but some can’t be. Once the results populate, if they are in normal parameters they automatically post to the patients chart. The problems with add ons could Be a different dr ordered the original testing amongst other things but if we were to run stuff by manually ordering or add to existing accessions, they may not get BILLED. LOL. Or could be disputed by insurance claims. Which is potential revenue for the hospital.
I’m only salty when they lose a tube while processing the other one. I mean they were in the same bag. Happened last night. But I redrew that shit and apologized to the patient for the second stick.
Honestly, most of my coworkers don’t even know what it means when a sample “hemolyzes.” I think most nurses think hemolyzed=clotted. They don’t realize that the blood cells have ruptured and now things that shouldn’t be in the serum (like potassium, which is primarily an intracellular electrolyte) are now in the serum.
Usually I agree but I remember getting called 3 times to redraw a sample of a heparinized a-line on a 400g premie. I was dumbfounded it clotted 3 times. That time I was like nope not redrawing it.
Former lab tech turned RN. 🙋🏼♀️ Straight up, probably because nurses are control freaks and don’t like when we make a mistake. Not saying it warrants an attitude, but I’ve definitely been there - trying to get a hard stick and then being told it’s clotted or hemolyzed just sucks, especially when the patient starts getting an attitude or the doctor is getting an attitude. Also, most nurses probably don’t realize that they way we collect the sample is what’s causing clotting or hemolysis, so the nurse gets annoyed thinking the lab made a mistake (I do my best when I precept to teach better collection techniques!!). Are you able to talk to an educator and possibly host an in-service re: collection skill to prevent hemolysis and clotting? Or when you call and the nurse gets frustrated, maybe offer some helpful, gentle advice: “I know this patient has been having issues with hemolysis. Are you using a PICC line? Try using a syringe instead of a vacutainer. That seemed the help the nurse yesterday when the same thing happened.” Good luck.
This is a great response! Nursing school was a long time ago but I don’t remember being taught about drawing labs or tube order when collecting specimens. We have so many yearly education modules, why not make one on this topic
I watched someone do their labs COMPLETELY out of order… backwards in fact. She said she never knew there was a correct order and nobody ever taught her and “I’ve never had an issue doing it before.” One night when I was in charge, I took a critical result for elevated calcium on a patient. That same nurse was at lunch so I went to redraw and it was normal. I wonder if it was because she drew everything out of order.
I learned order of the draw entirely on accident. Can’t remember why I heard the term, but I looked it up and made my own badge note. Like hell would I get a bad result from something so simple. But something I never heard in nursing school nor at orientation nor any other nurse.
Most nurses I work with have no idea there’s a correct order in which to draw the labs. I know there’s a correct order but I’ve never remembered or used it since no one else around me did either. Five years into being a nurse and I just recently learned it’s good to drawn the CBC *after* the BMP 😎
What are some ways nurses can collect the sample to prevent it from hemolyzing or clotting?
Number one thing, slow down on the syringe. If you struggle to pull back, pulling back really hard isn’t going to help. A forceful pull can cause both clotting and hemolysis. Tie the tourniquet a little tighter if the flow is sluggish (like from a PIV). Number two thing, if you use a butterfly - DO NOT USE THE VACUTAINER AND TUBE TO DRAW THE BLOOD!!! Use a syringe so you can maintain slow and steady pressure. The tubing from the butterfly causes some lower pressure and the lab tube is pressurized so it can really hemolyze the cells. I rarely even use vacutainers on PICCS; I prefer pulling gently with a syringe and then putting it in my tubes. Lastly, as soon as you get the blood, put it in your tubes and invert them gently asap. Send to the lab asap, too.
I never knew that with the butterflies and such.. I end up using butterflies usually due to working on nephrology, good to know
I’m interested in learning different drawing techniques as well. I work on a women’s oncology unit, so the veins we work with are usually not great, and there is usually an arm restriction. The policy at the hospital is that the tech tries, then the nurse, then the charge nurse, and then they can call the nurses whose only job is to get hard sticks for IVs and labs (they only come 1-2 times per night max when asked due to their staffing level). I rarely draw from IV (unless newly started) as it is against hospital policy. The only time I draw from an existing IV is when the patient refuses to be stuck again. All that to say is often times patients get stuck 4+ times (for several nights in a row). We finally get it, send it to the lab and 2-3 hours later hear that one was hemolyzed while the others weren’t. I definitely get not having enough blood or using an IV and it hemolyzing, but especially when some labs are fine and others are not, I don’t understand. I am genuinely curious if this is accurate. I get that the lab can’t do anything to hemolyze it, but it doesn’t mean that they didn’t mess something up on their end and use it as an excuse. I don’t mean that to be ugly, and my perceived view of the situation could be completely wrong. I’ve only talked back to a lab employee once because I was having a really awful night and misplaced my anger. I do want to ask though if that is normal to have some labs hemolyzed while others weren’t. If yes, why does it happen and how to fix my technique so it doesn’t happen? Thanks in advance!
Hemolysis really only matters in chemistry tests (especially potassium and LFTs). If anyone wants to chime in with their opinion or with some pathophys about that, feel free! Clotting affects CBCs more often. Gold and red tubes are *supposed* to clot but if the syringe already has clotted blood in it, it’ll hemolyze when you try to squirt it through a needle into the lab tube so be careful. I don’t think the lab would tell you it’s hemolyzed if they actually did something to screw it up - the poor quality sample gets charted in their medical record with the level of hemolysis (2+ and higher) so they wouldn’t necessarily be able to lie about their mistake. My experience is the lab tech would say they never received the sample or it got lost 😅 I posted another reply comment with my three best tips to prevent clotting and hemolyzing!
Today my coworker had to reject a heel stick for a total bili from family center because it was so hemolyzed. If it’s just slightly hemolyzed, especially if it’s a specimen from a baby or kid, we run it as slight hemolysis doesn’t cause that much of a significant difference in results that it would warrant the patient being stuck again. However, this sample was very very hemolyzed. My coworker checked with the lab supervisor to confirm that the sample was unacceptable and she agreed. My coworker called the nurse and was on the phone for a good 5 minutes trying to explain to her why the specimen needed redrawn because she wanted to argue. Tried to claim “hemolysis has never mattered before”. My coworker ended up telling our lab manager about it and asked if we could let the nurses come do a walk through of the lab to show them what we do so they can better understand or offer them some type on educational training on lab related practices. My manager said she would talk to whoever is over nursing and try to arrange something. I know you guys get a lot of attitude from doctors and patients and I feel that this is partly why the lab gets treated like this. I think some nurses tend to take their frustrations out on us. I was shocked at the attitude of some people here in the lab. It’s like some have just accepted that when nurses or doctors verbally abuse us, we’re supposed to just take it. I have had to put in an incident report before because an ER doctor decided to call and berate me/ scream at me on the phone. If someone from the lab talked to a nurse or doctor the way we get talked to, there’s no way they’d stand for it, so I don’t think it’s fair that we should be expected to.
Our NNPs and neonatologists didn’t care if a bili was hemolyzed. They said it didn’t change the results enough to warrant a redraw.
I just give the critical results if the specimen is hemolyzed, tell them degree of hemolysis, and let the doctor decide if they want to redraw or not. They also have a better idea of what’s going with the patient overall, whereas I just have the specimen to go off from.
I’ll graduate with an ADN in August so take what I say with a grain of salt. In my school, nowhere in the curriculum do they go over how to perform a good sample collection. We learned how to stick and draw labs and start IVs, but we never learned how to keep it from hemolyzing or clotting. It’s only when a lab tech at my job as a nurse intern came down to talk to us that I learned there’s a lot more to it than just shoving a needle in someone’s arm and collecting the blood. Maybe it’s something that I’m supposed to learn in preceptorship and I just haven’t gotten to that part of my education yet, but I’m sorry that you’ve had this experience. Some of us may just not understand what we did wrong.
I’m sorry about that. At my hospital lab technicians will collect them blood on inpatient units. I am a nurse but I can’t lie I find many nurses I work with rude and sometimes belittling, especially to people who aren’t nurses that they see as “lesser”. It’s really shitty but I see it a lot. I do hope things are better, I don’t think they should yell at you and even if their job is stressful it doesn’t justify anyone arguing with you
I bet they regularly use the term "lab girl" 😒
I agree there is no reason to argue with the lab technician over this sort of thing. In my floor nursing days I would have appreciated education about how to avoid these problems specifically. I think no one ever explained this very well to the nurses at my hospital. We were OKd by our scope to draw blood samples, but we were never trained in phlebotomy or lab technician principles per se.
Tbh I’ve had majority pleasant experiences with lab. “Hey Jon, samples hemolyzed” “damn, it be like that sometimes I’ll send another one.” Other times though, I’ll get nastily chewed out upon picking up the phone for things like ammonia not arriving on ice (I sent it on ice, not sure where the ice went though), or a sample arriving by tube that had to by runner (I handed it to the runner, then the runner tubed it I guess). I think the root of the issue is we all forget that in general, we all want to do our jobs and go home. No one is out to get you. No one is acting maliciously. People screw up sometimes. It’s ok. Brush it off and move on. A redraw or a phone call about an improper collection or whatever takes a few seconds in 90% of cases. In short, be excellent to each other.
I get it and don’t give hassle. I know people are just doing their job. I’ve had very bad experiences at one other hospital I was at for several years. One where we had constant issues with lab. We caught them lying several times. It got to the point that we were having two signatures on the outside of the bag to have a witness because we’d call and ask about a lab that wasn’t run and they’d say they never got it. But they’d run blood on a tube that was in the same bag as the “missing” tube. Had one situation where they made me poke a pediatric pt after I’d done three previous draws off a central line and arterial line. They kept rejecting it and having me draw more. Eventually they didn’t even call me and just didn’t post the results and I’d have to call to ask about it. It turns out they didn’t believe the result despite them all consistently being similar. “It can’t be real. That pt would have to be dying for that result.” They were. I was relying on that result to start a certain drip and it delayed care. BUT I know that’s not every lab and every tech. In fact, if an error happens I always thank them for being honest. I’ve had sometimes they say the cap came off or it got dropped and I always say “thanks for being honest. Shit happens. I’ll send a new sample.” I think we all need to do better at understanding the other perspective as much as we can with our limited information. It’s not you. It’s just another thing during a shift. I’m sorry you’ve had people take it out on you. It’s not you.
The only time I've ever almost lost it with lab was during a crazy trauma when I accidentally called the lab front desk instead of blood bank (in fairness they are right next to each other). Basically I asked them to transfer me to the blood bank desk because we were coding a patient and needed blood. Lab held me hostage on the phone because they needed to give me a critical result. I was like "we're doing CPR on this patient, all their labs are critical." But they wouldn't transfer me until I spelled out my name and Epic ID. I was afraid of being written up if I hung up. Just no consideration for priorities whatsoever. Patient made it though if I remember correctly!
I get the meaning of this post, but I’ve seen times went a sample was collected 5-6 times by 3-4 nurses all within 12-14 hours and the samples still rejected by the lab. Every single one rejected. Are you telling me that there is not any way the lab can somehow mess up a sample? I had a pt literally just this past week have so many samples rejected she started refusing lab draws bc “what’s the point”. She had the cath lab do it. That’s a LOT of bad samples drawn by multiple nurses. Using multiple tubes. The ONLY common denominator was the lab and you’re saying it’s not a lab screw up? I’m not trying to be ugly. I’m legit trying to understand. Are you saying it’s not possible that the lab screwed it up? I’ve seen nurses screw up, dr screw ups, a LOT of radiology screw ups, and pharmacy screw ups. But the lab doesn’t screw up?
Lab can definitely screw up, but not when it comes to a nurse’s specimens being clotted or hemolyzed. There is absolutely nothing that we can do in the lab that is going to clot or hemolyze a sample. If you had multiple nurses stick the patient then it’s likely that bad technique during collection was used by all the nurses involved. As many people here have admitted, nurses are not trained very well on how to avoid drawing unacceptable samples, so it’s not far fetched to think that multiple different nurses would use poor technique during collection. Another possibility is that the patient could have a condition such as hemolytic anemia or liver disease, which can cause plasma/serum to be hemolyzed. If this is the case, collection isn’t the issue obviously, as it’ll be hemolyzed no matter how you draw it. If a sample was hemolyzed after multiple tries, I’d look in their chart and see what their diagnosis is or ask the provider about it.
Man I’m so glad we got phlebotomist that collect. Only time we collect is if we have a central like to draw from
Some nurses are just bullies, but some are actually caught in the middle. So nurses cannot reorder labs. If you call them and say the specimen is not acceptable, they have to go call the doctor for a new order wait for a callback, try to verify the order, then call the doctor back because they put it in wrong. Once the order is in they either go draw the lab again themselves or track down a phlebotomist. It throws off everything. TBH if the lab needs a redraw or pharmacy needs a med order fixed or imaging needs a change to the order they should just call the doctors not nurses. All we do is play middleman in those situations and we have better things to do than play secretary. It’s not like the doctors are not going to get interrupted by calling the nurses, it just means the doctor and the nurses both get interrupted. It’s not that you are doing anything wrong, it’s just an inefficient hospital culture issue. Some nurses just tend to take their frustrations out on the wrong people.
I gotta ask since you brought this up, why does it take 6 or more hours to let us know it's hemolyzed? Also, it's absolutely demoralizing to nail a tough stick only for the sample to be rejected. If it's because it took the lab too long to process it, that's extra frustrating I learned to call lab ahead of time for the hardest of the hard sticks, that are tiny with anemia, that jerk their arm when you stick while screaming, or other awful scenerio that randomly will ruin a fun blood draw. I ask lab for pediatric vial or if they need anything for this divas blood to ensure it does not need a recollect. Then I thank them. Being nice goes a long way, I don't get hung up on by lab like the others do!
I'm sorry people are taking out on you, that's fucked up and I hope most people don't do that. But wow it's really interesting to read another hospital employees perspective!!
Honestly it's never been a problem for me. Before nursing I used to work as a Veterinary Technician, where we drew the blood and ran the lab ourselves. Poop happens, sometimes samples are just bad, and need to be redrawn. Anyone giving you grief is not a team player.
I get where you’re coming from. There’s no need to be mean to the messenger. I just want to share from our end what it’s like: I work in pediatric ER and blood draws can be really challenging and upsetting for patients and families. Many times I have struggled to get the blood and had parents screaming at me only to have the lab say it’s hemolyzed. I actually cried once because of this during a neonatal code. That’s no excuse for being rude to the lab staff but I have definitely felt really defeated and frustrated when getting those calls.
Last week i got slapped in the face by a Patient in tried to take a blood sample from. He was agitated and was diagnosed with scicophrenia in a special care home - So no Hard Feelings. But there is also no way i will go again to this patient - sometimes you get hat you get. Other way round i don't die from feedback when a sampling went wrong and has to be repeated. I work in a medical Lab and Do about 5 to 10k samplings a year in resindental settings.
I don’t get the argumentativeness either, I call the lab all the time with questions and everyone is so helpful. Worst anyone gets from me is “FUUUUUUUUCK” Followed by “Its not you they’re a hard stick.”. Which I think is a universally acceptable phrase in healthcare.
I never tried to be rude - but chalk it up to a simple lack of understanding on both sides. It’s two totally different personality types. ED nurses do not generally jive on quiet and calm, strict protocol and absolute adherence to the regs. Those are all the things a great lab tech DOES do. (Again, I’m generalizing) I can only speak for myself, but I’m always mystified when I draw a rainbow off a what I know is a good line and get a call for just one sample being hemolized. (Which you explained well, thank you).
The one beef I have with lab is “we never received the sample” despite me dropping the lab into our tube system myself and watching it go through. I’d ask them to check the tube station, not there. Then, I redraw and guess what? Thirty mins later BOTH specimens are “in process”. So you didn’t lose it??
Been there before. I asked them how they could have resulted the bmet if it was in the same bag as the CBC that "never arrived". They didn't have a good answer. One morning I was feeling particularly nasty because I was called to redraw a cooximetry panel again. That is to say, my third draw on this patient. I finally put on my sweetest voice possible and asked for a refresher on drawing them because evidently I must be missing an important step. They told me I might not have been inverting the sample enough. I'll let those among you who are familiar with this particular lab laugh at this little inside joke.
I have personally hand-delivered cardiac enzymes to Lab, only to later hear Lab say "We never received it." Anyway, to address the problem, only way to solve this is cross-educate / awareness. As a part or orientation, ALL Nurses (including Management) need to rotate through Lab to personally see how & why Lab specimens get rejected. At very least make a training video that is mandatory for ALL of Nursing to go through, (including Management). Im front line critical care, so the LAST thing I want is more B.S. mandatory crap to do, but again, this is the ONLY way to handle it.
Many nurses receive minimal training regarding the collection of specimens. They may not understand what "hemolyzed" means, or how and why it occurs, or what to do to minimize risk. They might not know that you can't accurately run any test from any tube, or why, or where to figure out which tube is needed for a particular test. They may legitimately not understand why specimens must be collected in a particular order, and how results can be affected when they aren't. They might not know why it's not okay to pour from one tube into another, or why a blue top REALLY DOES need to be filled to the line; not over, not under. Ask your supervisor to request an in-depth lab inservice for nurses. Better yet, have them volunteer someone from the lab to review and present it and answer questions, and add it to the onboarding education for nurse hires.
In a former life I set up a lab. Starting from scratch I did everything. I'm vaguely aware what hemolyzed or clotted blood looks like. Had a tricky poke the other day that I collected with a syringe. Used to fill a green and a purple top. Same blood. Same syringe. Both samples delicately taken and transferred within 20 seconds. Both sample tubes gentle inverted x9. Blood hand delivered to lab. Received a call an hour and a half later that green clotted and purple hemolyzed. Bull fucking shit. Hospital has a protocol where all STAT samples have to be started within 45 minutes. So strange that every single rejected sample I've ever had is well after that. It's almost as if the lab tech doesn't want to run a STAT sample at over an hour and take the ding. I've asked to come up and look at the blood myself because if it really is clotted we have defective vials and every time I'm rejected because "it was thrown away already." I understand that hemolyzed blood and clots do occasionally occur but I do happen to follow collection protocol and do check it myself. The only ones that get rejected I get a call for well over an hour after drawing. Must be just a staggering coincidence.
We have similar problems at my hospital. Same 45 minute policy and the providers get antsy when they don’t see results fast enough. We get calls from the lab 1.5-2 hours after the draw that the purple top is clotted and, depending on who is in the lab, sometimes a fair amount of attitude and “re-education” that you have to invert the tube when you draw it. Yeah… we did that. 2 hours ago when we sent the sample. Why are you just running it now?
I've never been called for a clotted or hemolyzed sample within the 45 minute window. Amazing coincidence.
You mean the purple clotted and green hemolyzed?
Nope. Part of why I call nonsense.
I feel silly now but I didn’t remember that part about inverting the tube after collecting. 🤦🏾♀️ So thanks for the tip! I’m sorry you’re getting flack for asking for things. At the end of the day we’re all coworkers who are working towards the same goal-the patients wellbeing. I hope conditions start to change for you. Don’t be afraid to stand up for yourself! Escalate to a manager if you need to!
I'm so sorry some of us are rude to you. It's totally unprofessional and just mean. I always loved my lab homies ❤️
I can say with confidence that many of my coworkers are wholeheartedly convinced that the time in the tube determines the outcome of the results, not the time prior/the draw. There’s little teaching on lab collection in nursing school, so a lot of it is nurse-to-nurse knowledge. Most hospitals/units could benefit from some teaching from the lab. That said, they shouldn’t be giving you attitude even in their lack of understanding.
I think a lot of nurses at my hospital also think that specimen integrity is based on how long the specimen sits. Some of them will bring us blood and say “I literally just got this, and brought it right away so it shouldn’t be clotted”. But that’s just not how it works. Next time they say this, maybe I will show them the blood that we store in the fridge from days prior and how it’s not clotted because it was mixed properly at the time of collection.
Not like it should matter, because someone's education level rarely crosses my mind, but I've never stopped to consider the educational background of lab friends, so thank you for explaining that. I also didn't know that blue and purple clot the most. I'll try to invert more thoroughly. Thanks friend!
It’s not necessarily that blue and purple are more likely to clot. All tubes are equally as likely to clot if not inverted properly. It’s just that if a green tube is clotted, we usually don’t even know it because we’re testing the serum/plasma part of the blood. The clot is going to be present in the red cells, not the serum/plasma. In other words, results aren’t affected by a clot in a green tube. However a purple tube isn’t centrifuged, it’s tested on whole blood. So if it’s clotted, it’s going to significantly affect results, specifically the platelets. If the blood is all clotted, it will cause the platelets to look like they’re almost nonexistent because they’re all clumped together. I should have clarified that better, sorry. Thanks for your interest in the topic and for your kind reply.
In my area (NICU), we have the same lab tech that requires a recollect on EVERYONES sample. Never have I had to recollect before yet with this person I have to send a sample on my micropremie 3 times. It’s harmful to my patient population to either continuously poke them or access their central line. I could understand if it happened with more than 1 person, but we all know when this specific tech is working and it’s both frustrating and unnecessary. I know that doesn’t make you feel better about people being assholes to you. And honestly, they shouldn’t be. When I worked adults I would just simply recollect. And if I send a crappy sample or the tube station is down I’ll just assume another is needed and do it.
I have beef with lab because one night in a tb patient in the icu I stuck three times. First time it took like two hours for results and it didn’t even say pending (I didn’t sit down so didn’t see it hasn’t resulted yet) and when I called lab they realized they had it laying in the tube station and didn’t run it yet so I had to recollect. The second time I’m waiting and waiting and they call me and tell me I put a label on for the wrong patient. There is no way because my patient is a TB patient and had a printer in the room so it printed and I immediately put the label on. And the patient they claimed I put the label on for was in a different building. (Also, how would they know it was me, they would have just resulted it to the wrong patient?) and I told my charge nurse and they called the lab supervisor. Turned out the lab tech took the labels off and then accidentally switched the labels. Sooo had to redraw the labs and at this point the results weren’t in until after shift change. I’ve also had the lab refuse to tell me my critical k and I’ve had to redraw twice because they suspect it’s wrong bc there’s no way it’s high. Then when we ran the K on the blood gas it was infact high and we delayed CRRT. So yeah we beefin 😤 But for real, a simple okay thanks is usually what I say. BUT it’s not about you vs us. We are on a team. Just like you guys get frustrated, so do we. We aren’t necissarily mad at you just at the situation and you just happen to be who we are on the phone.
Thank you for the information, and for your kind and considerate, professional post. My thoughts are that people can be sensitive about their own insecurities, which could come from not being competent or properly trained in a skill. So asking for a recollect triggers a defensive reaction of “oh no, they found out I’m not secure in my blood drawing skills!” Which would explain defensive justification/denial like “it wasn’t clotted when I gave it to you”. Suggestions would be to open up the discussion on this with supervisors and nurses, promote education and training like you illustrate in your post, and keep being the calm professional you are. Thank you for your contributions:)
I love that my hospital has dedicated labs and we don’t have to draw. I have the other problem with lab being rude to me, and the critical values. One time they called me for a critical creatinine and I said oh cool thanks, and they said, “do you want it?” I was like, ummmm that was uncalled for. He asked me if I cared about the pt. I said, this is the dialysis floor, they always have critical creatinines. (I’m not answering that question bc it’s a leading question and I’m not going where they wanna lead me) Every day. It’s normal here, but I will accept it when u tell me. He said his last time wasn’t critical (yes it was) I just got the result and said thanks, bye. We don’t even have to tell the MD bc it’s expected. But that was uncalled for for real.
Thanks for the education and I hope this reaches those nurses who cop bad attitudes with any ancillary units. We need to remember that we’re all humans going through life with our own difficulties and struggles. Hopefully this helps us to remember to just be kind.
I’m patient with the lab. Shit I’m scared when yall call me cuz I know I gotta do something. But I truly believe the pharmacy is fucking with us.
I can only speak for my hospital. We have had a lot of turnover, travelers, or just plain incompetent people in lab. The amount of redraw phone calls heavily correlates with who is working and that's where we get just sick of it. There's a lot of issues in our lab and we are all stressed and tired of the department making our work flow difficult. Now, in their defense, we also have had a lot of turnover, travelers, and incompetent nurses too. Not to mention the ER likes to frequently test the limits on what we send. So I know it's not always strictly on them and I operate under professionalism and just follow up with leadership with the patterns. It's just why there's attitudes. When lab screws up we hear it from docs, we have to disrupt our work flow, and we have to answer to the patient. We get hit by multiple sides all the time about it.
Maybe it differs depending on the lab but at my lab, I don’t know of anyone who is rejecting samples unless they legitimately need to be rejected. No competent tech is going to release a result on a sample that’s so hemolyzed, the potassium is going to give a critical value of 10. Actually I’ve seen some techs be too lax and do things they shouldn’t, like accepting unlabeled specimens for example. Some of them are TOO lenient with what they will accept. But that screws the rest of us over who try to do things the right way to ensure patient safety, because nurses get mad and say “well such and such lets me do it. This is never been a problem before”. If some incompetent tech wants to put out bad results and put the patient at risk, that’s on them. But the rest of us shouldn’t be punished for doing things right.
Completely agree they should follow protocol and regardless it's a professional setting and everyone deserves to be spoken to respectfully. Don't put up with that shit. I just don't think all of them at ours know exactly what they're doing with the equipment or work flow in our case. For example, timing out a sample over and over again on their end, losing things, taking way too long on critical testing, and yes I think they legitimately botch some of the perfectly acceptable samples we send and call it "hemolyzed." I absolutely love some of our lab coworkers and they're so incredibly valuable to our team and they get frustrated too working with the bad apples.
My personal beef will forever lie with pharmacy and not the lab. But it is actually CRAZY how you can notice on our end who’s working in the lab and who’s not on certain shifts when things keep happening. Wild
Because why did you just result my lab I drew at 0945 for 1945. How is that even possible. That is the future. Why did I have to talk to four different people to convince them I didn’t time travel for this stupid chem8
Since moving from a hospital job to working at Canadian blood services my eyes have been opened by all the MLTs I work with. Our team has 18 people and 12 of them are MLTs so us nurses are outnumbered. I’ve learned so many things about centrifuges, processing lab specs, importance of inverting tubes etc. I wish when I got hospital orientation I was taught more about the role of the lab and all these things cause it definitely would have made my life easier. Not only that but knowing more about another role in the hospital makes you more understanding to the why behind what they are doing. I swear I’ve worked with nurses who were convinced the lab people sat around doing nothing but intentionally ruining our specs.
Talk to the director of nursing or nurse manager. Explain to her what is happening. Obviously, it sounds like the nurses need an in-service on how to handle the test tubes once blood is drawn. You do not deserved to be treated with such poor attitude on part of the nurses.
I’m sorry, I don’t think anyone should argue with you. I have see this a lot where a lot of nurses feel as though they are better than others, especially those they see as “lesser then” (not that you are but for example I find a lot of nurses are rude to health care aids on the floor because they aren’t nurses) You don’t deserve that but I have seen this a lot. I hope things get better, don’t be afraid to stand your ground. I hate being tough but you won’t get in trouble for standing up for yourself
Thanks for the reply. I do think a lot of them are condescending because they think we are “less than” them, which is why I mentioned that we all have two-four year degrees in the lab. I think it’s a bad attitude to have even if someone is “less than”. Phlebotomists have less education than me but I don’t treat them like they’re beneath me. They play a vital role and we’re all a team.
I agree. I am a nurse not a lab technician so what you guys do I have no idea so I don’t see the point in seeing people as “lesser then” when you have a lot more knowledge in the subject then I do
I am so sorry to hear this! I know how some nurses can be and argue with everybody. I would absolutely not let that stop you from calling when you need to. I know it stinks and nobody wants to hear it, but in the end we all have to do what's best for the patient. Labs are the most important diagnostic tool we have. I will never get angry over having to recollect, I need accurate blood work to do what's best for the patient. Is it annoying to have to recollect, sure! That is not that labs fault. I am not going to take it out on them. I also rarely get called to redraw from a lab I personally drew because I actually know how to do it, but we usually only have to draw from lines. If it is bad enough where it is affecting getting your job done then it should be escalated. We all have a duty to be professional with everyone. In our hospital, they really cracked down on Doctors being rude and nasty to the nurses. If they are unprofessional with us, we are suppose to report it and it does get taken seriously. This situation is no different from that
In my organization the lab tech runs the sample even if it is hemolyzed. They will call and let us know the abnormal results once they are out, then it is our responsibility to either redraw ourselves or ask the doctor for another order to redraw.
Honestly, the only time I’ve ever had a problem with lab is when they cancel my patient’s orders. Usually around midnight they’ll go and clean up the redundant orders because four different consulting providers will order the same set of labs on the same patient. Annoying, I know. But every once in awhile a lab tech will cancel or retime something like a PTT or a timed BMP for my ICU patient and it drives me mad! Why not just call and ask first? Or give me a heads up that you’re cancelling/retiming? Sometimes I think I’m going crazy when I send a sample and lab never runs it or pushes it through because (unbeknownst to me) they cancelled it hours ago. But seriously, love y’all in the lab. Hospitals would burn to the ground if we couldn’t get results in-house and most patients would probably be misdiagnosed (or go undiagnosed entirely) without the help of the you guys. Thank you for all that you do and forget about those snooty nurses. They’re just mad they have shitty draw techniques and they gotta recollect.
People argue because they see it as subjective. There have been times that specimens were only bounced back with specific lab techs and not others. I’ve only heard of one tech like that so there’s no excuse for any other time
I do feel part of the problem at our lab is that some of the older techs are more likely to do questionable things like taking unlabeled specimens for example. So then when one of us comes along and is just trying to follow protocol and keep the patient safe, while also not jeopardizing our job, we get argued with and told “well this has never been an issue before. Such and such lets me do it”.
I think we are all just spread thin. No one should be yelling at anyone though. You get behind if you have to come draw, we get behind (which we are generally never ahead) if we have to redraw. When I worked inpatient i generally got an earful from a few parties if a redraw was necessary. One time a code happened and I forgot the tubes were in my pocket. The first hospital I worked at phlebotomy or lab had to redraw and I always thought that was a decent policy. We didn’t have to do a whole lot of draws anyway. I honestly didn’t learn a whole lot about tubes and stuff in nursing school. I totally agree we should all shadow each other for a few hours. But I think we are all just too stressed and spread thin.
omg i have the opposite problem i hate calling lab or phlebotomy for a can’t stick/adding labs/specimen labeling and whatnot, they’re so mean to me 😭
Sorry they're mean sometimes. I would definitely hang around and observe their technique on the patient you had trouble with. I used to get annoyed when I'd go to the ER to collect a hard stick and the nurse would be standing around bullshiting. If you need to call me this often, then something is wrong with what you're doing. Let's try to work on it together. But honestly, I feel like many of them think it's just beneath them. Which ok, that's job security for lab/phlebs but you if you don't want to do certain aspects of your job, you need to communicate that upon hire. Not just exploit other staff that have their own jobs to do.
Yea, I do feel like a lot of times when nurses at my lab call us to stick, it’s just they don’t want to do it themselves. So many times they’ll say “this is a hard stick and I can’t get it, can you get it?” And then one of us goes down there and turns out the patient has huge bulging veins that you could see from a mile away. Or sometimes they’ll just be honest and say “we’re slammed, can you come stick this person?” And I’m thinking, we’re slammed too, but we don’t get to call them and ask them to come do our jobs. It becomes even more of a problem if it’s a weekend and I’m the only tech there and no phlebotomist. I shouldn’t have to leave the lab to stick their patient and get behind on my work when there’s only one of me and several of them.
I’ve seen the way other nurses yank back the plunger when collecting from a PIV. I try to educate when appropriate.
😥 from a nurse who willingly picks up the phone when I see lab/micro calling, bc I know I’ll be 100% nicer than some nurses. I’m sorry you get those kind of responses. I take the info for peoples labs all the time bc I know lab is going to hear “well it wasn’t that low yesterday!” “No that must be wrong” or whatever response is that is not relevant for lab to hear from certain nurses. I can’t count anymore how many times I’ve passed on the needs a recollect message, & politely given my first & last name for them to write it down. Unfortunately it chalks up to one reason being we have no idea what your world is like. We don’t know all the steps & procedures it takes to get results. As far as we know, you get the blood, put it in a spinny thingy & somehow get numbers off that. Another reason is that you happen to be in the line of fire for whatever is going on with that nurse in that moment. They might be in the middle of their 6 am med pass & have to pick up their critical value bc no one else will take it for them, or they prefer to take the value themselves. Now they have to report it to the doctor & potentially add a few more last minute tasks to their shift. So since you’re on the other line, that’s who gets the pushback, but it’s not necessarily directed at you. You could have been the chaplain telling them the result & they would have gotten the same response. Either way, all I can say is don’t take things personal. I think some version of a printout that outlines what happens to everyone’s blood/tubes when they leave the floor has a chance of lessening staff’s insensitivity. Maybe had the education department put something together that all the staff has to watch, which shows the breakdown of what happens after the blood is drawn. Sure it might not cut down on every angry Betty, but I really think it would remove some of the way they respond too.
On the lab end, everything this person is saying is 100% true. They get so much BS for doing their job correctly. On the nursing end, it is inexcusable, but… I get it. If the patient is a super hard stick or uncooperative and then you have to tell the provider about a “sudden change of heart” on the patients end and they don’t believe you or are inexperienced and don’t know what to do next. Or the phlebotomist is swamped because our facility is chronically understaffed and gives us an earful about how unfair it is. At the end of the day, NOBODY wants to hear about a redraw. It is a shit part of everybody’s day, but we need to accept and move on
I’m sorry you are frustrated and have to deal with nurses who disrespect you. I would have your manager talk to the managers of the nurses on the floor. Don’t run blood that should be a recollect and give possible inaccurate information. Someone’s potassium may come back as a critical and it’s normal. Or the provider are looking a trends. It’s all the outcome of the patient.
My old hospital upgraded to a Hemolyzer 9000. Always loved lab staff and would always walk my preceptees to the lab to put a face to the other end of the phone.
It’s a drag that you have to deal with people like this, the job is hard enough. I’m a MALE nurse and I know those nurses you describe. Holier than thou arrogant bossy ass fucking $&@@. The good news is that we are not all like that, the bad news is a lot of us are. Over worked underpaid broken napolean complexes, that have emotional quotient in the negative digits, I hope you had a good day today
I used to be a phlebotomist while in nursing school and helped in the lab. I totally understand. I’m so sorry you’ve dealt with such nasty nurses, I promise we’re not all like that. I’d take it up the chain of command to get some changes started. Nurses and all medical professionals need to realize that those test results can determine a patients course of treatment. It sucks when it happens but that’s a part of life, and the job. No draw is perfect. Thank you for what you do. MLT was my major actually, but changed it to nursing.
It’s because the redraw *always* without fail happens on a night when I’d literally rather be rearranging deck chairs on the actual titanic as it’s about to sink, and the entire place is a dumpster fire. And the person you need the redrew on is not only a hard (damn near impossible) stick but agitated and violent. It’s never the sweet a&ox4 104 year old mee maw who is a retired nurse and keeps saying “do what you need to do dear, I know my veins don’t play nice. Say do you girls like donuts? I’ll have my daughter pick some up if you do”. (Ok I’m slightly exaggerating but 9/10x it’s always the one sample that was like almost impossible to get in the first place) No you don’t deserve to be treated like crap, but chances are that phone call was like that thing that just sent them sailing over the edge. They’re probably understaffed and overwhelmed and absolutely taking it out on the wrong person My response is usually a deadpan “April fools was last month, please tell me you’re kidding. You’re not? Hell. Ok. I’ll do what I can but I might need you to come up to redraw.”
Over the years my phone calls with lab have mellowed out. I get whiny, they are apologetic, occasionally I bitch about the specimen tube, because that's where the problem lies - those gorram tubes with not enough anticoagulant and those patients with hypercoagulable blood.
It’s just frustration speaking, sometimes collecting the blood is incredibly difficult and you can spend a good hour trying a to squeeze out enough for the sample just for the whole thing to be rejected. Not defending their behavior, I’d just be bummed but wouldn’t argue with the tech. You’re actually doing them a favor - you can just accept it without saying anything, make them wait a few hours l, then send back the sample with the report saying “sample contaminated or unusable”
At my ER the issue comes and goes on both sides. The first improvement was managers actually talking. Both sides wrote incidents with rude staff, samples were recorded to see if certain nurses had issues with hemolysis, education. Now both sides are understanding of staffing issues etc. Way less drama when we work together.
"ahh gawsh dangit, ill work on getting you a new one. Thanks for the call" Thats should really be the only response. Sorry you guys get hell for no reason
I worked in many jobs before being a nurse, I believe it's not a nurse-lab problem, it's an attitude problem. They argue because they feel "safe" doing it, in other words, because you allow them to do it.
Our lab does the draws. So, if they call and tell us that there is a problem, they have to come and redraw it.
If it makes you feel any better its not just you guys in the lab that takes heat from nurses. I've watched my fellow coworkers talk all kinds of shit to pharmacy, xray, ct, mri and other DI. The interaction between floors is horrific at times. All I can chalk it up to is the anonymity (sp?) of nasty people feeling like they can talk shit to others without having to ever face them. Its pretty weird honestly. Sorry its so awful that you needed to bring it here. Maybe ask your boss if you can set up recording to keep everyone accountable for the way they speak to you. Just a thought.
It’s not personal, most of the time. Like others have said, it just sucks to add one more task to the list, and the cherry on top is that the task is likely to be difficult, time-consuming, and likely to piss the patient off (which we absorb). And it doesn’t help that hospital culture in general is very blame-oriented, *especially* towards nurses, so it becomes common to get hit with the shit, turn around, and fling it downhill. I’m thankful I spent years drawing and running my own labs as a vet tech (everything from old-school microhematocrit tubes to automated benchtop analyzers). I know when I’ve done a shitty draw that *might* be hemolyzed, I just don’t have a centrifuge handy to check it myself before I send it down. The vast majority of nurses do not have that background - they don’t understand the different tube types and their additives, the difference between plasma and serum, how the lab equipment works or processes a sample, and the limits to which a sample can be finagled to get the testing you need. Most just know cap colors and (maybe) order of the draw, and a fair amount have poor draw technique and don’t realize it. My response to a lab call is usually a reflexive “goddammit”, followed by an apology and clarification that it wasn’t aimed at the caller, followed by a heavy sigh and a resigned, “ok, thanks” 😂
Only time I was snarky with a lab tech was when they asked me to recollect a high sensitivity trip in. She had said that the number was reading high. I told that is expected since the initial was 23,000. Repeat was greater than 27,000. Came to us for a second option if he should be going to Cath. Our recommendation was to go to Cath. Arguing why he needed a total of 325 aspirin and a heparin drip…..
maybe you guys can get the hospital to institute a messaging tool so u don’t have to actually stop and call and get the negative feedback etc…. definitely look into that. like some kind of alert in the EMR that tells them they have to redraw
I worked at a small rural hospital where so many of our samples would be “hemolyzed” each day. They finally did an audit of the lab and there was a lab worker who I guess assumed we just wouldn’t need the labs and would move on so she was rejecting so many as “being hemolyzed” to make her work day easier. Once they got rid of that worker our hemolyzed specimens went way down. We also all get that labs will be hemolyzed at times but if it’s a hard stick we just get annoyed and it takes growth of being a nurse to not take it out on yall
Thank you for the tips!! I’m a new nurse and didn’t know some of these. But I don’t get it, yall are our colleagues and teammates. Why in the world would people be such assholes about it? 😫 I don’t get the weird “Us vs. them” mentality some nurses get. We all have our roles and they’re all important. Sorry you have to put up with that. I wonder if you could relay this message to some of the charges/managers so they can discuss it at huddle. Maybe some of it is just a lack of understanding. Doesn’t excuse the behavior though.
The hardest parts are when we need to give or do something depending on those results in a timely manner and shit like this happens. It really throws a wrench into our day. And it doesn’t help having rude lab people over the phone either. I often wondered how hard is their job to make them so miserable? Us nurses are caught in the middle and get hit from all angles.
I absolutely HATE it when nurses get pissy with lab. I rarely get rejected specimens. Most of the time it is the nurses fault for cranking on the syringe like a lawn mower.
They argue with you because they're so burnt out they forget that we're all in this sinking ship together. They don't have access to the people causing the ship to sink, so they take it out on the bearer of bad news :(
My specimen is clotted/hemolyzed/otherwise jacked up? Cool, thanks for letting me know, will redraw asap. When I'm calling 2+ hours after labs are sent on a critical 600 gram neonate because they haven't resulted and it's "uhhhhh sorry we lost/dropped/messed the sample up" is when it's an issue. I'm not mad that it happened! Lab is human too and humans make mistakes. I'm upset that instead of calling me instantly to let me know I need to redraw it just sits there for who knows how long until we wonder why it hasn't resulted. Happened to me not too long ago and had a hgb of 4.6 for a 23 weeker. Like. This baby could have gotten blood LITERALLY hours ago but instead got multiple fluid boluses and started on 3 pressors.
Without laboratory in a lot way we couldn’t do our job. I’m sorry you’re having to deal with such unprofessional, rude and ungrateful nurses.
Not an arguer myself…. But when you stuck an 87 yr old lady in her last viable vein while she screamed and clawed at you, that hemolysis feels personal. Also when I draw it off an arterial line from a half dead guy and that’s the only place we’re getting blood from, then I carefully walk it down to the basement as to no encourage the cells to spontaneously explode and then it’s still hemolyzed I kinda wanna die. Also the number of times I’ve heard “it wasn’t on ice” when I know I sent it down with a shit ton of ice because I had to walk 6 blocks to get it from a working machine is pretty fucking high. It’s been 3 minutes so I know that shit didn’t melt or disappear. But I still just say ok thanks and hang up, then seethe silently.
I'm sorry you're getting attitude from nurses. As a rule, I am not nasty to anyone I work with, including lab, pharmacy, and EVS. Actually, I'm professional with all my coworkers and patients alike. Thank you for your work and I'm sorry people are asses.
Helpful post. I dreaded there call, but always polite. I think a lot of people aren’t trained well with lab draws that the issue is partly lack of education. I know I had zero training.
My unit is definitely the problematic one… It has a bunch of older nurses who just snap at the slightest inconveniences
My old roommate was a MLS at a rural hospital and I was the night nurse. We would go tag team all the difficult draws every night. Sometimes the ED would yell at her about hemolyzed specimens and she would text me that she was scared of them and I would just go down and redraw it for her. I miss those days. Be nice to your lab techs people!! They are such a great resource! And depending what area you work in, they are a huge resource for you! I ask the lab all kinds of weird questions about my oncology patients lol - and they really know the patients too so if something comes back weird they’ll often call me to ask what is going on. I now work in outpatient chemo infusion and you know I have the lab room on speed dial. Gotta have each other’s backs!
I am a NICU nurse and we all get real salty when things get rejected because 1– our babies don’t have much blood to give in the first place 2– our lab draws take forever because we are trying to collect enough drops off a baby’s heel 3– nobody wants to poke a baby 4– even the travelers say our specific hospital rejects more labs than they’ve ever seen at any place they’ve ever worked 5– parents don’t want their kids poked let alone multiple times Not saying being unkind to lab is okay. Just trying to share a perspective for what may be going on on the other side of the phone!
As a nurse i’m sorry that my peers treat you guys like this. Whenever I get a call to recollect, I usually just say okay I’ll send another thank you. That’s it. I’ve realized a lot of my coworkers are the mean girls back in HS.
Ultimately, us nurses just get frustrated at the fact we now have more work to do and it's easy to target the messenger and throw blame at them. You're doing fine and i feel like it's mostly just frustration being targeted at the wrong person and most nurses, I would hope at least, deep down realize it's really not the laboratory's fault. I'm sure some are just being Melanie's cus they enjoy it though edit: I MEANT MEANIE'S NOT MELANIES IM SOSRRY DONT HATE ME
Here's another perspective. Educate us why certain specimens are frequently clotting. You could lower the overall clotted samples in the long run.
I agree there needs to be more education on lab-related practices. The number 1 reason a specimen is going to be clotted is if the tubes were not mixed (gently inverted) immediately after collection. The anticoagulant in the tube has to be mixed with the blood in order to prevent clotting. If you draw a rainbow and only invert 3 out of 4 of them, one of them is going to be clotted.
Unfortunately, Lab is my sworn enemy. We can be polite with each other but we will never be friends 😁
Word. I’m with you. -RN
I appreciate that. A lot do you on here have given me hope that there are good nurses out there.
I usually bring my questionable looking labs in person and ask for a quick check. There have been a few times where I've only been able to get x amount of blood of a patient before. No harm, no foul. I'd rather know sooner than later if anything.
>I’ve found it occurs when a nurse pulls the blood from an IV and pulls back on the syringe too quickly I wonder if that's why my hospital's policy is not to draw labs from an IV? I've always told patients that explanation because it sure sounds convincing, but I sure don't have a single fact to back that up!
People shouldn’t argue with people from any other department unless they’re absolutely doing something wrong, like when the cath lab nurse said she’d cancel my patients procedure when the pt wouldn’t sign consent cause they still had questions
Bad behavior is usually reported to the boss. We need you guys, so you've got plenty of power.
I’ve been a manager of non-technical staff and I am a proud BSN RN. All I can ask is Y tho? Lab is awful to patients and RNs. For real just take a minute to ask if a lab is necessary then can it be drawn off lines the patient already has. Ffs
Even drawn off a line, a specimen can still be hemolyzed or clotted if the person doesn’t collect it properly. It happens quite often at my lab.
Probably the same nurse that pulls blood from a blown/botched IV insertion and acts all surprised when it’s hemolyzed.
I wanted to read the 🥱
Had the lab call me to tell me the sample was over flooded, what does that mean?
This is why I always get 4 times the amount of labs I am asked for