Franki-Marie Herdt, MLT(ASCP)

I have been a microbiology technician at a local regional medical center for a little more than three years now and have worked with numerous doctors, nurses, and pharmacists during this time. The medical center employs great doctors and nurses who are respectful and understand the laboratory profession and our importance in providing quality patient care. However, we all experience anger from a disgruntled doctors or nurses at some point in our careers. It can be frustrating when trying to provide the best patient care. What causes this anger and lack of understanding? What causes the blame game? 

We each must be experts in our own fields to provide the best care. The nurses and doctors do not receive much education on how the laboratory works. Therefore, it is our job as laboratorians to guide them and provide this education. In one instance, I had a nurse call down from our Emergency Room furious because she did not have the urine culture results on her patient. It had only been an hour or two since we had received the specimen. I kindly reminded her of the culture process and that the turnaround time is 24 hours. She apologized and we had a little laugh and discussed when the test would be completed. Situations like these are helpful because we can, as experts, provide education so this situation does not happen again. 

Another area other healthcare professionals do not often understand is the restrictions of the machine/kit requirements or manufacturers. Collecting two nasopharyngeal swabs is an unenjoyable experience for the patient as well as the nurse; however, if the swab collected isn’t providing the results desired or was the incorrect swab, it is necessary to recollect the specimen to give the best results. It is our jobs to provide the education on why we could not use the submitted sample for testing. Sometimes it is as easy as explaining the difference between the “red top” and “green top” tubes. Communicating these small facts can help the understanding of the whole process. 
We in the lab do not always know the full history or current status of the patient. Sometimes we are so focused on what we can see or do in the laboratory that we do not take into consideration what is happening on the floor. When the nurse says she will recollect the swab, but we don’t receive it for four hours, we cannot get upset with the nursing staff. We do not want nurses to assume we are ignoring their samples, and we cannot assume nurses are ignoring our requests based on the fact they did not resubmit a specimen right away.

I had a nurse ask if she needed to collect more stool for testing. She had collected five drops, and I communicated that it was not going to be enough to run the seven tests the doctor had ordered. She explained the patient had taken an antidiuretic before coming in and would be unable to provide the samples we needed. We decided she would ask the doctor the priority of tests needed on the specimen. Acting together, we figured out what was best both for the patient and the doctor to provide the results needed for treatment. 

Working together is beneficial for all. In my career in microbiology, I have had the opportunity to work directly with the chief infection control doctor, as well as our pharmacy manager. We worked directly with them to create an antibiogram agreeable to everyone. My coworkers and I collected the data for the most common organisms in our region and compiled the antibiotics into the antibiogram which we all reviewed This allowed all affected departments to have input to be sure we were releasing the most accurate information allowing doctors to provide the best patient care. 

Another example is when we had a particularly ill patient and the medical issue was unknown. The infection control doctor called us many times during the patient’s stay to ask about results or other tests he could order. He genuinely wanted our opinion and trusted us when we recommended testing. He was never upset if one test was not yet completed or the person speaking was not up-to-date on the situation. 

I believe having these more personal relationships can really help with the blame game. We joke about nurses or doctors having no idea what we do but it is our job to educate them. Respect goes both ways so even though we joke, we need to talk to each other with the understanding they might not know everything and that it is okay. One thing that could help with understanding would be to have tours of the lab during new staff orientation. This would allow an open-door policy for communication between departments. At my hospital, the pharmacy manager has all his pharmacy students spend a day in the lab and a day in microbiology to see our work flows. I believe this is hugely important and has led to lasting relationships with the new students. If we were to do something similar with other departments, I believe it would help with this communication gap between the laboratory and the rest of the hospital.