Sometimes, It’s Not You

I had a great day at work, today. It was a long shift in a somewhat unfamiliar place, but I’m a good phlebotomist and am pretty good at working with what I’ve got, and/or asking for help when I need it. I have worked for the organization and with their charting system (part time) for a couple of years now, and know enough to process clients pretty much independently. Mostly, my questions tend to involve how to handle an order or situation in that particular clinic, since I don’t deal with the people or the process every day.

[Backstory summary: I am a 0.01 FTE float “Support Staff Technician” (phlebotomist) for a health care organization. I float to 5 different clinics with 2-3 taking most of the hours, and work anywhere from 0 to 30ish hours a week. My FTE status ‘promises’ me 15 minutes per pay period, but it varies widely.]

So, the clinic I was assigned to today, I hadn’t worked in for approximately a year. It is one of my favorites as far as layout for lab drawing, but is still mostly unfamiliar in every other sense. They have two full-time phlebotomists, so the only time they need coverage is annually, when the two phlebotomists take their vacations together. (I guess they’re friends? I don’t ask, I just work.)

I have worked for this organization for upwards of two years (at 0.01 FTE) and am starting to feel relatively confident about specimen processing, the analysis equipment I work with, the medical record documentation system… The things that are standard across the company. What I haven’t figured out yet are the vagaries of each clinic. Standardized resources does not mean standardized practices. Every place has its unique process.

So, today, I drew a patient. One of fifty or so that I helped handle at this particular clinic. I pulled up the patient’s chart, found the labs that were currently due, selected them, printed labels, drew them correctly as ordered, and sent them through to the processing station.

An hour or two later, the processing station gal got an irate phone call from a provider, wondering where his results were. He had ordered tests to be sent to the local hospital. (As opposed to the standard company central lab, which takes quite a bit longer, as there are business hours and courier schedules involved…) She looked at the information in the system, told the doctor that he had ordered it to be sent to the central lab, and that it could either be processed at the central lab when it got there, or it could be redrawn since the local hospital required a different tube reagent for processing.

The processing gal mentioned the incident to me casually, and I said “Oh, ok…” not really thinking about it. Awhile later, it occurred to me that she wouldn’t have bothered telling me if I wasn’t involved somehow (because people simply don’t make small talk like that with floats much) and I said, “That was me, wasn’t it? I drew her. I drew her like it was ordered. I didn’t look twice at that.”

From the other drawing station, I heard, “That was his bad, not yours!”

The processing station gal agreed and reiterated that he would have to wait for the central lab, or re-order the test for the local hospital. She saw the possibly-important test come through and assumed that the provider had ordered it the way he wanted it to be ordered.

Awhile later, the doctor himself showed up with his MA (Medical Assistant) following behind, demanding to know why he didn’t have results for labs he had ordered that very day. There ended up being three out of six orders he had wanted for either “today” or “stat” (which means ASAP) that were ordered incorrectly. (The original problem test, plus one one was ordered to the local hospital but for a month from today, and another was ordered for 6 months out {which is a normal recheck time, so we wouldn’t consider drawing it} but was actually wanted now…). As lab staff, we could go back and dig through chart notes, encounters, and other history to find discrepancies or questions before we draw patients, but as a rule, we tend to draw people’s blood for the tests and dates that are ordered in the system and appear in our lab-relevant sections of the chart.

All a very long explanation to say that: I dealt with this patient. I drew the labs that were ordered, I documented and let her go. I could have been easily thrown under the bus for not babysitting the provider and anticipating his mistakes. In my experience, the fact that I’m a float makes the normal lab staff 100% more likely to blame such a thing on me.

They didn’t. The gal at the processing station (who leads this lab, as far as my limited experience can tell) defended me, reiterated that she had seen the possibly-stat lab cross her desk with a ‘routine’ order and let it go because it was ordered that way, argued with the provider face-to-face on his method and scheduling of orders, and explained to the MA why and how it was wrong (because really, the MA gets more grief from the doctor than we do when things like this happen). The most acid comment I heard was “She’s a float, she can’t be expected to know how to babysit our providers.” I cannot express how much that one exchange makes me love this lab.

I get thrown under the bus for not knowing a certain lab’s quirks a lot. The generic example goes:

I do something the way it’s ordered. I check the patient, ask the questions, draw the tubes that are required (or use the appropriate machine), and then hear, “Why did you do that?”

“That’s what the policy says,” I say, fairly confident of my actions, but becoming less so because of the question.

The response is: “No! We ALWAYS do the [not standard thing] because [standard thing] doesn’t work!” (I’m obviously telepathic and clairvoyant, and should have known that intuitively); “Just for next time, we click the blue button and we always check the other not-lab’s-area tab for missed things because X provider doesn’t do Z.”; or “Oh no! We don’t EVER do Z as A! We have to Z as B!” (Though every other clinic does Z as A. )

It’s a risk you take as a float, I guess, but it does get tiresome being used as an easy excuse for failures. “Sorry, Doctor. We have a float today, and she can’t do anything right, so it’s slowing the whole lab down. We’ll get that done right away.”

This time: I didn’t catch something I might have questioned with intimate knowledge of the provider’s quirks and/or failures, but would otherwise complete as ordered. And they didn’t say “Well, she’s just the dumb float.” They defended my decision to follow the orders that were written, as they were written. The lab-leader told me, “He ordered it wrong. It’s not your fault, it’s his.”

I was really kind of… Floored. And immensely pleased. I didn’t get blamed for something I couldn’t be expected to have anticipated, for once. And when the Provider Himself came back to scold the lab staff, there was zero talk about “she didn’t do it right,” or “sorry, she’s just a float and doesn’t know.” It was “She did exactly what you ordered, and there was no reason she ought to have known what you really wanted based on these orders.”

Hooray for sticking to your guns! I know the support staff matters to the bottom line a lot less than the providers, but they’re not celebrities to be coddled. They’re workers, too. I appreciate when I see someone remind providers assertively that they need to complete their work so that we underlings can complete ours. I like it even better when the balming of lofty egos does not involve making me look incompetent.

It’s too bad that it’s so rare that I have to be excited when it happens.

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