Patients are not pincushions

The drawing of blood in the hospital is organized by an incredibly complex system. We have phlebotomists who draw blood at specified intervals throughout the day, and if a physician decides that they want something drawn at another time, they generally have to do it themselves. Unfortunately, they do not have access to the Omnicell, which is like a giant system of lockers that store supplies for patients. That means that nurses have to fetch the supplies when they need them. A while ago, I took care of a man who was about 50 and had had a massive stroke earlier in the year. It left him bed-bound, unable to speak, and unable to perform fine motor movements. For some reason, the phlebotomists were unable to draw his blood in the morning. I still don't know whether it was because they couldn't find a vein or because the patient wouldn't hold still.

Later, in the busiest part of my morning, an intern (it was her third week as a doctor) came up to me and said, "I need to draw blood from your patient." "OK--what do you need?" In a "you're an idiot" voice, she said, "The stuff to draw blood." I said, "I realize that. What tubes do you need?" Again, in the idiot voice, "the stuff to draw blood!" At this point, I'm about to walk away, but I tried to give her the benefit of the doubt and asked, "what labs are you drawing?" She told me what she needed, and I went to get the supplies. When I returned, she looked at the supplies with a puzzled look and asked that I put the pieces together. Frustrated, I did it. Then she asked me to come into the room and help her. Begrudgingly, I agreed.

The doctor proceeded to begin to tie a tourniquet directly over my very tenuous IV. Yelling out, I told her that if she wanted to draw blood from that arm, I'd have to stop the IV fluids. Also, "could you please not tie the tourniquet right over the IV?" I stopped the fluids while she moved the tourniquet. She then took out the needle and successfully got the patient's vein. Then, she asked me what to do next. I stood, horrified, when I realized that she had no idea what she was doing, and it was too late to do anything about it, because the needle was already in the patient. Annoyed, I explained what to do. I was extremely irritated that she clearly had no idea what a vacutainer was or how it worked. Trying times, I tell you.

As a side note, as soon as she stuck him, he moved his arm. She kept yelling at him to please stay still, progressively getting louder while I got more and more annoyed. Finally, I told her, "yelling louder won't make him stay still. He can't follow your directions." When she yelled at him one more time, I lost it and said, "this patient cannot follow your directions. Do you know your patient at all?!"

Unfortunately, the vein she successfully stuck blew after the first tube of blood. The intern removed the needle from the patient and the patient's hand started dripping blood. Silly me, I had figured that since I had gotten her all the supplies she needed, she might have pulled out a bandaid and/or piece of gauze. The patient bled on the nice new sheets we had made the bed with. I couldn't help but make an obnoxious comment about how we'd have to fix them. In the meantime though, the intern was waving around an open needle. Waving is no exaggeration--my nursing student and I had to literally bend back a few times to avoid the swinging needle. Finally, I held my hands in front of me in a guarding-type position and I asked her, "can you please just cap that needle?" She ended up capping it with this tiny little plastic tube that initially covers the needle when you take it out of the package rather than the safety device that is attached to the needle itself. This caused me to release another scream, because she looked dangerously close to poking herself! She looked at me in an annoyed fashion and asked what was wrong. "You should NEVER cap a needle like that. It has a SAFETY device on it." Her excuse was that she didn't know about the safety device. My response: "We are here to take care of patients. One way we DON'T take care of patients is by treating them like pincushions and using equipment we don't know how to use on them. Where is your senior??" I told her not to draw any blood on any of my patients (and hopefully any others) until she knew how to do it before walking into the room. She said, "am I stressing you out?" "Uhh...yeah!"

Now, there was still that second tube of blood to draw. Because I was clearly so angry, the intern asked me if I would do it. While I technically could, none of the nurses ever draw blood on patients because we'd be asked to do it alllllll day otherwise. Nothing else would get done, and doctors would never learn how to properly order their labs for the phlebotomists. So I said no. She gave me an attitude, but she finally got the job done. Lucky for that intern, I haven't seen her on the floor since.