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PAs and Blood Draws


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In most states, venipuncture can be performed by anyone who has been trained to do it.  It can be time consuming.  You could see an entire patient in the time it takes to nail a difficult stick.  Over the course of the day performing venipunctures, you could see an additional two or three low acuity patients.  That translates into a huge billing hit for the entire year.  It's not just a bad financial decision to have you do it, but it is bad for PEOPLE who need HEALTHCARE.

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I totally agree!  I should add that it is a methadone clinic, so we do not treat for anything but opiod abuse, but I do all the H&Ps with ECGs for intakes, annual physicals, treatment team/case conferences, any coordination of care or follow-up that's needed, education, and referrals.  I'm a new PA, so I want to be helpful (and always ready to learn), but the Nursing Supervisor would like this on my plate, and it seems to me that the patients are better served by my focusing on getting through more intakes and physicals.

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I'm a new PA, so I want to be helpful (and always ready to learn), but the Nursing Supervisor would like this on my plate, and it seems to me that the patients are better served by my focusing on getting through more intakes and physicals.

Do the docs there do it?

 

In my very humble, *PA student*, opinion, we should have the same duties that a physician would have.

 

Not to include taking out the garbage, cleaning the whiteboard, stocking the supply closet, etc. Unless the physicians at the practice do the same.

 

Sounds as if the NURSING supervisor might be trying to lump this on your plate because he/she is trying to get away with it since you're "just a PA". Don't stand for it if it isn't standard practice for the other medical providers.

...Also have they never heard of hiring a medical assistant (no assistant jokes plz)...

 

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Do the docs there do it? In my very humble, *PA student*, opinion, we should have the same duties that a physician would have. Not to include taking out the garbage, cleaning the whiteboard, stocking the supply closet, etc. Unless the physicians at the practice do the same. Sounds as if the NURSING supervisor might be trying to lump this on your plate because he/she is trying to get away with it since you're "just a PA". Don't stand for it if it isn't standard practice for the other medical providers. ...Also have they never heard of hiring a medical assistant (no assistant jokes plz)...

 

Completely agree.  While it may be good for you as a new PA to get familiar with this skill, it sets a precedent for all other PA's after you that you don't want, which is the nursing supervisor dictating what your scope of practice is at the clinic.  

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Isn't this a skill that's pretty much mastered by the end of rotations?  I know in the ER where I worked, PA students where doing the majority of the IVs and blood draws, at least for a few days.

 

 

Random addition: I have found that anesthesiologists are some of the best IV starters  Must be the practice. Maybe practice makes perfect. 

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I never learned blood draws enough to be proficient.   I think I did one successful one. I'm actually ok with it as I get enough other stuff to do that takes me away from patient care.  If I ever leave the practice I'm at and work at a more remote place I will learn it ....  

 

I do not think all PA students learn the same skills.....it all depends on the rotation.

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My mantra has been that I should know how to do any task that someone under me would do regarding patient care (draw blood, start an IV, give any kind of injection, place a catheter, etc....)

But I was trained this way. It's come in handy in rural clinics when the MA couldn't get the "difficult" stick that I got easily (I was a phlebotomist for a few years before PA school) and when the inevitable patient crashed in my urgent care and my cheap SP only staffed MAs who couldn't start IVs.

You should learn, because you can, and because then you can teach someone else.

And to the poster who feels these scut tasks are beneath PAs--docs learn them too. Used to learn them a lot more...in the bad old days the residents did EVERYTHING I listed above...these days there are many other critical tasks to master in the short time of residency but I still do the occasional stick myself. Throw in US guidance and I'll stick anything ????

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In my Pre-PA days I was the "hard stick" guy. I drew babies elderly, IVDUs etc. I still draw the pts my MAs and RNs can't get. I usually use it as a teaching opportunity for the staff and at one clinic I work at, I have an MA that I trained up from her externship at my practice and now at the community clinic I moonlight at. She is becoming one heck of a vampire.

 

I don't see it as menial. I work in HIV and blood work is a vital part of care. If it needs to be done I do it. I actually miss drawing blood, starting IVs, etc sometimes. YMMV

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I don't think the last few posts are quite getting it. There is no problem with the PA doing blood draws/having that skill...IF...that same duty is also expected of the physicians and NPs working the site.

 

If they are sitting around the coffee pot and laughing as the LPN does their sticks, but the PA is asked to do his/her own >>>> No. Not acceptable.

 

I don't know what the nursing supervisor is asking for at this site. Is this duty expected of all providers (good, do it) or is it just being lumped solely on the PA (no, refuse). It's not about being able to do it, it's about the standard of WHO usually does it in the practice. And keeping those standards commensurate among the providers.

 

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I don't see anyone suggesting it is too menial to perform, either, and I would be embarrassed if I weren't able to make a solid go at it (at the same time, a little reverence for your phlebotomist wizards is also only polite).  I feel PACdan has a useful metric by which to begin to analyze the situation.

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All I can say is I tried to improve my skills.  I asked the MD to let me go to a phlebotomy class and also an IV start class.  It was always.....good idea....then no action or approval to actually go and improve my skills.  We are staffed better now with 2 RNs and the lab tech so it's not a need any more. 

 

Sigh. 

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Agree with Prima. my dad went through residency in the 60s and drew all his own labs, started all his own IVs, pushed pts to xray, and did ever "menial task" you can imagine while doing 36 hrs on/8 off and taking dexedrine from a candy dish in the docs lounge every day....

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Dont let the nursing supervisor put this on your plate. In fact she should have nothing to do with your plate at all. Make sure your supervision is from your SP only. The LPNs can do this task easily, you have other things to do. Equate this to having to do all your work plus answer the phone. Eventually, everyone will expect you to also do this along with the more complicated things you are already responsible for. Draw a line now or you will find that line controlled by others in the future.

G Brothers PA-C

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I shadowed a PA in an allergy specialty who spent about 1/2 of his time in clinic as an FDA sub-investigator. When working with the research patients, only he was supposed to do the blood draw. So he did several blood draws per day.

 

Of course, this is definitely a special case.

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i will have to agree with another thread, two types of people, Type A master the skill of phlebotomy/IV and move on, Type B are easily moved by non-medical staff to do the work of others and trivialize their training. choose your destiny. I tend to sway towards the Type A and only step in if it is a challenging stick, my time is to valuable to waste on routine venipuncture that is easily accomplished by MAs.

P.S. Research falls under a different category, it is supposed to be a strictly regulated environment that usually has protocols for testing/venipuncture to ensure reliable outcomes.

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