* A lot of trusts make nurses jump through extra hoops to be allowed to take blood, even if they have been doing it routinely in a previous job.
* Some nurses might not be able to take bloods - until recently, I understand that this was an "enhanced skill" and not required to graduate from nursing school.
* Some nurses are overworked and will get in trouble if they haven't done their VTE assessments, pressure checks, drug round, documentation, etc which is much more likely if they've been doing bloods/cannulas.
* Some nurses are lazy and think the overpaid doctors are dumping work on them...
* Some nurses are told not to take bloods by their seniors because it sets up an expectation that nurses will always undertake this role.
I always give nurses the benefit of the doubt about this and just inform them, I have generally found most reduce how often they call for things like a cannula after they find it out just how many patients we have in our care. Doctors rota’s are complicated to keep track of, even for us.
If I get a cannula call OOH I will often just say ‘I’m covering x number of wards tonight by myself, even the unwell patients are having to wait x time. Has the bloods/cannula/other job nursing staff can do been escalated to the nurse in charge?’.
Nurse in charge should be able to help. If not I would call site team because that needs escalating, a nurse who can’t do such basic procedures during an arrest/peri arrest call should not be in charge.
None of my charge nurses were able to draw blood or put a cannula in. I moved to A&E and then when I did bank on the ward I would be doing all cannulas/venepuncture plus the 4 wards on the same corridor would come by and ask me to do theirs too.
It takes 6 months or more to get on the additional training for it in my old trust. I also got my training cancelled twice due to staff shortages. It's a joke.
Exactly. It’s a joke. And if we don’t escalate nothing happens (both nursing staff and doctors).
I don’t datix and report to site as a punishment, but as a genuine safety concern. A nurse in charge should be not just signed off but CONFIDENT in trouble shooting difficult venepuncture/cannulations/catheters. How on earth can they be running a ward and support more junior nursing staff if they they themselves can’t do these procedures.
Unfortunately I was made the "nurse in charge" regularly as a very newly qualified RN. Mainly because all other staff were agency. Happens all the time. Even more fun when you also have half a 40+ ward to care for!
Better thing to consider would be if the cannula is even needed OH and whether it can wait until day team. Better for the patient too as they can sleep peacefully
They aren't doing nothing and 99% of the stuff they do is shit I'm grateful I don't have to do. I work at a trust where there usually is a nurse or two on the ward who can do cannulas, bloods etc as well as HCAs. This means that apart from obstetrics (where I'm amazed at the lack of some basic skills the midwives have) I've done far less of these things than F1s at other trusts but I still understand why sometimes it does land on me. Putting a cannula in when they have three patients to roll and a delirious patinet trying to escape is hardly a priority when I could do it.
Nice to see a doctor on this sub Reddit give numerous reasons, rather than just jumping on the usual..
‘’THEYRE TOO LAZY TO DO SO!!!!!!!’’ shite you often see.
I think this comes idea comes from agency staff.
Often doctors are covering wards they don’t usually work on so can’t tell the difference between agency and regular staff. I found when covering my own day ward out of hours there was a clear split between the work done by regular staff vs agency, but to someone who didn’t know the staff the agency ones watching YouTube/having a nap made the whole ward look lazy.
I’m not sure if this is a problem across the board but I’ve had a few nursing friends moan about it to
They will take bloods if they work in ITU or want to appear important on the wards but it's either left to the phlebotomist (obviously only routine) or to the doc doing the clerking but but but them a cream cake and they might and you'd have saved them from the food bank!
Counterintuitively I've often found ICU nurses unable to take blood - presumably as they are used to looking after patients with central +/- arterial lines.
Ward nurses that learn to take blood have usually either worked in an area where this was expected (e.g. ED) or just want to be less dependent on doctors. Ultimately their jobs fall behind (and they have to give poor handovers) when they've missed IV drugs, gent levels haven't been sent on time, etc.
The most common answer you get is the hoops nurses have to jump through to get "signed off" to do bloods.
The hoops do exist, but are not the real issue.
Case in point. I worked on a ward where a good proportion of the nurses were all sent off to do a venipuncture / cannula course. Of course all juniors were extraordinarily enthusiastic in helping them complete their logbooks.
Nevertheless, a proportion never completed their logbooks. Those that did would for a time only try when the stars aligned and someone looked like they had good veins and the nurse felt inclined to try e.g had literally nothing else to do at that moment in time.
A month or so later and it was like the course had never even happened. Even the few nurses who did do a cannula here or there for a few weeks lost all confidence due to a self imposed lack of practice and no longer felt able to even attempt.
There was also pressure from more long in the tooth nurses for those who had been on the course not to be too enthusiastic, out of fear of it becoming expected and them having to train up.
The problem is human nature. If a regular ward nurse trains to do bloods all they are doing is adding on an extra potential duty to their days for zero personal benefit. Sure nurses with a eye on an ANP job or moving to critical care or whatever may do it as "CV padding", but then they get that job and are whisked away from the ward floor.
The only way to make more nurses do bloods is for your hospital / ward to make it a universally expected primary nurse duty. And who on earth wants to fight that fight? Certainly no one with the power to achieve it.
Been a while since I worked in a ward but it's a mixture of factors:
- practical: most nurses aren't signed off to do bloods and will be punished if they try to
- workload: they're often working out of ratio and too busy. when you're drowning in work, there is nothing to gain from an extra job nobody will pat you on the back for (even if it's beneficial for the patient)
- culture of the ward: some nurses fear others will be mad at them if they start doing bloods as expectations from doctors will shift
- previous toxic interactions: they may have done bloods in the past and got burned for it e.g. mislabelling it or taking it at the wrong time and were rudely told off
- laziness: they don't want to set up the expectation that they can do bloods
Most nurses on the wards haven’t been signed off as competent to do bloods/cannulas because there is an insane amount of paperwork stopping them from doing it fresh from nursing school even though they learn it.
Also as a doctor we can’t sign them off as competent. It’s ridiculous.
As a doctor you can sign off (in my trust) but obviously you're not lying I believe you, it's all trusts local bullshit policies and procedures making red tape
This is definitely a huge problem. I was a nurse for two years, and at every appraisal I had I asked to be put on a cannulation/phleb course until eventually they agreed. Problem is that hardly any of my nursing colleagues are trained so getting signed off takes forever. I promise you, most of us are just as pissed off as you are that we are stopped from doing such a basic skill.
I’ve been working in the nhs for 6 years .. Are the nurses that used to refuse to take bloods cos they were not trained to when I was a house officer 6 years ago now able to do them as they have had 6 years to learn and get signed off … I think you know what the answer is gonna be …
The typical argument made by trusts is that doctors can be held to a higher standard in determining their own personal competence and scope, while nursing staff and AHPs typically are expected to get things signed off.
I appreciate you’re being facetious but there is literally a list of skills you need to have competency in to finish medical school:
https://www.gmc-uk.org/-/media/gmc-site/education/downloads/guidance/practical_skills_and_procedures_a4_july_2023.pdf
Nurse here - give me a needle and a vein any day 😂 I suspect it may be department dependent. I’ve only ever worked in oncology for the last decade, more often than not we would be called on for the trickiest patients as absent veins are our bread and butter. Doctors were also grateful we were the only dept in the hospital with a policy that nurses could take cultures.
However, I totally know where you’re coming from as when I have done bank shifts in elderly care I was looked at as though I have three heads when I put a tray together to re-cannulate or bleed a patient!
Away from all that in the community private sector now and probably 80% of my work is blood tests 😅
It is always ludicrous for me that the Doctor covering 3 Wards overnight (100+ patients) is expected not to just assess, diagnose and put a treatment plan (what doctors are paid to do) but also do procedural skills (bloods, cannulas, catheters).
There also seems to be an expectation when nurses bleep you that bloods is a "doctors' job".
Absolutely ridiculous and unsafe
Escalate. If a ward says they have nobody competent in basic procedures out of hours explain politely this is dangerous for patients so you will be contacting site to see if they can help redistribute nursing staff and will be putting in a Datix that entire wards have nobody signed off in x procedure.
Site are often very senior nursing staff, they have very good oversight on who should be competent in what and when I’ve got them involved suddenly all the wards have at least someone signed off for procedures.
Just wanted to chime in here.
Whilst I personally agree with you that taking bloods is a basic procedure and one everyone should be trained in, it is unfortunately not a basic procedure in the nursing world.
It is literally defined as an "enhanced skill" in nursing land, defined by (probably) 100% of the Trusts policies. I personally haven't worked in a trust in England that doesn't define it as an enhanced skill. Every trust requires Nurses to do an extra course and get signed off on it.
The NMC attempted to remedy this, I was the first Nursing cohort (8 years ago) to undertake venepuncture as part of the degree. When I qualified the trust asked what evidence I had to suggest I could undertake venepuncture. I highlighted the new NMC standards and produced my degree certificate. They did not accept it. To this day it is still the same for all NQN's within my Trust. I hear other trusts are also no different still.
You might have 100+ patients which I absolutely sympathise with. Just remember that nurses might have 15+ patients on a ward with one healthcare assistant or perhaps two, if they’re lucky
In other European countries, it's pretty much a nurses job to bleed. Many of my colleagues coming from abroad found it quite shocking that in the UK most don't to be honest.
I was once working in an acute medical unit. Overnight staffing was meant to be 5 doctors on paper, 90% of the time we only had 3. On this occasion we only had 2, crazy night. Me and the other SHO running around like madmen.
Nurses on this unit unwilling to do bloods, cannulas and ECGs, “not our job”, “not signed off”, “short staffed” all the usual excuses.
On this night a nurse made a serious drug error. Not giving specifics however this necessitated repeat bloods on multiple occasions overnight to monitor a certain parameter. In hindsight this was probably excessive but that’s the plan we were handed over at the time.
Due to the short staffing, we weren’t able to keep up with the bloods because of the already excessive workload and the patient in question was clinically well. I have never been harassed more by nursing staff over bloods, not out of concern for the patient but trying to cover their colleagues ass. Still total refusal to do the bloods themselves. By the time it got to 2 hours late for one of the tests, they “magically” found someone to do them. This knight in shining armour happened to be someone who previously claimed to not be signed off. Either blatantly lying beforehand or acting outside of competency to cover their mate.
TL;DR If they wanted to do it, they could
I accept the necessary sign offs and paperwork are a pain but hardly insurmountable, I have witnessed multiple nurses refuse opportunities to progress in this regard but as soon as they’re applying for more advanced roles or postgrad courses etc they are hell for leather in getting it signed off.
As a doctor from sub continent when I first started I was amazed to hear that nurses dont do bloods. It is deemed core compentncy in asia and most european country but hey its NHS and tbh not surprised anymore.
because they do not know how to or they feel incompetent or afraid, they're weak specially the 'local' ones who are most of the time 'all talk' but no skills - I'm a nurse by the way
It is amusing how such a basic skill that can contribute to patient care and management is not allowed or made easily achievable by the so called people who preach daily about ‘patient safety’ and ‘team work’ above all.
Apart from ED (which I'm in no hurry to go back to. Ever) the only nurse that attempted to phleb/PVC was one nurse in charge.
Said she'd attempted but didn't even unpack a PVC to put needle to skin because she couldn't see a vein let alone feel for one. Really pissed me off, thanks for helping, actually wait you didn't even help...
I always bounce back for them to call the oncall phleb service (not the anaesthetists lol) to do it before I come. There's always some push back and some complaint how they'll have to wait. But if they need to wait (and aren't unwell) then they'll wait.
Complete a bit of datix idc. Way to resolve a datix would be to complete. Training. In. Basic. Clinical. Skills.
Bleep the site manager, say you’re swamped and you need support for venepuncture while on your on call shift. They will know if the nurses on that ward can do it and delegate formally to them.
If you’re not swamped, just take the blood test and cannulate as per clinical urgency.
If site manager can’t help, let your boss know you’re stretched.
What if instead of either doctors or nurses taking bloods and doing minor procedures, we make it the sole duty of the quacks to do bloods and cannulas. Whoops sorry I misspelled PA 😂
Very simply, we're overloaded.
I'm v happy to do bloods- if I have time, which I rarely do.
All back to government mismanagement through cuts. We're all victims of this, so let's not give them 'divide n rule'.
A big reason why I have decided on pathology as a specialty - a hidden gem and everyone is a lot nicer and actually does their job compared to patient facing medicine where everyone makes your life harder. It’s just a cultural thing I think that other staff crap on residents (going to use the term ‘resident’ for trainee doctors as that is the correct term now I think)
The majority of ward nurses just can't take bloods (in my trust). It's not a obstructive thing.
We weren't taught at uni (although I believe it is now being taught) and it is an additional skill that we have to go on a course and be signed off for. This isn't something that is facilitated for many ward nurses.
I work in ED though and all our staff do get put on cannukation and venesection training (nurses and HCAs) although new starters and agency staff may not be able to.
I also know some HCAs who have refused to do it at all and some who will venesect but not cannulate (feel it is responsibility beyong their band).
In the ICU I cover overnight last night there were 3 patients and 5 nurses (2 very senior). One of the patients didn’t have an Aline but needed a bloods. They put the bloods out for phlebs to do!! When I realised at 630 I took them myself but surely this is INSANE
I’ve worked in 2 different ITUs and in both of them there were no nurses who could cannulate or take bloods. So if pt had no art line/PICC etc it was doctors’ job to take bloods. Madness.
Because that's NHS trying to reinvent the wheel again. Instead of having a strong base of competent nurses, we have a huge gap between bedside nurses with very limited skill and alphabet soup nurses who like to play doctors.
They’re incredibly busy - nursing ratios have been getting worse so each has to work more. They have to spend even more time on bs documentation. Trusts make them jump through hoops to be able to do stuff.
We’re short staffed in all areas which is showing.
This is why assistants who can do such “simple” tasks in/out hours were not a bad idea… lol
Cause they're lazy and they can make you do it.
I personally do a prolonged teaching session where I make them do it. If they say they're busy I tell them to call me when they're free.
People will offload work onto you if you let them.
In reality the nurse are generally massively overstretched.
They have a completely ridiculous amount of documentation (because “if it’s not documented it’s not done “), meds rounds which can take hours and all the personal care stuff.
Trusts also make perfectly competent people jump through ludicrous hoops to re-prove their competence to do these tasks then refuse to pay them more for it. So why would they put themselves through it?
It’s rarely nurses being lazy.
Doctors these days don’t know they’re born.
Nurses didn’t used to give IV drugs, that was a doctors job.
They certainly didn’t take blood or insert cannulas when I was a PRHO. I remember weekends with no phlebotomy. First job - take all the daily bloods from all the patients on 5 wards. Never mind referrals and acute deterioration.
Learn to prioritise and if you can do it then just get on with it.
Unless you want to do the nurses jobs whilst they put a cannula in. Thought not.
"Back in my days we only had halothan and we still managed...." Why is it hard for some people to take their blindfolds off and see that if NHS nurses did what the rest of the world does, things on the ward would just go more smoothly AND it would be more cost-effective? Back where I'm from, we don't need to employ phlebotomists, we just have competent nurses who do their bloody job.
* A lot of trusts make nurses jump through extra hoops to be allowed to take blood, even if they have been doing it routinely in a previous job. * Some nurses might not be able to take bloods - until recently, I understand that this was an "enhanced skill" and not required to graduate from nursing school. * Some nurses are overworked and will get in trouble if they haven't done their VTE assessments, pressure checks, drug round, documentation, etc which is much more likely if they've been doing bloods/cannulas. * Some nurses are lazy and think the overpaid doctors are dumping work on them... * Some nurses are told not to take bloods by their seniors because it sets up an expectation that nurses will always undertake this role.
All spot on. Only thing I might add is some nurses genuinely think you're only covering 1-2 wards, not the 10-12 you probably are if this is medicine!
I always give nurses the benefit of the doubt about this and just inform them, I have generally found most reduce how often they call for things like a cannula after they find it out just how many patients we have in our care. Doctors rota’s are complicated to keep track of, even for us. If I get a cannula call OOH I will often just say ‘I’m covering x number of wards tonight by myself, even the unwell patients are having to wait x time. Has the bloods/cannula/other job nursing staff can do been escalated to the nurse in charge?’. Nurse in charge should be able to help. If not I would call site team because that needs escalating, a nurse who can’t do such basic procedures during an arrest/peri arrest call should not be in charge.
None of my charge nurses were able to draw blood or put a cannula in. I moved to A&E and then when I did bank on the ward I would be doing all cannulas/venepuncture plus the 4 wards on the same corridor would come by and ask me to do theirs too. It takes 6 months or more to get on the additional training for it in my old trust. I also got my training cancelled twice due to staff shortages. It's a joke.
Exactly. It’s a joke. And if we don’t escalate nothing happens (both nursing staff and doctors). I don’t datix and report to site as a punishment, but as a genuine safety concern. A nurse in charge should be not just signed off but CONFIDENT in trouble shooting difficult venepuncture/cannulations/catheters. How on earth can they be running a ward and support more junior nursing staff if they they themselves can’t do these procedures.
Unfortunately I was made the "nurse in charge" regularly as a very newly qualified RN. Mainly because all other staff were agency. Happens all the time. Even more fun when you also have half a 40+ ward to care for!
Sheesh, that’s grim. Does not sound safe too. The populace deserves better than this, but how do we push to achieve it?
Better thing to consider would be if the cannula is even needed OH and whether it can wait until day team. Better for the patient too as they can sleep peacefully
100%
Thats one of the things which differentiates good hospital management to a useless one. May be include this in feedback by all junior doctors.
Why do we pay people to do nothing? Increasingly, i have found that more and more things are not a nurse’s job or things they can’t do.
Seems a bit unfair. They're not doing nothing.
> Why do we pay people to do nothing? Well they're not doing nothing are they? This is the exact same type of rhetoric used to degrade doctors
They aren't doing nothing and 99% of the stuff they do is shit I'm grateful I don't have to do. I work at a trust where there usually is a nurse or two on the ward who can do cannulas, bloods etc as well as HCAs. This means that apart from obstetrics (where I'm amazed at the lack of some basic skills the midwives have) I've done far less of these things than F1s at other trusts but I still understand why sometimes it does land on me. Putting a cannula in when they have three patients to roll and a delirious patinet trying to escape is hardly a priority when I could do it.
Lack of some midwifery skills! Spot on.
They like to diagnose though!!!!?🤦🏻
Lol.
Nice to see a doctor on this sub Reddit give numerous reasons, rather than just jumping on the usual.. ‘’THEYRE TOO LAZY TO DO SO!!!!!!!’’ shite you often see.
I think this comes idea comes from agency staff. Often doctors are covering wards they don’t usually work on so can’t tell the difference between agency and regular staff. I found when covering my own day ward out of hours there was a clear split between the work done by regular staff vs agency, but to someone who didn’t know the staff the agency ones watching YouTube/having a nap made the whole ward look lazy. I’m not sure if this is a problem across the board but I’ve had a few nursing friends moan about it to
Yeah actually that’s probably pretty accurate, I hadn’t considered that being the case.
This.
They will take bloods if they work in ITU or want to appear important on the wards but it's either left to the phlebotomist (obviously only routine) or to the doc doing the clerking but but but them a cream cake and they might and you'd have saved them from the food bank!
Counterintuitively I've often found ICU nurses unable to take blood - presumably as they are used to looking after patients with central +/- arterial lines. Ward nurses that learn to take blood have usually either worked in an area where this was expected (e.g. ED) or just want to be less dependent on doctors. Ultimately their jobs fall behind (and they have to give poor handovers) when they've missed IV drugs, gent levels haven't been sent on time, etc.
The most common answer you get is the hoops nurses have to jump through to get "signed off" to do bloods. The hoops do exist, but are not the real issue. Case in point. I worked on a ward where a good proportion of the nurses were all sent off to do a venipuncture / cannula course. Of course all juniors were extraordinarily enthusiastic in helping them complete their logbooks. Nevertheless, a proportion never completed their logbooks. Those that did would for a time only try when the stars aligned and someone looked like they had good veins and the nurse felt inclined to try e.g had literally nothing else to do at that moment in time. A month or so later and it was like the course had never even happened. Even the few nurses who did do a cannula here or there for a few weeks lost all confidence due to a self imposed lack of practice and no longer felt able to even attempt. There was also pressure from more long in the tooth nurses for those who had been on the course not to be too enthusiastic, out of fear of it becoming expected and them having to train up. The problem is human nature. If a regular ward nurse trains to do bloods all they are doing is adding on an extra potential duty to their days for zero personal benefit. Sure nurses with a eye on an ANP job or moving to critical care or whatever may do it as "CV padding", but then they get that job and are whisked away from the ward floor. The only way to make more nurses do bloods is for your hospital / ward to make it a universally expected primary nurse duty. And who on earth wants to fight that fight? Certainly no one with the power to achieve it.
Thankfully no one important will be harmed by this selfishness - just a sick patient here or there.
Been a while since I worked in a ward but it's a mixture of factors: - practical: most nurses aren't signed off to do bloods and will be punished if they try to - workload: they're often working out of ratio and too busy. when you're drowning in work, there is nothing to gain from an extra job nobody will pat you on the back for (even if it's beneficial for the patient) - culture of the ward: some nurses fear others will be mad at them if they start doing bloods as expectations from doctors will shift - previous toxic interactions: they may have done bloods in the past and got burned for it e.g. mislabelling it or taking it at the wrong time and were rudely told off - laziness: they don't want to set up the expectation that they can do bloods
Most nurses on the wards haven’t been signed off as competent to do bloods/cannulas because there is an insane amount of paperwork stopping them from doing it fresh from nursing school even though they learn it. Also as a doctor we can’t sign them off as competent. It’s ridiculous.
As a doctor you can sign off (in my trust) but obviously you're not lying I believe you, it's all trusts local bullshit policies and procedures making red tape
Not to be too kind to trusts but I guarantee this nonsense is coming from the insurance.
Very much doubt it, they're covered by CNST which has very broad coverage.
This is definitely a huge problem. I was a nurse for two years, and at every appraisal I had I asked to be put on a cannulation/phleb course until eventually they agreed. Problem is that hardly any of my nursing colleagues are trained so getting signed off takes forever. I promise you, most of us are just as pissed off as you are that we are stopped from doing such a basic skill.
Why pull nurses off valuable paperwork duties when you've got a couple of dirt cheap FY1-3 who will have to do it any way if the nurses dont?
Two years? Is that it?
I’ve been working in the nhs for 6 years .. Are the nurses that used to refuse to take bloods cos they were not trained to when I was a house officer 6 years ago now able to do them as they have had 6 years to learn and get signed off … I think you know what the answer is gonna be …
Those nurses are now managers walking around with clipboards
True n tragic.
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Completing medical school
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The typical argument made by trusts is that doctors can be held to a higher standard in determining their own personal competence and scope, while nursing staff and AHPs typically are expected to get things signed off.
I appreciate you’re being facetious but there is literally a list of skills you need to have competency in to finish medical school: https://www.gmc-uk.org/-/media/gmc-site/education/downloads/guidance/practical_skills_and_procedures_a4_july_2023.pdf
Nurse here - give me a needle and a vein any day 😂 I suspect it may be department dependent. I’ve only ever worked in oncology for the last decade, more often than not we would be called on for the trickiest patients as absent veins are our bread and butter. Doctors were also grateful we were the only dept in the hospital with a policy that nurses could take cultures. However, I totally know where you’re coming from as when I have done bank shifts in elderly care I was looked at as though I have three heads when I put a tray together to re-cannulate or bleed a patient! Away from all that in the community private sector now and probably 80% of my work is blood tests 😅
Because: - They’re often are busy with their own list of bs jobs - There’s no consequence when they refuse - Some aren’t trained/signed off
It is always ludicrous for me that the Doctor covering 3 Wards overnight (100+ patients) is expected not to just assess, diagnose and put a treatment plan (what doctors are paid to do) but also do procedural skills (bloods, cannulas, catheters). There also seems to be an expectation when nurses bleep you that bloods is a "doctors' job". Absolutely ridiculous and unsafe
Escalate. If a ward says they have nobody competent in basic procedures out of hours explain politely this is dangerous for patients so you will be contacting site to see if they can help redistribute nursing staff and will be putting in a Datix that entire wards have nobody signed off in x procedure. Site are often very senior nursing staff, they have very good oversight on who should be competent in what and when I’ve got them involved suddenly all the wards have at least someone signed off for procedures.
Just wanted to chime in here. Whilst I personally agree with you that taking bloods is a basic procedure and one everyone should be trained in, it is unfortunately not a basic procedure in the nursing world. It is literally defined as an "enhanced skill" in nursing land, defined by (probably) 100% of the Trusts policies. I personally haven't worked in a trust in England that doesn't define it as an enhanced skill. Every trust requires Nurses to do an extra course and get signed off on it. The NMC attempted to remedy this, I was the first Nursing cohort (8 years ago) to undertake venepuncture as part of the degree. When I qualified the trust asked what evidence I had to suggest I could undertake venepuncture. I highlighted the new NMC standards and produced my degree certificate. They did not accept it. To this day it is still the same for all NQN's within my Trust. I hear other trusts are also no different still.
You might have 100+ patients which I absolutely sympathise with. Just remember that nurses might have 15+ patients on a ward with one healthcare assistant or perhaps two, if they’re lucky
In other European countries, it's pretty much a nurses job to bleed. Many of my colleagues coming from abroad found it quite shocking that in the UK most don't to be honest.
Shocking indeed
“Cannula has tissued, patient needs IV Abx, needs new cannula, I’m on break”
Got to document first "call bell provided, sandwich given, pt refused hot drink, daughter unhappy that we only had coffee and not iced latte"
this
I was once working in an acute medical unit. Overnight staffing was meant to be 5 doctors on paper, 90% of the time we only had 3. On this occasion we only had 2, crazy night. Me and the other SHO running around like madmen. Nurses on this unit unwilling to do bloods, cannulas and ECGs, “not our job”, “not signed off”, “short staffed” all the usual excuses. On this night a nurse made a serious drug error. Not giving specifics however this necessitated repeat bloods on multiple occasions overnight to monitor a certain parameter. In hindsight this was probably excessive but that’s the plan we were handed over at the time. Due to the short staffing, we weren’t able to keep up with the bloods because of the already excessive workload and the patient in question was clinically well. I have never been harassed more by nursing staff over bloods, not out of concern for the patient but trying to cover their colleagues ass. Still total refusal to do the bloods themselves. By the time it got to 2 hours late for one of the tests, they “magically” found someone to do them. This knight in shining armour happened to be someone who previously claimed to not be signed off. Either blatantly lying beforehand or acting outside of competency to cover their mate. TL;DR If they wanted to do it, they could I accept the necessary sign offs and paperwork are a pain but hardly insurmountable, I have witnessed multiple nurses refuse opportunities to progress in this regard but as soon as they’re applying for more advanced roles or postgrad courses etc they are hell for leather in getting it signed off.
Because everyone forgets that phlebotomist exists.
Why do domestics refuse to do washing up? That wouldn't happen if I was running the NHS. Which is why I do not run the NHS!!
As a doctor from sub continent when I first started I was amazed to hear that nurses dont do bloods. It is deemed core compentncy in asia and most european country but hey its NHS and tbh not surprised anymore.
because they do not know how to or they feel incompetent or afraid, they're weak specially the 'local' ones who are most of the time 'all talk' but no skills - I'm a nurse by the way
lazy
It is amusing how such a basic skill that can contribute to patient care and management is not allowed or made easily achievable by the so called people who preach daily about ‘patient safety’ and ‘team work’ above all.
Apart from ED (which I'm in no hurry to go back to. Ever) the only nurse that attempted to phleb/PVC was one nurse in charge. Said she'd attempted but didn't even unpack a PVC to put needle to skin because she couldn't see a vein let alone feel for one. Really pissed me off, thanks for helping, actually wait you didn't even help... I always bounce back for them to call the oncall phleb service (not the anaesthetists lol) to do it before I come. There's always some push back and some complaint how they'll have to wait. But if they need to wait (and aren't unwell) then they'll wait. Complete a bit of datix idc. Way to resolve a datix would be to complete. Training. In. Basic. Clinical. Skills.
Datix is a good idea
Like you, a lot of nurses are either bank or locum, they are either not trained or not bothered.
Bleep the site manager, say you’re swamped and you need support for venepuncture while on your on call shift. They will know if the nurses on that ward can do it and delegate formally to them. If you’re not swamped, just take the blood test and cannulate as per clinical urgency. If site manager can’t help, let your boss know you’re stretched.
What if instead of either doctors or nurses taking bloods and doing minor procedures, we make it the sole duty of the quacks to do bloods and cannulas. Whoops sorry I misspelled PA 😂
When I was in hospital recently the nurses and HCAs took bloods, the Dr only did the blood gasses but that's it.
Very simply, we're overloaded. I'm v happy to do bloods- if I have time, which I rarely do. All back to government mismanagement through cuts. We're all victims of this, so let's not give them 'divide n rule'.
A big reason why I have decided on pathology as a specialty - a hidden gem and everyone is a lot nicer and actually does their job compared to patient facing medicine where everyone makes your life harder. It’s just a cultural thing I think that other staff crap on residents (going to use the term ‘resident’ for trainee doctors as that is the correct term now I think)
The majority of ward nurses just can't take bloods (in my trust). It's not a obstructive thing. We weren't taught at uni (although I believe it is now being taught) and it is an additional skill that we have to go on a course and be signed off for. This isn't something that is facilitated for many ward nurses. I work in ED though and all our staff do get put on cannukation and venesection training (nurses and HCAs) although new starters and agency staff may not be able to. I also know some HCAs who have refused to do it at all and some who will venesect but not cannulate (feel it is responsibility beyong their band).
In the ICU I cover overnight last night there were 3 patients and 5 nurses (2 very senior). One of the patients didn’t have an Aline but needed a bloods. They put the bloods out for phlebs to do!! When I realised at 630 I took them myself but surely this is INSANE
I’ve worked in 2 different ITUs and in both of them there were no nurses who could cannulate or take bloods. So if pt had no art line/PICC etc it was doctors’ job to take bloods. Madness.
Because that's NHS trying to reinvent the wheel again. Instead of having a strong base of competent nurses, we have a huge gap between bedside nurses with very limited skill and alphabet soup nurses who like to play doctors.
They’re incredibly busy - nursing ratios have been getting worse so each has to work more. They have to spend even more time on bs documentation. Trusts make them jump through hoops to be able to do stuff. We’re short staffed in all areas which is showing. This is why assistants who can do such “simple” tasks in/out hours were not a bad idea… lol
Everyone is “busy” but it should technically be their job. A better excuse is that the trust’s don’t allow them because of formalities.
It wasn't part of my job when I trained.
Cause they're lazy and they can make you do it. I personally do a prolonged teaching session where I make them do it. If they say they're busy I tell them to call me when they're free. People will offload work onto you if you let them.
In reality the nurse are generally massively overstretched. They have a completely ridiculous amount of documentation (because “if it’s not documented it’s not done “), meds rounds which can take hours and all the personal care stuff. Trusts also make perfectly competent people jump through ludicrous hoops to re-prove their competence to do these tasks then refuse to pay them more for it. So why would they put themselves through it? It’s rarely nurses being lazy.
Doctors these days don’t know they’re born. Nurses didn’t used to give IV drugs, that was a doctors job. They certainly didn’t take blood or insert cannulas when I was a PRHO. I remember weekends with no phlebotomy. First job - take all the daily bloods from all the patients on 5 wards. Never mind referrals and acute deterioration. Learn to prioritise and if you can do it then just get on with it. Unless you want to do the nurses jobs whilst they put a cannula in. Thought not.
"Back in my days we only had halothan and we still managed...." Why is it hard for some people to take their blindfolds off and see that if NHS nurses did what the rest of the world does, things on the ward would just go more smoothly AND it would be more cost-effective? Back where I'm from, we don't need to employ phlebotomists, we just have competent nurses who do their bloody job.
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I don't get paid to be pushing beds, yet here I am.