Dreading Monday

I just realized I've been sitting in front of this infernal machine avoiding the very real time that tells me it's time to head for bed.

I began the training of a new student on Friday. I'm a good teacher most of the time. When I feel as if I'm *not*, then it depresses the hell out of me.

So it is right this minute. The new student is "T", a woman who is probably close to me in age - dunno for sure, as I haven't asked her. She followed Samah twice last week, just observing how things are done. Now, each one of us eventually develops our own methods of stocking our trays, how we approach the patients, etc. My job as a trainer is to coordinate with Kathy (my boss), Dean (the other trainer) to develop plans to make the training methods as similar and cohesive as possible so we're all on the same page. Thus, Dean and I should both be teaching students how to do blood cultures the same, for example.

Because T had been out with Samah twice, when she became assigned to me, I sat down with her and showed her how to do the morning paperwork, which is done by taking the doctor's test requisitions, and comparing them to two identical sets of papers which list out the patients, their rooms, the test acession numbers, the other identifiers necessary and a listing of all the specific blood tests ordered. These are then compared to the labels we put on each tube after we draw them. All these things have to match.

T did fine with this, so I was hopeful that the rest of the day would go as smoothly. I explained to T that what I wanted her to do as she followed me was to a): Watch how I did things as I went into each patient's room, and b): I wanted her to palpate each patient to begin developing a finer sense of what the veins do in various patients, and then to pull the correct tubes and basic supplies from my tray. This is something I do exactly the same in each room. I walk into the room, identify myself to the patient, ask permission to turn the light on; I then glance at the labels to see what tests are ordered, and pull the correct tubes, two pieces of 2x2 gauze, an alcohol pad to cleanse the site I select. Same thing, every time. Only thing that changes are which tubes are pulled. I then put a tourniquet on the patient, find the vein, and decide if I'm going to use a straight needle, a butterfly needle or do some kind of a syringe draw, or a capillary stick.

I had 28 patients that day - that's a horrible amount that will mean a slow day right there, and it's worse when you've got a student with you because you're slowed down by them; you need to explain more, answer more questions that crop up, etc. That's why Dean and I both strive to have them start the preliminary set-up, and also have them sign off on the labels and get the samples into the bags for the lab. We can still *teach*, but we have someone doing the "grunt" work so we can keep going as quickly as possible.

As I said, I explained all this to T. We went to the first three patients and she only began pulling stuff after I reminded her I needed things. And this continued. I'd have her palpate each arm, I'd ask her what she would do, then go ahead with the draw if I thought it was correct, or I'd explain why I wasn't going to use the vein she had chosen. (New phlebotomists are so very afraid that if they can't see a prominent vein, it's not there). I would proceed with the draw, hand the filled tubes to T, who just stood there. I had to then remind her to take the label, notate the draw time and my initials, then put the correct label on each tube and bag it for the lab. And this went on...and on...and on.

It was well past our usual finishing time when we got back to the lab. T needed to draw a real human being before she can draw patients, so my buddy Anne volunteered to loan a vein to the cause. So, instead of absorbing anything we had done in the last four plus hours, T puts the tourniquet on Anne, sticks her with a straight needle hub (which is what I wanted her to do) and instead of *listening* to both Anne and I, she sees blood in the tube, and yanks the needle out of Anne's arm, thereby letting blood gush all over the place because she didn't hear both of us saying, "Tourniquet, take off the tourniquet before you do anything else." After you get the draw, the correct order of procedure is, 1. Loosen tourniquet, 2. Release the drawn tube from the hub to release the vaccum on the vein, 3. Pull the needle out of the arm and put gauze with pressure on the site, 4. Cap the needle so you don't stick yourself or anyone else in the "Zone of Death".

So, Anne is bleeding profusely, T is waving the needle all around in front of Anne's face, and she almost sticks herself because she didn't remember to cap the needle. *shakes head* And, I'm supposed to let her draw patients tomorrow. It's enough to make me want to call in sick.

What really bugs me more than anything, though, is we have a full group of students in training at Kirkwood right now, several of which have expressed a great deal of interest in working for the University. Yet, the U, in its infinite wisdom, hires someone who wanted to transfer out of her current no-patient-contact type job and gives her the opportunity to learn a skill, which, admittedly is taught to people as on-the-job training in many places, but it leaves one less opening for someone who has taken the time, spent the money, and has gone through an internship for placement in exactly that kind of job, when there are few enough phlebotomy jobs to go around anyway.

And, as an instructor, I'm stuck in that horrible no-man's-land of teaching 'by the book' and the 'real world' with someone who, right now, I'm afraid just isn't going to cut it as a phlebotomist. It's imperative that students understand that even though in the ideal world all things would go by the book, the real world indicates that this is just not so. So, even though we stress to students that you never never never EVER pull the finger out of a glove to feel a vein, reality says that if you only want to stick a patient one time, there are rare instances when you *do* have to pull that glove off, alcohol your fingertip well, and use that "bare" finger to feel the vein. And, you become part of the secret underground brother/sisterhood which becomes two-faced: you teach one Truth, all the while knowing that there is yet another Truth. And, when you become part of the second Truth, you have to be able to know that you can't speak of this even though you know it exists. And, one of the things I do fear is that T isn't smart enough to know to keep her mouth shut. I'll keep you informed if I end up in the office and lose my job as a trainer!

Anyway, I've vented...and I really *do* need to go to bed. Even though I slept a lot this weekend, I'll never get used to the alarm going off at 4 a.m.

Keep your fingers crossed for me this week.

Kate