Sad work day.

No, nothing "sad" sad happened today. I define sad in this instance as just a day where the things I observed were pathetic, as in poorly done. It's only my opinion, and I guess maybe I'm overreacting because where my work craft is concerned, I'm anal about doing things right.

And, I didn't see them being done right. So many things make me feel like my work environment is going to hell in a handbasket. As a teacher, I am obligated to teach things by the book. In this case, the "book" is guidelines set up by governing agencies that license labs. Studies are done and care is taken to make things the best they can for both the patient's welfare and the lab itself. For example, what good does it do a patient to have a blood culture if it is supposed to be done under sterile conditions, yet the phlebotomist doesn't bother to put on sterile gloves? That's your taxpayer's dollars at work, folks...if the people hired by the state to do these jobs don't do them properly, the very bottom line for those mistakes comes out of the taxpayer's pocket, and one also must consider the patient's health and well-being.

I've mentioned before that one of these days I'll write about the antics that have gone on since our new supervisor came on board. But that would take far longer than I have time for right now; I've got to get this off my chest, then get things lined up for class tonight, not to mention more laundry and if I'm lucky, some knitting time to destress myself a bit.

But, today was sadly enlightening. After I was done with my floor today, I accompanied Abir down to the peds floor to observe. I'm thinking about taking the training for peds, just so I can help out if necessary. I don't want to be in charge of getting the draws for the floor, but I can help out, and I think I may be willing to do that much. We'll see. After today I really am uncertain.

Why, you might ask? Because as an instructor I must know *how* peds works; must know how to do heelsticks and fingersticks even if they are not part of my daily work schedule. And, I have worked peds, I just don't like to work peds. It tears my heart to bits to see those wee souls sick and hurt. With grown ups, you can almost figure that in a huge percentage of cases, they got themselves into whatever fix they might be in.

Anyway, I followed along to peds. Child one was older, and was a regular draw. Child two was a fingerstick. Child three was a heelstick and therein began my sadness. Abir is a wonderful phlebotomist with adults. And, personality wise, very good with the kids, too. But when she went to heelstick this child, she wasn't doing it correctly. Oh yeah, she held the heel right, she just didn't do the stick with the lancet correctly. She didn't seem to even realize where to place the lancet. Consequently, the baby's heel didn't bleed enough to get the samples we needed. She decided to wrap the baby's heel in a warm pack for several minutes and we'd come back after the foot warmed up. That was okay and the correct thing to do in this instance.

And, off to the next child, another fingerstick. No problem. Back to baby, whose foot is now comfortably warm. Instead of doing the poke on the other side of the heel opposite her first attempt, she chose the same side, and more centered into the foot...a BIG no no. Once more, the child did not bleed enough to get the sample.

A venous draw was the next attempt. Found a vein, but it also would not bleed. The child's dad said that they'd had a rough time getting blood from the child the day before. The doctor came in, asked if we were getting the labs. We said no, and explained, and showed her the tube which we were trying to fill.

The doc said, "Well, if you can't get all the labs, then what we need is to check the potassium level. Get that if you can."

Uh, yeah. The order of draw for a heelstick is to draw the hemotology tubes first, followed by the chemistry. Potassium is a chemistry test. There was no way we were going to get that tube.

"Just cancel the CBC, then and get the potassium," the doctor said. Doc, you're not listening to us. We can't get the potassium - we can't get enough blood for ANY of the tests you've ordered.

She then said, "Well, it won't do you any good to get the potassium, because the baby is crying so hard that the test results will be skewed on the potassium anyway."

"Doctor, do you want us to cancel the tests?"

"No, keep trying." And she walked out of the room.

Abir and I looked at each other and packed up the gear and went to talk to the baby's nurse. The test got cancelled. As it turned out, the baby was due to be dismissed anyway. I'll never understand decisions to release the patient and still insist on more blood draws right before the patient leaves.

Abir and I were getting ready to leave when we heard our names called. Snippet was coming after us, begging us to come take a look at the child she wasn't able to get the stick on. We went in there, and though Abir did her best, it looked like prior to our arrival things were being done in a very lazy manner; not a surprise where Snippet is concerned, I'm afraid. She oftentimes looks for ways to get out of her work.

The supervisor was on that floor, too. Again, I observed methods that are not part of the procedure.

And, I'm stuck (no pun intended). I have no authority to make any changes. Once I'm done training people and they're signed off and on their own, there's nothing I can do that I know of to get things back on the correct path. Doesn't do any good to talk to the supervisor. Tried that; she thinks that if I perceive a problem, then I'm having "a personality conflict" with that phlebotomist. Not at all. I just want them to do their job according to procedure, dammit! But, at this moment in time, it appears unlikely that some things can or will be corrected. I'll teach my students the proper way, I'll do my own job properly, and just continue to do the best I can.

Thank goodness I can vent about it here.