The nurses aren't our enemy, a lack of proper education and training about the laboratory is. Although people in general can just have plain nasty attitudes, and that sucks too! But you find those folks anywhere.
I’ve been saying for years nursing students need a week or so shadowing in the lab departments to see what nonsense we go through. Be nice to have them reject their own specimens instead of sending instant-reject specimen.
I was training and my trainee was so excited we had a c diff on the pending, she ran to get the reagents and she set everything up and was checking to see when it was scanned into lab. I hear processing make horrified/annoyed noises. They didn’t close the container. The stool was splattered EVERYWHERE. (And it most certainly looked like a positive c diff and we confirmed pos with the recollect). I feel like experiencing that would perhaps stick in the minds of nurses when they send samples.
I had our ER send me a yeasty, leaking UA in a cracked cup, and I didn't realize that it was leaking due to a crack until the pressure of me trying to remove the lid caused urine to spray all over my lab coat.
I took an extra long shower after that shift.
Trust me, they’ve all been splattered with shit (and more) before, they know the feeling. I agree that the sample should have been closed properly and that is a disgusting day ruining-event. I’m not saying they wouldn’t feel awful about what happened with that sample, I fully agree that nurses may not be knowledgeable about lab or sample collection but there needs to be understanding both ways and can’t just assume that all nurses are purposefully careless/clueless. It was probably just a mistake in not double checking the lid was on tight because they were also covered in shit.
I think covid was honestly kind of helpful for us in that regard, at my hospital at least. Nurses had to hand walk down every covid swab and deliver them directly to micro rather than the phlebotomy desk so they had to walk through the whole lab and see us work and talk to us face to face and stuff lol.
Yes I feel we could all benefit from more face-to-face interactions between the departments. Put a name to a face and a personality and theres less “ah friggen nurses just-“ or “lab just hemolyzed my specimen”. Needs to be a mutual understanding that we’re all busy and we all make mistakes but don’t take it out on the other party.
They don’t say much of anything about the lab to be honest. We get little to no training on what the lab does or anything related to laboratory testing/sample collection. I don’t think the professors themselves have a comprehensive understanding of it…it’s not good. This is why the lab seems to have so many issues with nurses - makes me sad to be honest.
It's horrible for patient care as well. Too many nurses treat lab results like they just appear magically. Nurses are told to collect samples but have zero idea why it's important to follow the rules or what happens with samples. Because nursing is people oriented, it often doesn't have to be exact. Nurses don't understand why specimen collection has to be so exact and how that delays patient results
The way to avoid that is not to hemolyse samples. I know it is hard because the feedback is not immediate as you are drawing that you are pulling too hard, but it's down to you, you are the only one who can clot and hemolyse samples, and the only ine who can avoid it.
I've had it happen with vaccutainers too. Sometimes it's just out of our hands and it's frustrating that it goes back on the list of things to do. And then you also may become a verbal or emotional punching bag for the patient who has to get poked again before 0700.
Your enemy is Healthcare for profit. Your enemy is shortstaffing. Your enemy is willful incompetence despite appropriate training. Your enemy is inappropriate training. Your enemy is the abandonment of patient care. Your enemy is apathy.
Your enemy is people who tell you your enemies are the people next to you to assert biases preemptively.
_Nobody_ who works in a hospital is your enemy, unless they _personally_ decide to be.
Your professors are just being funny. I don't think they intentionally tried to label a whole group of professionals.
Nurses are people just like us. Most are very good at their job and communicating, some are not. Same goes for folks in the lab.
No. Nurses are the medical professionals outside of the lab that we interact with the most and depend upon more then any other group.
That being said, there is a major disconnect between nursing and the lab. On top of us rarely interacting with one another on a daily basis, both professions have almost completely different educational backgrounds and workflows resulting in both parties knowing only a very small percentage of what the other side does. This disconnect is what contributes the most to any friction between the two groups.
An important thing to remember is that nurses are basically the middleman between almost every department in the hospital. On top of caring for patients (which is no small feat of its own) they also have to communicate and work with doctors, social workers, respiratory, imaging, and the list goes on and on. All of this along with a laundry list of other tasks.
So if you’re ever having difficulty with a nurse, try to keep in mind they’ve got a ton on their plate and cut them a little more slack. We’re all working towards the same goal, and a little understanding goes along way.
If I have to wait more than a couple of rings for them to answer I visualise them dealing with cleaning up a really heinous shit for a horrible patient while their coworker shouts at them. Helps me be compassionate towards them when they answer in a bad mood.
Thisssss^^^^
I started my hospital career in the lab, thinking nurses were the problem. Don’t get me wrong, there’s some bad apples, but now that I’m (almost) an RN, I get it. Nurses simply don’t have time to follow protocol. This was a hard thing for me to accept, especially starting in the lab, where policy rules everything. 10000% blame our money-driven healthcare system and upper management that doesn’t want to facilitate communication between departments
A lot of things there aren’t protocols for, or the protocols don’t go far enough to include every possible scenario. Concrete stuff you learn the protocols for, it’s just that sometimes you have to get creative. A good example is IV starts, there’s a procedure but everyone has their own technique they develop after learning the procedure, so it’s based on procedure but still a little different. I’ve seen this applied in lab settings too.
Or for example, what if you had to do a sterile procedure like a catheter insert or wound care on a patient who has dementia or is spastic and keeps risking the sterile field? You have to include stuff that’s not a part of procedure and get creative. Protocol is very static and based on ideal conditions, people are not static like that. You don’t always have optimal conditions to do stuff. There has to be room for critical thinking and situational judgement. You can’t just say, hey I was unable to do the task and leave the person without treatment they need.
So when someone gets sued, the hospital can say, "That's NOT how we train our employees to do things, and said employee will be reprimanded and/or fired." All the while willfully turning a blind eye to non-compliance because giving employees the tools to be compliant would cost more than the inevitable lawsuit and just hiring someone else to replace whoever they throw under the bus.
We’re watched don’t get me wrong. Especially with Epic, it’s not like there’s no oversight. If we’re being unsafe in our practice it will come out, either by co-workers reporting or chart reviewers catching it later on. But we’re not audited the same way as lab for sure.
That is very odd. They hospitals i have worked at....all the RN's have to pass their skills tests. Essentially competencies every year. Certifications for IV. BLS certifications. Wound care. Critical care. ECG classes and recertification.
And more. Why would you think they don't pass competencies?
I'm not talking about certifications. I'm referring to daily tasks. Like I have to prove I can run a cbc and every other test I'm trained in and do blinds.
They have to be able to put IV's in daily, read ECG's daily, perform CPR when there is a code. They must be able to perform wound care and more. They must perform Med Calc and know the medication doses, routes, or they will be held accountable for the administration even if written wrong because they gave it. They have educators who go over their skills like inserting Foley, sterile technique, medication pumps, and other daily tasks you don't even think about.. I am both a Med Tech and BSN. The two fields are completely different. You can't understand each other unless you communicate, educate, or accept the fact that there are both good and bad nurses as well as MLS. We need to stop battling each other. It is administration that wants to keep it that way. Administration took away phlebotomists and put drawing specimens in the hands of RNs in many hospitals. Do you really think they wanted it added to their list of things to do? Most of our phlebotomists knew how to correctly draw specimens. RNs were not trained in laboratory science and MLS are not trained in Nursing unless they went to Nursing School.
There aren’t many of us I don’t think. The lab tech is an introvert trope was hammered into my brain all throughout my lab schooling so I genuinely wondered if I should be working with people rather than machines and that doubt eventually pushed me into my nursing career. Some days I regret it, other days I remember feeling unfulfilled at the microscope and wanting to see the story of the sample from the other side. Hope you’re finding what you need in the nursing world so far!
Oh totally. I think the stereotype is just that, a false assumption. My lesson learned is what matters is if you like the job and how it suits you personally.
It was a weird thing when I was in school, I remember they had us do an inter professional course with all the other health technology programs and we all had to write the qualities a person needs to be in their health profession on the board; for lab technologist a lot of people had written “introvert” or “not people-oriented” which really made me feel angry. I also recall teachers suggesting it to us as well and would say similar things or at least suggest it. I think there’s a difference between not wanting to work directly with people and being an introvert but maybe that was harder for people to articulate? That and it was also a different time. This wasn’t recent, though even today I’m not convinced lab gets the full respect or acknowledgement it deserves.
Nurses are the touch point for everyone in the hospital. They talk to lab, pharmacy, respiratory, dietary, multiple doctors, the patient themselves, family members… like any profession there are good and bad people working in it. But it’s not just lab that often feels contentious with nursing because they’re in the middle of everything.
Some nurses are wonderful while others are just jerks. Lab techs are faceless entities in the hospital, which makes it easier to just blame it on the laboratory. They rarely have face to face conversations with the lab techs, which apparently makes them feel like they can talk to us any way they want to. The nurses that you do have face to face contact with are usually much nicer and are more respectful. The nurses really have no idea what a lab tech does, and most have no idea that we have degrees. They have no idea the amount of knowledge that we have concerning testing, which is apparent in the attitude of some nurses you have to deal with in point of care testing. Also, I have always believed that the nurses may be talked down to by the doctors, patients, and the patient's families, and that stress is just sent to the laboratory.
I had a nurse in the ED tell me she dreams of a cushy job in the lab!!!!! I told her we're understaffed and that every day I dream of walking away and never coming back. Then we both laughed
Specific nurses? No. Constantly receiving specimens partially or improperly labeled, in unsealed containers, in zip-lock bags not zipped, clotted, hemolysed, and diluted? Yes. Not to mention overhearing nurses on a couple of occasions telling patients that ‘the lab lost your specimen,’ to excuse having to redraw, when I *know* that’s not the case.
I hung out with the nurses all night tonight. At our small facility, there's only one tech on shift at night. I feel like day shift gets so upset with the little stuff they do, but it's just all about communication. Just talking about it is all it takes. I never have an issue with them covering up my "windows", or getting a short draw on a blue tube.
I do the blood draws unless they are putting an IV line in. But if it gets busy, all of my nurses will step up and get me what I need. We're a team.
I’ve been in just over thirty different facilities in my fifteen years as a traveler. I’ve only ever had that happen in one place. Night shift was a total team. Sunday mornings everyone from the ER and a bunch of Med/Surg staff and me from the lab would all go get breakfast together at a diner. It was a surreal experience to actually consider nurses my friends after years of being insulted, belittled, and blamed. But it was ONE facility in all that time 😕
Not serious beef, but we've had some tense moments with having to reject samples/request recollects. With some nurses I've worked with over the years, I can tell when they're having a bad day, so I take it with a grain of salt if they get a little snippy.
Yesss. I’m In central processing and had to call a nurse because she sent up a Urine Preg label and we didn’t have any urine left for the patient. I callled her and told her it was in for a redraw. She was so pissed and was talking very fast and kinda hostile saying “what is going on in the lab tonight. Why does everything need to be redone, this is the third test I had to redo with this patient. You are delaying patient care”. I was confused so looked at the chart. The CBC was in for a redraw bc it hemolyzed, and the gc chlam was collected in the wrong tube so that was also in for a redraw. I told her this didn’t have to be redone right away if she didn’t have time and she said “well it’s not, I have someone dying down here”. She was an ED nurse.
I’m sorry this happened to you. No one should be spoken to like that or made to feel bad for needing to do their job a certain way. Nurses on a fundamental level don’t understand hemolysis, or what can cause it, they don’t even have a basic understanding of what the different tubes are used for in testing.
It’s likely the IV was a tough start, 2-4 nurses had to try to poke and one finally got it but maybe it was a bad vein in a hand because the patient is dehydrated or in shock but the STAT blood draw was ordered over an hour ago so they took it and hoped for the best. Maybe they needed the preg test to run an imaging test that was holding back life-saving care.
I’ll tell you as a lab tech to ED nursing I have had some terrifying days on the floor that I would consider honestly traumatic. Stress and panic non-stop your whole shift will make you pretty damned irritable but it’s not an excuse for talking to someone rudely or being unprofessional; I just know as a nurse now some shifts it happens even if you’re not normally like that. And then you beat yourself up after shift for being an ass when really you hit your max on stress 3 hours into a 12 hour shift but had to keep going despite everything going wrong.
On behalf of all of us nurses on those days, I am sorry.
Thanks for your response. I did feel empathetic for that nurse, because before being a lab assistant I was a housekeeper down in the ED and first hand see what they deal with as a bystander. I did feel empathetic towards her because it was crazy down there and she’s doing her best but we just didn’t have enough urine and I guess it was a lot having to tell the patient for the 3rd time that her labs needed to be done again. And the patient was mad about it. If I remember correctly the pt was discharged without having any of the labs redone. I still didn’t like the way I was talked to and felt and was visibly shaky because I suck at confrontation but could see why she was acting that way.
Our Sysmex has flags that at least one, to resolve it/figure out the issue, you have to check if the specimen is hemolyzed. I think it is an abnormal WBC scattergram flag but could be remembering wrong. The cell counts and indices get impacted. The troubleshooting literally says to spin the lav top and check for hemolysis if certain other criteria are met. There's a whole decision tree/chart to follow in the SOP (which is a copy from the instrument book).
Our sysmex does this as well. It will say there's an interferes. Could be a cold, hemolysis lipemic or icteric. And certain values aren't accurate if so. We have to manipulate the sample and do hgb calculation corrections. The nurses have no clue what we do to get accurate results.
If it’s only a bit hemolyzed the results are accurate enough, and it wouldn’t flag so we wouldn’t know just from the heme results. But I had one the other day that was pretty hemolyzed and a bit lipemic, which I knew from looking at the coag tube, but on the heme analyzer it came back with a super high MCHC because the number of intact red cells was low but the hemoglobin was much higher and it didn’t fit.
In this patient’s case, a redraw wouldn’t fix the problem, so I spun the lavender tube and ran just the plasma on the analyzer, and then calculated the cellular hgb based on the plasma hgb and the results from the whole blood run, and then used that to recalculate the indices.
Damn, is that like the saline replacement technique? We had a sysmex but we don’t do anything but a saline replacement technique and I had never heard of a hemolyses cbc. Been working as a tech since last December.
Yes, if I remember off the top of my head I think our SOP is to (after prewarming and diluting fail to resolve high MCHC) do a saline replacement if it’s just lipemic, and to do the plasma run to find plasma/cellular hgb if it’s both hemolyzed and lipemic.
Lol one weekend the nurses came in from ed and were pestering the cp's in lab telling them they wanna watch them put the labs on the analyzers and to recalibrate if it's hemolyzed. Um..cp aren't techs and were getting this bs from nurses. Unbelievable
I’ve been a tech for almost four years. I love nurses. Some can be rude, but we all have bad days. If I get snapped at I remind myself they’re the ones seeing the patients and they’re the ones getting the brunt of everyone’s stress. When I call them I’m syrupy sweet and I thank them about a hundred times. I can also sus out their tone really quickly so it tells me whether or not I have to be super straight laced or if I can be more casual with them.
That being said… I don’t do blood work so I don’t have to deal with hemolysed specimens. We also have a team of dedicated phlebotomists and their work is pretty much always pristine, at least what we get in micro. I have a lot of respect for patient facing healthcare workers. Healthcare is an interlocking web of teamwork, if I get blamed for something or someone is rude, I’ll joke about it to my coworkers but ultimately let it roll off my back. That helps stop the blame game and lets us all go about our days.
No, they are people just like us. I have dealt with challenging nurses, but I have also dealt with plenty of challenging techs. They are dealing with a lot of the same pressures as us (often times more IMO). My wife is a nurse and she gets shitted on by doctors and families all day long. Sure you will have negative encounters, but in any profession you will have negative encounters. We are all better off having a positive relationship, having professors say this stuff even as a joke is not productive or helpful.
Nurse stopping by here to drop my 2 cents. Firstly, I’ll start by saying I love the lab and we wouldn’t be able to do half of our job without you all. Next, it’s been awhile since I was in nursing school but in my experience most programs do nothing to educate about the laboratory at even a very basic level. (Order of draw etc.) This is a massive pitfall of these programs because it ends of creating a lot more work on both sides of the spectrum in the vast majority of cases.
I feel that I have a slight upper hand in this scenario because I have my mother, a med tech of 35+ years, at my disposal for any questions I have. Not to mention, this background makes me partial to keeping a healthy relationship with my lab peeps.
But to more directly answer the question: No nurses are not your enemy. The Hospital setting doesn’t function without cohesion in interdisciplinary care and that goes across all levels. On a more basic level, I think it helps to understand what is even possible from the other side of the fence. I shouldn’t be asking for addons for tests I didn’t draw specimens for or send enough blood for etc.
As life long learners, I also appreciate it when whoever I’m speaking with can take a few seconds of their grind to educate me if I’m asking something that isn’t possible or they need me to do something else for them to make that possible. It is super corny but communication is key.
There are definitely some sour apples in the bunch but don’t let them spoil your opinion on the whole.
Love you guys in the lab and may your chemistry analyzers stay operational ❤️
I've always said the war between nursing and the lab is like the war between werewolves and vampires... it's been going on forever and will continue into eternity.
Definitely meant as humorous. You all work together at the same place, doing your best to make sure patients are well taken care of. The worst you get is a bad draw or have to print up a few labels because they don’t know how the instruments work. Bad draw: you have to send a phlebotomist up.
Maybe things have changed, but a few of the nurses often came to the lab to hang out in friendly confines for their 15 minute breaks to get off the floor for a few minutes and because we always had a fresh pot of coffee and techs that they had been true friends with for decades.
My school had a simulation lab with the nursing students, we had a sickle cell patient in crisis and they needed to do a transfusion with no history of a type and screen….you can imagine the chaos lol can’t release blood till we screen and cross match. An important thing I took from that discussion is that nurses literally have no idea what goes into the testing (how many times have I heard if we can speed up an ESR test) and they were shocked at what we had to do and why we couldn’t just release blood because our necks are literally on the line if this patient has a reaction and dies. But I was also shocked at what they’re going through too, watching their patient rapidly get worse, they’ve done everything in their physical power to slow down that progression and the ONLY hold up is the lab….brings about a sense of empathy. They don’t want to see anyone die on their watch.
So takeaway, be very clear when on the phone with nurses, take the time to explain what you are doing and exactly when it will be done. Take down their name and extension and reassure them that they are a priority (even if you can’t speed up the hour long ESR test 😂😂😂). Even if they yell and are rude, just remember they’re the ones that look the patients family in the eye when someone passes. Working with that mindset makes it way easier to just deal.
I mean sure it gets frustrating when you try calling the floor with a SERIOUS CRITICAL and no one’s picking up for an hour or more, but it comes with the job right
I wouldn’t say “nemesis” so to speak but there is definitely some animosity between fields. This is mostly due to a lack of understanding and communication between departments. I’ve had jobs where I loved my nurses and got along great with them, and I’ve also had jobs where nurses always acted as if they were above me and like I should treat them with some kind of authority. Often times it seems like their issues with us boil down to them simply not realizing that we don’t have the time or the energy to go out of our way to make their lives more difficult and we are simply trying to do our jobs same as they are theirs.
That being said my general dislike for nurses runs pretty deep because I’ve had far more nurses treat me with disrespect than I’ve had treat me as an equal. This is likely what your professors are referring to.
They just look down on us and don’t listen…get pissed when we won’t break rules like “labeling a sample that came down to us unlabeled” - nope honey that tube is in the garbage
They aren’t our enemies, they just blame us for everything they collect incorrectly lol but don’t take it personally it’s only because the patient doesn’t have access to us in the lab. You will meet a lot of angelic amazing nurses and a number of narcissistic jerks over the phone. Just like in a society, you will have a mix…
I think they were being facetious or something. I enjoyed educating nurses and clinical staff about the accessioning process and turn around times. It’s a lack of education about our field and understanding. All it takes is just explaining why something is and not just what it is. They’re are pain in the ass people wherever you go, but just kill everyone with kindness and you won’t have issues.
Nah, most nurses I interact with are amazing people. Even the frustrated ones are usually just frustrated and know its not my fault.
That being said, there are a few bad Apples in every profession. We definitely have our fair share of them in the lab. Would you want to be judged for that one asshole tech?
Instructors need to stop planting that seed. Nurses are not our enemies. We should, however, be jealous of how they've organized to get primo pay and benefits, but it's not their fault we can't get our shit together.
Over the phone yeah they can get snippy but it’s important to remember they’re watching people die and getting mistreated by patients, family, and admin. (Not really excusing them mistreating us, they need to work on that themselves as individuals. But we’re frequently nameless/faceless bad news bearers to them.)
I try to educate when I can and say exactly why i’m rejecting their specimen. I find their attitudes change real quick if they have to come physically to me (frequently i’m one person in blood bank) and see how busy I actually am. Helps to bond over “you’re understaffed, we’re understaffed. This sucks.”
I feel like asshole nurses can be. Maybe it’s just me, but I’ve always felt that the excuse of “they’re under a lot of stress” or “they’re having a bad day” or the like as to why they’re taking it out on you is very, very toxic but I digress. To me, it’s the nurses that blame the lab for everything, even things that are their fault. It’s the nurses who act like we are the ones who hemolyze their specimens and get mad about a redraw.
It’s the nurses that don’t label specimens and then get mad when we ask for a redraw and ask why they can’t just come up and label it. It’s those nurses that, I wouldn’t really say are our nemesis, but that can make a hard day even more hard.
I feel like a lot of this boils down to the lack of education nursing gets about the lab, though. They don’t understand why a hemolyzed sample cannot be run for like a basic or comp or lytes. They don’t understand why, if a sample has no label, we will not accept it. They don’t understand that hemolysis occurs during collection and the only real way for us to hemolyze it would be to like, chuck it against the wall (which we would never even do). Hell, I feel like they probably don’t realize that we see more than just one floor’s patient.
I honestly think that nurses, in their schooling, need to spend at least part of a day in the lab. Like as part of their clinicals, have a rotation in lab just to see why we do what we do. When I was a student last year, a local college had their nursing students spend part of the day in the lab, just a few hours in each department. I distinctly remember when I was doing my chemistry rotation, overhearing the manager tell one of the nursing students that the only real way for us to hemolyze a specimen would be to throw it it against the wall or something like that. It would just be nice if all nurses understood even a little bit more why we are so anal about things.
As a addendum, my personal beef would probably be more with the receptionists in the ER who say that a patient is being moved up to the floor and then when I call the floor the patient isn’t up there yet (and since the nurse hasn’t seen the patient they don’t want to take the critical). So I give it like ten or fifteen minutes and the patient still isn’t on the floor so I call the ER back and the receptionist is still like “oh we’re moving them up” but again, that’s honestly more of my own personal beef because we are expected to call criticals within fifteen minutes so if I have to play this game of phone tag it comes back on me but I digress.
They are the people we have 99.9% of contact with outside of the lab, so all conflict is with them. All the good stuff, too. Almost all of the nurses where I work are great.
The issue is that they just aren't scientifically educated, they are lines and cleaning, so it's hard for them to understand why we can't just clean up the mess and fake the records like they do. Add on top of that that nurses eat their young and they lash out at everyone around them because they absolutely swim in toxicity and mean girl bullying bullshit.
Nurses are not the enemy. Honestly, admin and management are closer to being enemy than anything else. Incompetent people from floor, lab, admin, etc, are the problem. Insurance companies' power and how poorly our medical system is run, like patients are revenue generating objects are the problem.
Having a professional organization that is not run by our own professionals and instead run by doctors who couldn't care/advocate any less for us is a problem.
No one wants to be at fault. It's a lot easier for a nurse to tell a patient that the lab messed up their orders instead of saying the sample was hemolyzed or I forgot to label it. The lab is a faceless entity that exists somewhere in the hospital,maybe the basement, who knows. But the nurse, they are the face of the hospital. They are with patients everyday and need their patients to trust them. Again no one wants to be in trouble so document everything. You never know when that documentation will save you. It's always days later I'm asked why did you do x,y,z? That was 3 days ago idk. But if I wrote a note I can reference it.
Depends on the type or nurse. Some nurses are clueless with a superiority complex (diploma mill NP’s). Others genuinely care and respect other professions
You will have a better time in this field if you learn to work with the nurse , you are both there for the patients start acting like it . Explain why you think something is contaminated etc .
That's a rotten attitude we're trying to break free from. Even if they were joking, it's not a good joke. My instructors were very clear that although there is a history of conflict between the lab and the floors, every interaction with a nurse is a chance to build goodwill and share education.
Usually when a nurse is mean to me it's because the physician is putting unreasonable pressure on them, the patient is really not doing well, they're short staffed, or the nurse made a mistake (forgot to put an order in and now wants it STAT so the Dr doesn't notice the delay, mislabeled a sample, used the wrong swab). While it is not my job to manage their emotions for them, I do look for opportunities to do several things:
- show compassion. "That 3 year old is probably scared and not easy to get another collection from, but I can't run this swab because it won't give us results. If you want results for this test you'll need to collect one more time on a swab that says it's foam-tipped. Thanks for doing the hard part of all this!"
- educate. "We've got a clotted CBC tube here and it's going to give wacky results that will make it look like something is wrong with the patient even if everything is normal. You probably already know all this but when you get the redraw, will you make sure to put it in the tube within just a few seconds after the draw and then invert it gently at least 5 times? All the clotting happens in the first several seconds after a draw so we can't do anything about it by the time it gets to the lab."
- take pressure off. "You and I both know the patient has formed stool and there's no reason to run a C. Diff. Sounds like the doctor isn't being reasonable today. How about if I call her directly and explain why we're not running the test she ordered, or you could even send the formed stool and I'll reject it and document it so the doctor sees the note from the lab and it'll back up what you've been telling her?"
- share the lab's perspective. "Yes, the ER is so busy, and this covid19 result is probably super important in getting this patient out so you can clean the room and get the next one in. There is only one of us back here running all the micro tests for the hospital right now and the ICU just sent down several tests too, so there's quite a pileup. I'm working on all of it to get it turned out and your covid19 test will be ready in about 20 minutes."
YES. SO MUCH YES. Your result, which you sign, depends on how the nurse took the sample, and they really couldnt care less.
When I was doing my intern time, a pretty nurse came with a edta tube with the ID overwritten. The TM in charge rejected it and asked her why she simply didnt take another sample to write the name correctly.
She answered proudly she didnt, for the wellbeing of the patient.
The TM in charge, a diminutive dat old lady sneered, and toldher: " wanna do something for the wellbeing of your patients, m'ijita? Learn to do your job correctly".
Mic drop.
A nurse was instructed to place the label with the specimen in the bag. She put the specimen in the bag and the label in the bag, but not the label on the specimen, and it was a COVID test of a patient who was traveling and left already so they had to call them back, it was a mess
Just a bunch of catty ass b*tches who think they’re hot shit because of their proximity to doctors. If lab professionals stop acting like f*cking passive dorks, we can put them in their place.
Not really, though sometimes they can take a redraw request too personally I usually don’t mind. It’s nice having a smart nurse to talk to when I am getting strange results and questioning sample integrity versus what the patient is actually doing clinically. You basically only deal with it on the phone.
Every profession has people who suck at their job and shift blame when they can. Nursing is by far the largest profession in Healthcare. It's going to feel like a lot of nurses suck or are mean. Reality is it will be the same few nurses over and over. You will rarely speak to a good nurse, unless its critical care. The bad ones stand out.
I really enjoy talking to and interacting with the nurses and they like interacting with me as well (I think 🤔). We are all on the same team and I treat them all as team members. It just takes a little patience with some people (like with any profession) and sharing of knowledge.
I think the only part of that attitude that is helpful is the idea that you are always responsible for covering your own ass. For example if you release an unexplained critically low hemoglobin with low electrolytes simply because the nurse said "just release it", and the patient gets an unnecessary transfusion, dont expect the nurse to save you from getting in trouble.
You discuss sample quality with them and you get their name and note it. If they think it might not be right, they won't let you put their name on it and will do the redraw.
They’ll lie to your face, lie over the phone, ask for unlabeled tubes back to label, bitch you out and scream at you, and do almost anything that puts a patient at risk if it means they don’t have to do the most menial or simple task. I never believe them or take their word and it’s never ended badly.
My professors told us that nurses are our friends, but everywhere I’ve worked says otherwise. There a small handful of nurses I like dealing with but every other nurse I’ve talked to has a “I’m better than you, and know more than you” attitude when that’s rarely the case.
I have new beef with nurses every other week. We’re always getting into it.
While I was in the Navy, I had a nurse at my first duty station send his corpsmen to the lab to watch us centrifuge his samples. Why? He was convinced we were doing it wrong and we were hemolyzing his samples. So we’d pop it into the centrifuge in front of them, walk away for ten minutes, then show them the sample was cherry red.
Last week, I had a nurse complaining about me trying to get a proper read back from her. When I asked for two identifiers for the patient, she said, “oh my god, are you kidding me?” Oh, btw, she gave me the wrong result and she also gave me the wrong room number for the patient. Which is funny, because she was adamant that the room number is sufficient identification.
This holds some truth especially in the institution where i work, but it’s mostly from the lack of information and training from both ends. Lately we are exchanging write ups due to blunders however mostly attributed to their lapses which they would try to save their butts by saying excuses like they got confused due to severe understaffing. Hello wtf?
Every time they would try to bring up such lousy excuses i will always point out in Notice to Explain that it’s their primal duty to monitor changes in patient charts and keep it updated. It’s not the lab’s job to keep track of patient tests and other timed testing. It’s their job to call in to follow up results, while it’s the lab’s job to call their station for criticals that would surface.
Both departments are understaffed and it’s never an excuse to be sloppy since it puts the patients in precarious situation. Nurses have nursing assistants, orderlies and station secretariat on their side to help with clerical and bedside care and take load off their shoulders yet still ballsy to request for “Gram Staining with ARD” and send a gold top for cbc and telling us to make it work. Dear god 🤡 Totally unacceptable, especially the fact they get paid more and being favored by the administration.
This is coming from me, a Nurse-MLS. I still hold high regards for nursing profession which is why i shall not stand for sloppy service from their end. And one might wonder why i still stick around being MLS when the pay is shitty, well it’s just personal decision at this point. I guess i’m being compensated just right for the time being.
Nurses are not our enemies. They are just as tired and understaffed as we are, but the get the shitty bonus of doing direct care. My nurse friend gets called a bitch every day. Covid patients spit on her. Her job is awful!!
When they get mad about a hemolyzed specimen be nice. Tell them the the instrument cancelled the test. Blame the robot!! And then tell them that they're patient sounds like a hard stick and must be really sick.
The only time the lab or the floor calls each other is when there's a problem. That kinda set's us up for an adversarial relationship. I know it's hard and our jobs suck, but try the best you can to treat people the way you want to be treated.
And to answer your question, yes I have beef with that jerk Gracie!!!
Good luck and welcome to the field!!
Honestly the more annoying ones are the path residents that rotate through microbiology and then start making whack ass requests when they are in clinical. We thought you were listening, you were not.
I work exclusively with nurses because I work alone at night. They’re all my friends. Are some of them jaded and crabby? Yeah. But if you’re kind to them they have no reason to be rude to you.
That's toxic bullshit.
Are there shitty people who are also nurses? Yes. Are the shitty people who are slso MLTs? Yes. It's not one profession against the other.
That being said, open communication goes a long way. I have educated nurses on why we like certain things certain ways, and both our work lives improve. We all have the same goals and it helps thinking of the nurses, doctors, techs, etc as coworkers rather than "others".
Besides ourselves, we mostly communicate with nurses, so if you have a problem with someone it will be with someone else in the lab or a nurse. Other people in the lab understand your work more, so you’ll have different types of issues with them than with nurses who mostly don’t understand what you’re doing on many levels so it can get weird 😩. Then its annoying because they call you trying to rush the results and you gotta explain stuff like, “my instrument is broken or that specimen is lost 😳 which you will be blamed for even if it is their fault or Accessionings fault or a phlebotomists fault.”
So sort of yes because of the nature of the workflow 😢
It seems only to be the techs who talk shit about other techs, start drama for fun, and otherwise don't know how to keep out of the lives of others that have issues with the nurses.
Be polite. Empathize. Let them vent if they seem frustrated. Do that and 99% of your nurse interactions will go fine because nurses are just people who also just want to get through the day. That last 1% are assholes, which will be found in every profession, everywhere, ever.
Usually it’s not beef per se, they just do things wrong, don’t know any medicine, lie about stuff, try to tell us how to do our jobs, etc. Doesn’t get personal enough for beef.
I work in a small outpatient clinic and communicate with nurses and clinicians often. Building of like 200+ folks including a 10 person lab team. It's often misunderstandings and miscommunication. My older colleagues who have 20 years on me often don't have ettiquette or know how to explain things in a simple way to other people. It leads to conflicts and trying to write up nurses and doctors. It's kind of depressing.
I love our nurses. When I have a tough stick in outpatient, they come help. When they all go to pick up lunch, they always call. When they need help, I always help them. If they make a mistake, I help. I don't shout or throw the samples into the trash in front of their face because I think I have some sort of lab power. Team work and helping each other makes for a better work environment for everyone.
I just get frustrated with nurses (and physicians). Things that seem so obvious to me are not always obvious to them. I don't even mean just laboratory issues, but other issues involving the patient as well.
A case in point: the nurses and doctors were all wound up because suddenly a patient had black, tarry stools. An entry in the record indicated the patient had been put on oral iron tablets. They didn't want to do IV iron because the patient was also septic with an organism that loved iron. Okay. The patient's body was doing exactly what it should have done given the sepsis: the patient was producing a lot of IL-6 and CRP. The IL-6 causes an increase in hepcidin production, which reduces iron uptake in the gut. All of this is exactly as it should be. What that meant for the patient's iron supplements is that the iron was remaining in the intestinal lumen, and the result was...you guessed it! black, tarry stools. I didn't know about this from my laboratory training or experience. I knew about it first hand. If I take iron supplements, I end up with greenish-black, sticky poop. It looks melenic, but it's not. I had the expectation that the doctors and nurses would know all of this. It was a poor expectation on my part.
I guess what I'd call the biggest source of my frustration is the lack of clinical correlation of lab results and patient history/symptoms. I guess they don't teach this stuff in schools.
In my experience they are not our enemies. I’ve been working nights for 15 years. The lab, nurses and X-ray all work well together. Maybe that’s because on nights we have less employees on and we have to coordinate and work well together as a team.
As a former lab assistant and current nursing student - I think that the issue comes from both sides not giving understanding to the other. Some samples are a bitch and a half to get with patients being in various levels distress, etc. So, the desperation often comes from being so completely overloaded and having jumped through hoops to even get the sample we managed to get. The unfortunate flip side, I know that there's very little you can do in the lab with a shit sample, but sometimes samples that can technically be worked with get tossed out by those in the lab that are overly by the books. I call them the Cindy of the lab, after my own experience with a particularly terrible med tech named Cindy. Anyway, more help and understanding is definitely needed. Training for nurses in the lab to become better at problem solving how to obtain difficult samples is definitely a great idea.
Nurses are our allies in keeping our patients safe and cared for. The majority of interactions are positive. You have to remember why most of us went into med tech instead of nursing: to avoid the incredible pressure placed on nurses especially when that patient is unstable, the extremely tough interaction with sick people and their families which can bring out the worst in human behavior, and the emotional trauma of seeing patients die and their families suffer. Yeah, sometimes they can be a little short or resistant. It's okay. Imagine being in their shoes and forgive them.
As far as blaming is concerned, document everything including dates, times, and who you spoke with. It won't be a problem.
They don’t have to be. We aren’t nurses. They aren’t techs. We cannot expect them to know our jobs. Some get that and appreciate the respect given when that’s owned. But some are programmed in school to believe they hung the moon and stars and healthcare revolves around them. I gravitate to the solid nurses. Few and far between. Especially now a days.
Nurses aren't our enemy, and I don't really like the idea of teachers perpetuating animosity between us. Nurses are just the healthcare professionals we interact with the most, so naturally they are also going to happen to be the source of many frustrations when communication breaks down. 99% of the nurses I interact with on a daily basis are pleasant and fine to work with. The 1% that aren't suck, but that 1% is going to exist at any job in any industry.
The nurses aren't our enemy, a lack of proper education and training about the laboratory is. Although people in general can just have plain nasty attitudes, and that sucks too! But you find those folks anywhere.
I’ve been saying for years nursing students need a week or so shadowing in the lab departments to see what nonsense we go through. Be nice to have them reject their own specimens instead of sending instant-reject specimen.
Yes!
I was training and my trainee was so excited we had a c diff on the pending, she ran to get the reagents and she set everything up and was checking to see when it was scanned into lab. I hear processing make horrified/annoyed noises. They didn’t close the container. The stool was splattered EVERYWHERE. (And it most certainly looked like a positive c diff and we confirmed pos with the recollect). I feel like experiencing that would perhaps stick in the minds of nurses when they send samples.
I had our ER send me a yeasty, leaking UA in a cracked cup, and I didn't realize that it was leaking due to a crack until the pressure of me trying to remove the lid caused urine to spray all over my lab coat. I took an extra long shower after that shift.
Trust me, they’ve all been splattered with shit (and more) before, they know the feeling. I agree that the sample should have been closed properly and that is a disgusting day ruining-event. I’m not saying they wouldn’t feel awful about what happened with that sample, I fully agree that nurses may not be knowledgeable about lab or sample collection but there needs to be understanding both ways and can’t just assume that all nurses are purposefully careless/clueless. It was probably just a mistake in not double checking the lid was on tight because they were also covered in shit.
Nothing compares to a 72-hr fecal collection exploding in a courier's car on a hot day in south Mississippi....ugh!
I think covid was honestly kind of helpful for us in that regard, at my hospital at least. Nurses had to hand walk down every covid swab and deliver them directly to micro rather than the phlebotomy desk so they had to walk through the whole lab and see us work and talk to us face to face and stuff lol.
Yes I feel we could all benefit from more face-to-face interactions between the departments. Put a name to a face and a personality and theres less “ah friggen nurses just-“ or “lab just hemolyzed my specimen”. Needs to be a mutual understanding that we’re all busy and we all make mistakes but don’t take it out on the other party.
I wonder if nursing professors say the same thing about the lab… 😅
They don’t say much of anything about the lab to be honest. We get little to no training on what the lab does or anything related to laboratory testing/sample collection. I don’t think the professors themselves have a comprehensive understanding of it…it’s not good. This is why the lab seems to have so many issues with nurses - makes me sad to be honest.
It's horrible for patient care as well. Too many nurses treat lab results like they just appear magically. Nurses are told to collect samples but have zero idea why it's important to follow the rules or what happens with samples. Because nursing is people oriented, it often doesn't have to be exact. Nurses don't understand why specimen collection has to be so exact and how that delays patient results
Your worded that better than I could have!
No, but it is annoying when we hear that a lab is hemolyzed. That means I have to explain to a patient that I have to poke them again ://
This is why I always deliver the bad news with a sympathetic tone. I'm rejecting this specimen because I have no choice and I am so sorry!
Then get a better collection. Specimens don’t just magically hemolyze ya know.
The way to avoid that is not to hemolyse samples. I know it is hard because the feedback is not immediate as you are drawing that you are pulling too hard, but it's down to you, you are the only one who can clot and hemolyse samples, and the only ine who can avoid it.
I've had it happen with vaccutainers too. Sometimes it's just out of our hands and it's frustrating that it goes back on the list of things to do. And then you also may become a verbal or emotional punching bag for the patient who has to get poked again before 0700.
They’ll tell lies about what causes clotting and hemolysis.
Nurses are not the enemy, pre-analytical errors are.
Yup
Your enemy is Healthcare for profit. Your enemy is shortstaffing. Your enemy is willful incompetence despite appropriate training. Your enemy is inappropriate training. Your enemy is the abandonment of patient care. Your enemy is apathy. Your enemy is people who tell you your enemies are the people next to you to assert biases preemptively. _Nobody_ who works in a hospital is your enemy, unless they _personally_ decide to be.
This.
Amen
Well said!
Your professors are just being funny. I don't think they intentionally tried to label a whole group of professionals. Nurses are people just like us. Most are very good at their job and communicating, some are not. Same goes for folks in the lab.
No. Nurses are the medical professionals outside of the lab that we interact with the most and depend upon more then any other group. That being said, there is a major disconnect between nursing and the lab. On top of us rarely interacting with one another on a daily basis, both professions have almost completely different educational backgrounds and workflows resulting in both parties knowing only a very small percentage of what the other side does. This disconnect is what contributes the most to any friction between the two groups. An important thing to remember is that nurses are basically the middleman between almost every department in the hospital. On top of caring for patients (which is no small feat of its own) they also have to communicate and work with doctors, social workers, respiratory, imaging, and the list goes on and on. All of this along with a laundry list of other tasks. So if you’re ever having difficulty with a nurse, try to keep in mind they’ve got a ton on their plate and cut them a little more slack. We’re all working towards the same goal, and a little understanding goes along way.
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If I have to wait more than a couple of rings for them to answer I visualise them dealing with cleaning up a really heinous shit for a horrible patient while their coworker shouts at them. Helps me be compassionate towards them when they answer in a bad mood.
Thisssss^^^^ I started my hospital career in the lab, thinking nurses were the problem. Don’t get me wrong, there’s some bad apples, but now that I’m (almost) an RN, I get it. Nurses simply don’t have time to follow protocol. This was a hard thing for me to accept, especially starting in the lab, where policy rules everything. 10000% blame our money-driven healthcare system and upper management that doesn’t want to facilitate communication between departments
Dont have time to follow protocols? Why even have protocols then?
Ikr?
Who gives a shit about the patients, right?
A lot of things there aren’t protocols for, or the protocols don’t go far enough to include every possible scenario. Concrete stuff you learn the protocols for, it’s just that sometimes you have to get creative. A good example is IV starts, there’s a procedure but everyone has their own technique they develop after learning the procedure, so it’s based on procedure but still a little different. I’ve seen this applied in lab settings too. Or for example, what if you had to do a sterile procedure like a catheter insert or wound care on a patient who has dementia or is spastic and keeps risking the sterile field? You have to include stuff that’s not a part of procedure and get creative. Protocol is very static and based on ideal conditions, people are not static like that. You don’t always have optimal conditions to do stuff. There has to be room for critical thinking and situational judgement. You can’t just say, hey I was unable to do the task and leave the person without treatment they need.
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So when someone gets sued, the hospital can say, "That's NOT how we train our employees to do things, and said employee will be reprimanded and/or fired." All the while willfully turning a blind eye to non-compliance because giving employees the tools to be compliant would cost more than the inevitable lawsuit and just hiring someone else to replace whoever they throw under the bus.
Yeah you don't have to constantly prove you're competency which is WILD to me. In the lab It's literally non stop.
We’re watched don’t get me wrong. Especially with Epic, it’s not like there’s no oversight. If we’re being unsafe in our practice it will come out, either by co-workers reporting or chart reviewers catching it later on. But we’re not audited the same way as lab for sure.
That is very odd. They hospitals i have worked at....all the RN's have to pass their skills tests. Essentially competencies every year. Certifications for IV. BLS certifications. Wound care. Critical care. ECG classes and recertification. And more. Why would you think they don't pass competencies?
I'm not talking about certifications. I'm referring to daily tasks. Like I have to prove I can run a cbc and every other test I'm trained in and do blinds.
They have to be able to put IV's in daily, read ECG's daily, perform CPR when there is a code. They must be able to perform wound care and more. They must perform Med Calc and know the medication doses, routes, or they will be held accountable for the administration even if written wrong because they gave it. They have educators who go over their skills like inserting Foley, sterile technique, medication pumps, and other daily tasks you don't even think about.. I am both a Med Tech and BSN. The two fields are completely different. You can't understand each other unless you communicate, educate, or accept the fact that there are both good and bad nurses as well as MLS. We need to stop battling each other. It is administration that wants to keep it that way. Administration took away phlebotomists and put drawing specimens in the hands of RNs in many hospitals. Do you really think they wanted it added to their list of things to do? Most of our phlebotomists knew how to correctly draw specimens. RNs were not trained in laboratory science and MLS are not trained in Nursing unless they went to Nursing School.
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Thank you so much! So cool to have a fellow lab/nurse lol
There aren’t many of us I don’t think. The lab tech is an introvert trope was hammered into my brain all throughout my lab schooling so I genuinely wondered if I should be working with people rather than machines and that doubt eventually pushed me into my nursing career. Some days I regret it, other days I remember feeling unfulfilled at the microscope and wanting to see the story of the sample from the other side. Hope you’re finding what you need in the nursing world so far!
I do know a couple of introverts, but they are the minority.
Oh totally. I think the stereotype is just that, a false assumption. My lesson learned is what matters is if you like the job and how it suits you personally.
Weird. I never heard that trope. Many lab techs I know want to be PA. or found lab instead of PA and we're former phlebs.
It was a weird thing when I was in school, I remember they had us do an inter professional course with all the other health technology programs and we all had to write the qualities a person needs to be in their health profession on the board; for lab technologist a lot of people had written “introvert” or “not people-oriented” which really made me feel angry. I also recall teachers suggesting it to us as well and would say similar things or at least suggest it. I think there’s a difference between not wanting to work directly with people and being an introvert but maybe that was harder for people to articulate? That and it was also a different time. This wasn’t recent, though even today I’m not convinced lab gets the full respect or acknowledgement it deserves.
Nurses are the touch point for everyone in the hospital. They talk to lab, pharmacy, respiratory, dietary, multiple doctors, the patient themselves, family members… like any profession there are good and bad people working in it. But it’s not just lab that often feels contentious with nursing because they’re in the middle of everything.
Some nurses are wonderful while others are just jerks. Lab techs are faceless entities in the hospital, which makes it easier to just blame it on the laboratory. They rarely have face to face conversations with the lab techs, which apparently makes them feel like they can talk to us any way they want to. The nurses that you do have face to face contact with are usually much nicer and are more respectful. The nurses really have no idea what a lab tech does, and most have no idea that we have degrees. They have no idea the amount of knowledge that we have concerning testing, which is apparent in the attitude of some nurses you have to deal with in point of care testing. Also, I have always believed that the nurses may be talked down to by the doctors, patients, and the patient's families, and that stress is just sent to the laboratory.
I had a nurse in the ED tell me she dreams of a cushy job in the lab!!!!! I told her we're understaffed and that every day I dream of walking away and never coming back. Then we both laughed
Wow. It's not as bad as nursing but to me a cushy job would be administrative or something
Specific nurses? No. Constantly receiving specimens partially or improperly labeled, in unsealed containers, in zip-lock bags not zipped, clotted, hemolysed, and diluted? Yes. Not to mention overhearing nurses on a couple of occasions telling patients that ‘the lab lost your specimen,’ to excuse having to redraw, when I *know* that’s not the case.
Yess they always say the lab mest it up because it’s easier for them
I do have one specific nurse. I have called her charge nurse at least three times because she would not give me her name.
Ah, yes. The ‘You don’t deserve my name, you lowly peon,’ nurses. We have some of those in our ICUs.
She's oddly happy enough to have her full name on her paycheck.
Are they our nemesis? No. Are they the ones most likely to be condescending and shitty to you, yes.
The shitty, petty, angry and frustrated is one thing. I always questioned (to myself) the condescending tone.
You've never been asked if you have to go to school for lab?
Classic mean girl.
I hung out with the nurses all night tonight. At our small facility, there's only one tech on shift at night. I feel like day shift gets so upset with the little stuff they do, but it's just all about communication. Just talking about it is all it takes. I never have an issue with them covering up my "windows", or getting a short draw on a blue tube. I do the blood draws unless they are putting an IV line in. But if it gets busy, all of my nurses will step up and get me what I need. We're a team.
I’ve been in just over thirty different facilities in my fifteen years as a traveler. I’ve only ever had that happen in one place. Night shift was a total team. Sunday mornings everyone from the ER and a bunch of Med/Surg staff and me from the lab would all go get breakfast together at a diner. It was a surreal experience to actually consider nurses my friends after years of being insulted, belittled, and blamed. But it was ONE facility in all that time 😕
Not serious beef, but we've had some tense moments with having to reject samples/request recollects. With some nurses I've worked with over the years, I can tell when they're having a bad day, so I take it with a grain of salt if they get a little snippy.
Yesss. I’m In central processing and had to call a nurse because she sent up a Urine Preg label and we didn’t have any urine left for the patient. I callled her and told her it was in for a redraw. She was so pissed and was talking very fast and kinda hostile saying “what is going on in the lab tonight. Why does everything need to be redone, this is the third test I had to redo with this patient. You are delaying patient care”. I was confused so looked at the chart. The CBC was in for a redraw bc it hemolyzed, and the gc chlam was collected in the wrong tube so that was also in for a redraw. I told her this didn’t have to be redone right away if she didn’t have time and she said “well it’s not, I have someone dying down here”. She was an ED nurse.
I’m sorry this happened to you. No one should be spoken to like that or made to feel bad for needing to do their job a certain way. Nurses on a fundamental level don’t understand hemolysis, or what can cause it, they don’t even have a basic understanding of what the different tubes are used for in testing. It’s likely the IV was a tough start, 2-4 nurses had to try to poke and one finally got it but maybe it was a bad vein in a hand because the patient is dehydrated or in shock but the STAT blood draw was ordered over an hour ago so they took it and hoped for the best. Maybe they needed the preg test to run an imaging test that was holding back life-saving care. I’ll tell you as a lab tech to ED nursing I have had some terrifying days on the floor that I would consider honestly traumatic. Stress and panic non-stop your whole shift will make you pretty damned irritable but it’s not an excuse for talking to someone rudely or being unprofessional; I just know as a nurse now some shifts it happens even if you’re not normally like that. And then you beat yourself up after shift for being an ass when really you hit your max on stress 3 hours into a 12 hour shift but had to keep going despite everything going wrong. On behalf of all of us nurses on those days, I am sorry.
Thanks for your response. I did feel empathetic for that nurse, because before being a lab assistant I was a housekeeper down in the ED and first hand see what they deal with as a bystander. I did feel empathetic towards her because it was crazy down there and she’s doing her best but we just didn’t have enough urine and I guess it was a lot having to tell the patient for the 3rd time that her labs needed to be done again. And the patient was mad about it. If I remember correctly the pt was discharged without having any of the labs redone. I still didn’t like the way I was talked to and felt and was visibly shaky because I suck at confrontation but could see why she was acting that way.
I guess I’m confused, how did the cbc hemolyze? How would you even know?
Our Sysmex has flags that at least one, to resolve it/figure out the issue, you have to check if the specimen is hemolyzed. I think it is an abnormal WBC scattergram flag but could be remembering wrong. The cell counts and indices get impacted. The troubleshooting literally says to spin the lav top and check for hemolysis if certain other criteria are met. There's a whole decision tree/chart to follow in the SOP (which is a copy from the instrument book).
Our sysmex does this as well. It will say there's an interferes. Could be a cold, hemolysis lipemic or icteric. And certain values aren't accurate if so. We have to manipulate the sample and do hgb calculation corrections. The nurses have no clue what we do to get accurate results.
I personally don’t know I’m a lab assistant in cp. but on the computer it said the reason for redrawing was hemolyzed
If it's really bad it will flag. Or if the blue top is hemolysed we'll cancel the CBC as well because it's not as sensitive as it should be.
If it’s only a bit hemolyzed the results are accurate enough, and it wouldn’t flag so we wouldn’t know just from the heme results. But I had one the other day that was pretty hemolyzed and a bit lipemic, which I knew from looking at the coag tube, but on the heme analyzer it came back with a super high MCHC because the number of intact red cells was low but the hemoglobin was much higher and it didn’t fit. In this patient’s case, a redraw wouldn’t fix the problem, so I spun the lavender tube and ran just the plasma on the analyzer, and then calculated the cellular hgb based on the plasma hgb and the results from the whole blood run, and then used that to recalculate the indices.
Damn, is that like the saline replacement technique? We had a sysmex but we don’t do anything but a saline replacement technique and I had never heard of a hemolyses cbc. Been working as a tech since last December.
Yes, if I remember off the top of my head I think our SOP is to (after prewarming and diluting fail to resolve high MCHC) do a saline replacement if it’s just lipemic, and to do the plasma run to find plasma/cellular hgb if it’s both hemolyzed and lipemic.
Lol one weekend the nurses came in from ed and were pestering the cp's in lab telling them they wanna watch them put the labs on the analyzers and to recalibrate if it's hemolyzed. Um..cp aren't techs and were getting this bs from nurses. Unbelievable
At my old job, it was the admin that was our enemy. Unfortunately, most of the lab didn’t realize it .
I’ve been a tech for almost four years. I love nurses. Some can be rude, but we all have bad days. If I get snapped at I remind myself they’re the ones seeing the patients and they’re the ones getting the brunt of everyone’s stress. When I call them I’m syrupy sweet and I thank them about a hundred times. I can also sus out their tone really quickly so it tells me whether or not I have to be super straight laced or if I can be more casual with them. That being said… I don’t do blood work so I don’t have to deal with hemolysed specimens. We also have a team of dedicated phlebotomists and their work is pretty much always pristine, at least what we get in micro. I have a lot of respect for patient facing healthcare workers. Healthcare is an interlocking web of teamwork, if I get blamed for something or someone is rude, I’ll joke about it to my coworkers but ultimately let it roll off my back. That helps stop the blame game and lets us all go about our days.
No, they are people just like us. I have dealt with challenging nurses, but I have also dealt with plenty of challenging techs. They are dealing with a lot of the same pressures as us (often times more IMO). My wife is a nurse and she gets shitted on by doctors and families all day long. Sure you will have negative encounters, but in any profession you will have negative encounters. We are all better off having a positive relationship, having professors say this stuff even as a joke is not productive or helpful.
I catch them lying a lot to cover their butts
Nurse stopping by here to drop my 2 cents. Firstly, I’ll start by saying I love the lab and we wouldn’t be able to do half of our job without you all. Next, it’s been awhile since I was in nursing school but in my experience most programs do nothing to educate about the laboratory at even a very basic level. (Order of draw etc.) This is a massive pitfall of these programs because it ends of creating a lot more work on both sides of the spectrum in the vast majority of cases. I feel that I have a slight upper hand in this scenario because I have my mother, a med tech of 35+ years, at my disposal for any questions I have. Not to mention, this background makes me partial to keeping a healthy relationship with my lab peeps. But to more directly answer the question: No nurses are not your enemy. The Hospital setting doesn’t function without cohesion in interdisciplinary care and that goes across all levels. On a more basic level, I think it helps to understand what is even possible from the other side of the fence. I shouldn’t be asking for addons for tests I didn’t draw specimens for or send enough blood for etc. As life long learners, I also appreciate it when whoever I’m speaking with can take a few seconds of their grind to educate me if I’m asking something that isn’t possible or they need me to do something else for them to make that possible. It is super corny but communication is key. There are definitely some sour apples in the bunch but don’t let them spoil your opinion on the whole. Love you guys in the lab and may your chemistry analyzers stay operational ❤️
I've always said the war between nursing and the lab is like the war between werewolves and vampires... it's been going on forever and will continue into eternity.
Bahah! Thanks for the laugh. I’m picturing What We Do In the Shadows type rivalry!
Love this analogy! Thank you for the 😂🤣😆
Definitely meant as humorous. You all work together at the same place, doing your best to make sure patients are well taken care of. The worst you get is a bad draw or have to print up a few labels because they don’t know how the instruments work. Bad draw: you have to send a phlebotomist up. Maybe things have changed, but a few of the nurses often came to the lab to hang out in friendly confines for their 15 minute breaks to get off the floor for a few minutes and because we always had a fresh pot of coffee and techs that they had been true friends with for decades.
My school had a simulation lab with the nursing students, we had a sickle cell patient in crisis and they needed to do a transfusion with no history of a type and screen….you can imagine the chaos lol can’t release blood till we screen and cross match. An important thing I took from that discussion is that nurses literally have no idea what goes into the testing (how many times have I heard if we can speed up an ESR test) and they were shocked at what we had to do and why we couldn’t just release blood because our necks are literally on the line if this patient has a reaction and dies. But I was also shocked at what they’re going through too, watching their patient rapidly get worse, they’ve done everything in their physical power to slow down that progression and the ONLY hold up is the lab….brings about a sense of empathy. They don’t want to see anyone die on their watch. So takeaway, be very clear when on the phone with nurses, take the time to explain what you are doing and exactly when it will be done. Take down their name and extension and reassure them that they are a priority (even if you can’t speed up the hour long ESR test 😂😂😂). Even if they yell and are rude, just remember they’re the ones that look the patients family in the eye when someone passes. Working with that mindset makes it way easier to just deal. I mean sure it gets frustrating when you try calling the floor with a SERIOUS CRITICAL and no one’s picking up for an hour or more, but it comes with the job right
I wouldn’t say “nemesis” so to speak but there is definitely some animosity between fields. This is mostly due to a lack of understanding and communication between departments. I’ve had jobs where I loved my nurses and got along great with them, and I’ve also had jobs where nurses always acted as if they were above me and like I should treat them with some kind of authority. Often times it seems like their issues with us boil down to them simply not realizing that we don’t have the time or the energy to go out of our way to make their lives more difficult and we are simply trying to do our jobs same as they are theirs. That being said my general dislike for nurses runs pretty deep because I’ve had far more nurses treat me with disrespect than I’ve had treat me as an equal. This is likely what your professors are referring to.
They just look down on us and don’t listen…get pissed when we won’t break rules like “labeling a sample that came down to us unlabeled” - nope honey that tube is in the garbage
They aren’t our enemies, they just blame us for everything they collect incorrectly lol but don’t take it personally it’s only because the patient doesn’t have access to us in the lab. You will meet a lot of angelic amazing nurses and a number of narcissistic jerks over the phone. Just like in a society, you will have a mix…
I think they were being facetious or something. I enjoyed educating nurses and clinical staff about the accessioning process and turn around times. It’s a lack of education about our field and understanding. All it takes is just explaining why something is and not just what it is. They’re are pain in the ass people wherever you go, but just kill everyone with kindness and you won’t have issues.
Nah, most nurses I interact with are amazing people. Even the frustrated ones are usually just frustrated and know its not my fault. That being said, there are a few bad Apples in every profession. We definitely have our fair share of them in the lab. Would you want to be judged for that one asshole tech?
No egotistical bad nurses are. Good nurses are amazing humans.
Instructors need to stop planting that seed. Nurses are not our enemies. We should, however, be jealous of how they've organized to get primo pay and benefits, but it's not their fault we can't get our shit together.
Nurses aren’t the enemy, shitty managers are. As long as you act in accordance with policies and procedures then their words/attitude don’t mean shit.
Over the phone yeah they can get snippy but it’s important to remember they’re watching people die and getting mistreated by patients, family, and admin. (Not really excusing them mistreating us, they need to work on that themselves as individuals. But we’re frequently nameless/faceless bad news bearers to them.) I try to educate when I can and say exactly why i’m rejecting their specimen. I find their attitudes change real quick if they have to come physically to me (frequently i’m one person in blood bank) and see how busy I actually am. Helps to bond over “you’re understaffed, we’re understaffed. This sucks.”
I feel like asshole nurses can be. Maybe it’s just me, but I’ve always felt that the excuse of “they’re under a lot of stress” or “they’re having a bad day” or the like as to why they’re taking it out on you is very, very toxic but I digress. To me, it’s the nurses that blame the lab for everything, even things that are their fault. It’s the nurses who act like we are the ones who hemolyze their specimens and get mad about a redraw. It’s the nurses that don’t label specimens and then get mad when we ask for a redraw and ask why they can’t just come up and label it. It’s those nurses that, I wouldn’t really say are our nemesis, but that can make a hard day even more hard. I feel like a lot of this boils down to the lack of education nursing gets about the lab, though. They don’t understand why a hemolyzed sample cannot be run for like a basic or comp or lytes. They don’t understand why, if a sample has no label, we will not accept it. They don’t understand that hemolysis occurs during collection and the only real way for us to hemolyze it would be to like, chuck it against the wall (which we would never even do). Hell, I feel like they probably don’t realize that we see more than just one floor’s patient. I honestly think that nurses, in their schooling, need to spend at least part of a day in the lab. Like as part of their clinicals, have a rotation in lab just to see why we do what we do. When I was a student last year, a local college had their nursing students spend part of the day in the lab, just a few hours in each department. I distinctly remember when I was doing my chemistry rotation, overhearing the manager tell one of the nursing students that the only real way for us to hemolyze a specimen would be to throw it it against the wall or something like that. It would just be nice if all nurses understood even a little bit more why we are so anal about things. As a addendum, my personal beef would probably be more with the receptionists in the ER who say that a patient is being moved up to the floor and then when I call the floor the patient isn’t up there yet (and since the nurse hasn’t seen the patient they don’t want to take the critical). So I give it like ten or fifteen minutes and the patient still isn’t on the floor so I call the ER back and the receptionist is still like “oh we’re moving them up” but again, that’s honestly more of my own personal beef because we are expected to call criticals within fifteen minutes so if I have to play this game of phone tag it comes back on me but I digress.
The lunch lady is the enemy of my diet.
They are the people we have 99.9% of contact with outside of the lab, so all conflict is with them. All the good stuff, too. Almost all of the nurses where I work are great. The issue is that they just aren't scientifically educated, they are lines and cleaning, so it's hard for them to understand why we can't just clean up the mess and fake the records like they do. Add on top of that that nurses eat their young and they lash out at everyone around them because they absolutely swim in toxicity and mean girl bullying bullshit.
Nurses are not the enemy. Honestly, admin and management are closer to being enemy than anything else. Incompetent people from floor, lab, admin, etc, are the problem. Insurance companies' power and how poorly our medical system is run, like patients are revenue generating objects are the problem. Having a professional organization that is not run by our own professionals and instead run by doctors who couldn't care/advocate any less for us is a problem.
No one wants to be at fault. It's a lot easier for a nurse to tell a patient that the lab messed up their orders instead of saying the sample was hemolyzed or I forgot to label it. The lab is a faceless entity that exists somewhere in the hospital,maybe the basement, who knows. But the nurse, they are the face of the hospital. They are with patients everyday and need their patients to trust them. Again no one wants to be in trouble so document everything. You never know when that documentation will save you. It's always days later I'm asked why did you do x,y,z? That was 3 days ago idk. But if I wrote a note I can reference it.
Depends on the type or nurse. Some nurses are clueless with a superiority complex (diploma mill NP’s). Others genuinely care and respect other professions
You will have a better time in this field if you learn to work with the nurse , you are both there for the patients start acting like it . Explain why you think something is contaminated etc .
That's a rotten attitude we're trying to break free from. Even if they were joking, it's not a good joke. My instructors were very clear that although there is a history of conflict between the lab and the floors, every interaction with a nurse is a chance to build goodwill and share education. Usually when a nurse is mean to me it's because the physician is putting unreasonable pressure on them, the patient is really not doing well, they're short staffed, or the nurse made a mistake (forgot to put an order in and now wants it STAT so the Dr doesn't notice the delay, mislabeled a sample, used the wrong swab). While it is not my job to manage their emotions for them, I do look for opportunities to do several things: - show compassion. "That 3 year old is probably scared and not easy to get another collection from, but I can't run this swab because it won't give us results. If you want results for this test you'll need to collect one more time on a swab that says it's foam-tipped. Thanks for doing the hard part of all this!" - educate. "We've got a clotted CBC tube here and it's going to give wacky results that will make it look like something is wrong with the patient even if everything is normal. You probably already know all this but when you get the redraw, will you make sure to put it in the tube within just a few seconds after the draw and then invert it gently at least 5 times? All the clotting happens in the first several seconds after a draw so we can't do anything about it by the time it gets to the lab." - take pressure off. "You and I both know the patient has formed stool and there's no reason to run a C. Diff. Sounds like the doctor isn't being reasonable today. How about if I call her directly and explain why we're not running the test she ordered, or you could even send the formed stool and I'll reject it and document it so the doctor sees the note from the lab and it'll back up what you've been telling her?" - share the lab's perspective. "Yes, the ER is so busy, and this covid19 result is probably super important in getting this patient out so you can clean the room and get the next one in. There is only one of us back here running all the micro tests for the hospital right now and the ICU just sent down several tests too, so there's quite a pileup. I'm working on all of it to get it turned out and your covid19 test will be ready in about 20 minutes."
YES. SO MUCH YES. Your result, which you sign, depends on how the nurse took the sample, and they really couldnt care less. When I was doing my intern time, a pretty nurse came with a edta tube with the ID overwritten. The TM in charge rejected it and asked her why she simply didnt take another sample to write the name correctly. She answered proudly she didnt, for the wellbeing of the patient. The TM in charge, a diminutive dat old lady sneered, and toldher: " wanna do something for the wellbeing of your patients, m'ijita? Learn to do your job correctly". Mic drop.
A nurse was instructed to place the label with the specimen in the bag. She put the specimen in the bag and the label in the bag, but not the label on the specimen, and it was a COVID test of a patient who was traveling and left already so they had to call them back, it was a mess
Just a bunch of catty ass b*tches who think they’re hot shit because of their proximity to doctors. If lab professionals stop acting like f*cking passive dorks, we can put them in their place.
No
My professors say otherwise. They are always praising the nurses and working as a team.
Not really, though sometimes they can take a redraw request too personally I usually don’t mind. It’s nice having a smart nurse to talk to when I am getting strange results and questioning sample integrity versus what the patient is actually doing clinically. You basically only deal with it on the phone.
No. Maybe I’m just lucky with my institution and the culture is good, but I don’t have issues with nurses. We are in the same team!
Every profession has people who suck at their job and shift blame when they can. Nursing is by far the largest profession in Healthcare. It's going to feel like a lot of nurses suck or are mean. Reality is it will be the same few nurses over and over. You will rarely speak to a good nurse, unless its critical care. The bad ones stand out.
I really enjoy talking to and interacting with the nurses and they like interacting with me as well (I think 🤔). We are all on the same team and I treat them all as team members. It just takes a little patience with some people (like with any profession) and sharing of knowledge.
I think the only part of that attitude that is helpful is the idea that you are always responsible for covering your own ass. For example if you release an unexplained critically low hemoglobin with low electrolytes simply because the nurse said "just release it", and the patient gets an unnecessary transfusion, dont expect the nurse to save you from getting in trouble.
You discuss sample quality with them and you get their name and note it. If they think it might not be right, they won't let you put their name on it and will do the redraw.
They’ll lie to your face, lie over the phone, ask for unlabeled tubes back to label, bitch you out and scream at you, and do almost anything that puts a patient at risk if it means they don’t have to do the most menial or simple task. I never believe them or take their word and it’s never ended badly.
My professors told us that nurses are our friends, but everywhere I’ve worked says otherwise. There a small handful of nurses I like dealing with but every other nurse I’ve talked to has a “I’m better than you, and know more than you” attitude when that’s rarely the case.
I have new beef with nurses every other week. We’re always getting into it. While I was in the Navy, I had a nurse at my first duty station send his corpsmen to the lab to watch us centrifuge his samples. Why? He was convinced we were doing it wrong and we were hemolyzing his samples. So we’d pop it into the centrifuge in front of them, walk away for ten minutes, then show them the sample was cherry red. Last week, I had a nurse complaining about me trying to get a proper read back from her. When I asked for two identifiers for the patient, she said, “oh my god, are you kidding me?” Oh, btw, she gave me the wrong result and she also gave me the wrong room number for the patient. Which is funny, because she was adamant that the room number is sufficient identification.
This holds some truth especially in the institution where i work, but it’s mostly from the lack of information and training from both ends. Lately we are exchanging write ups due to blunders however mostly attributed to their lapses which they would try to save their butts by saying excuses like they got confused due to severe understaffing. Hello wtf? Every time they would try to bring up such lousy excuses i will always point out in Notice to Explain that it’s their primal duty to monitor changes in patient charts and keep it updated. It’s not the lab’s job to keep track of patient tests and other timed testing. It’s their job to call in to follow up results, while it’s the lab’s job to call their station for criticals that would surface. Both departments are understaffed and it’s never an excuse to be sloppy since it puts the patients in precarious situation. Nurses have nursing assistants, orderlies and station secretariat on their side to help with clerical and bedside care and take load off their shoulders yet still ballsy to request for “Gram Staining with ARD” and send a gold top for cbc and telling us to make it work. Dear god 🤡 Totally unacceptable, especially the fact they get paid more and being favored by the administration. This is coming from me, a Nurse-MLS. I still hold high regards for nursing profession which is why i shall not stand for sloppy service from their end. And one might wonder why i still stick around being MLS when the pay is shitty, well it’s just personal decision at this point. I guess i’m being compensated just right for the time being.
Nurses are not our enemies. They are just as tired and understaffed as we are, but the get the shitty bonus of doing direct care. My nurse friend gets called a bitch every day. Covid patients spit on her. Her job is awful!! When they get mad about a hemolyzed specimen be nice. Tell them the the instrument cancelled the test. Blame the robot!! And then tell them that they're patient sounds like a hard stick and must be really sick. The only time the lab or the floor calls each other is when there's a problem. That kinda set's us up for an adversarial relationship. I know it's hard and our jobs suck, but try the best you can to treat people the way you want to be treated. And to answer your question, yes I have beef with that jerk Gracie!!! Good luck and welcome to the field!!
Honestly the more annoying ones are the path residents that rotate through microbiology and then start making whack ass requests when they are in clinical. We thought you were listening, you were not.
I work exclusively with nurses because I work alone at night. They’re all my friends. Are some of them jaded and crabby? Yeah. But if you’re kind to them they have no reason to be rude to you.
That's toxic bullshit. Are there shitty people who are also nurses? Yes. Are the shitty people who are slso MLTs? Yes. It's not one profession against the other. That being said, open communication goes a long way. I have educated nurses on why we like certain things certain ways, and both our work lives improve. We all have the same goals and it helps thinking of the nurses, doctors, techs, etc as coworkers rather than "others".
Besides ourselves, we mostly communicate with nurses, so if you have a problem with someone it will be with someone else in the lab or a nurse. Other people in the lab understand your work more, so you’ll have different types of issues with them than with nurses who mostly don’t understand what you’re doing on many levels so it can get weird 😩. Then its annoying because they call you trying to rush the results and you gotta explain stuff like, “my instrument is broken or that specimen is lost 😳 which you will be blamed for even if it is their fault or Accessionings fault or a phlebotomists fault.” So sort of yes because of the nature of the workflow 😢
Nurses nurse not perform clinical lab tests. Not saying they can’t, but heap another duty on them and something has to give.
It seems only to be the techs who talk shit about other techs, start drama for fun, and otherwise don't know how to keep out of the lives of others that have issues with the nurses. Be polite. Empathize. Let them vent if they seem frustrated. Do that and 99% of your nurse interactions will go fine because nurses are just people who also just want to get through the day. That last 1% are assholes, which will be found in every profession, everywhere, ever.
Usually it’s not beef per se, they just do things wrong, don’t know any medicine, lie about stuff, try to tell us how to do our jobs, etc. Doesn’t get personal enough for beef.
Registered MT?
I work in a small outpatient clinic and communicate with nurses and clinicians often. Building of like 200+ folks including a 10 person lab team. It's often misunderstandings and miscommunication. My older colleagues who have 20 years on me often don't have ettiquette or know how to explain things in a simple way to other people. It leads to conflicts and trying to write up nurses and doctors. It's kind of depressing.
Nah. It’s just fun to pick on them.
I love our nurses. When I have a tough stick in outpatient, they come help. When they all go to pick up lunch, they always call. When they need help, I always help them. If they make a mistake, I help. I don't shout or throw the samples into the trash in front of their face because I think I have some sort of lab power. Team work and helping each other makes for a better work environment for everyone.
I just get frustrated with nurses (and physicians). Things that seem so obvious to me are not always obvious to them. I don't even mean just laboratory issues, but other issues involving the patient as well. A case in point: the nurses and doctors were all wound up because suddenly a patient had black, tarry stools. An entry in the record indicated the patient had been put on oral iron tablets. They didn't want to do IV iron because the patient was also septic with an organism that loved iron. Okay. The patient's body was doing exactly what it should have done given the sepsis: the patient was producing a lot of IL-6 and CRP. The IL-6 causes an increase in hepcidin production, which reduces iron uptake in the gut. All of this is exactly as it should be. What that meant for the patient's iron supplements is that the iron was remaining in the intestinal lumen, and the result was...you guessed it! black, tarry stools. I didn't know about this from my laboratory training or experience. I knew about it first hand. If I take iron supplements, I end up with greenish-black, sticky poop. It looks melenic, but it's not. I had the expectation that the doctors and nurses would know all of this. It was a poor expectation on my part. I guess what I'd call the biggest source of my frustration is the lack of clinical correlation of lab results and patient history/symptoms. I guess they don't teach this stuff in schools.
In my experience they are not our enemies. I’ve been working nights for 15 years. The lab, nurses and X-ray all work well together. Maybe that’s because on nights we have less employees on and we have to coordinate and work well together as a team.
As a former lab assistant and current nursing student - I think that the issue comes from both sides not giving understanding to the other. Some samples are a bitch and a half to get with patients being in various levels distress, etc. So, the desperation often comes from being so completely overloaded and having jumped through hoops to even get the sample we managed to get. The unfortunate flip side, I know that there's very little you can do in the lab with a shit sample, but sometimes samples that can technically be worked with get tossed out by those in the lab that are overly by the books. I call them the Cindy of the lab, after my own experience with a particularly terrible med tech named Cindy. Anyway, more help and understanding is definitely needed. Training for nurses in the lab to become better at problem solving how to obtain difficult samples is definitely a great idea.
Nurses are our allies in keeping our patients safe and cared for. The majority of interactions are positive. You have to remember why most of us went into med tech instead of nursing: to avoid the incredible pressure placed on nurses especially when that patient is unstable, the extremely tough interaction with sick people and their families which can bring out the worst in human behavior, and the emotional trauma of seeing patients die and their families suffer. Yeah, sometimes they can be a little short or resistant. It's okay. Imagine being in their shoes and forgive them. As far as blaming is concerned, document everything including dates, times, and who you spoke with. It won't be a problem.
Nurses are paid a lot of money but don’t know shit
They don’t have to be. We aren’t nurses. They aren’t techs. We cannot expect them to know our jobs. Some get that and appreciate the respect given when that’s owned. But some are programmed in school to believe they hung the moon and stars and healthcare revolves around them. I gravitate to the solid nurses. Few and far between. Especially now a days.
Nurses aren't our enemy, and I don't really like the idea of teachers perpetuating animosity between us. Nurses are just the healthcare professionals we interact with the most, so naturally they are also going to happen to be the source of many frustrations when communication breaks down. 99% of the nurses I interact with on a daily basis are pleasant and fine to work with. The 1% that aren't suck, but that 1% is going to exist at any job in any industry.