POCT in the Era of Agency Staffing
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There's great opportunity to make $$$ as a traveling nurse, tech, or other allied healthcare worker. With all the perks being a traveler/agency worker, it's becoming a very hot market. Unfortunately, this had created an absolute nightmare for POC testing, at least in my organization.
Some of the issues we're facing include:
Some of the issues we're facing include:
- How to regulate access to POC devices when staff are needing access day-1 of working, work at multiple sites, and only stay for a short time.
- Staff using other testing personnel's badge to log into equipment due to TAT on getting access approved (glucose meters and iSTAT).
- POC procedures and policies not being followed because agency staff are held to different standards (informally) than non-agency staff.
- Finding time to perform other POC duties when access requests are taking 70% of our POC Coordinator resources.
We've developed an electronic access request process to increase our ability to respond to requests, and also ensure we get the needed information for entry into our POC middleware (UniPOC). We're also working on piloting some other workflow adjustments to decrease our glucose meter related safety events. That said, I fear access requests and associated compliance regulations will continue to plague our system for the foreseeable future.
I'd love to hear your thoughts, experiences, and solutions regarding this new age of POC testing personnel.
Onward friends,
Dean Derhaag MS, MLS(ASCP)
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We've had an influx of agency RNs, too. I agree, it's been a bit of a harrowing experience!
I don't know how many people you are dealing with, but we get maybe 1-2 or 3 starting in any given week, usually on Mondays.
To allow them access to the glucometers, we assign them special IDs in RALS that begin with A- for agency- and then a 5 digit number, like A00001 and then count up. Then, we make a barcode sticker with that ID and put it on their badge at their training session, since they don't have the normal 'employee' barcode on their badge.
The borrowing or loaning of an ID badge is against hospital policy here.
The Agency people have to get the same training as any other new hire for the BGMs. As such, we have scheduled standing training sessions for them, available every Monday. Otherwise, we may make special arrangements with their managers. We all keep in close contact with the HR person who is overseeing when these people start. We also let agency people attend our regular BGM orientation sessions if that works better for them.
You stole my list!
But also add:
WT POC Molecular instrument in use that will perform testing under an 'admin' function...especially urgent care which is off hours and weekends/holidays and always short staffed is a problem and the local oversight management shares the 'how to' use the admin function so agency/float can 'do their jobs'. No need to steal a badge#.
You and I are Houston/Galveston, TX to Minneapolis, MN miles in distance but we share the same 'agency'/float staff concerns.
Our system in Southern Oregon onboards about 10 new clinical staff members per day using a hybrid virtual training (powerpoint with quiz at the end), then on-the-floor-with-preceptor initial training checklist. Once they complete the training and checklist, they show up on a report that is automatically sent to me every morning. I've cross trained 2 general lab techs and 2 lab service reps (they answer the lab phones) in how to check completions and give people access to take SOME of the pressure off me. Luckily, we only have the glucose meters to worry about with access issues. We don't have iStats.
Fortunately we do have a very automated/electronic process for onboarding/elearn assignments/elearn sign offs with educators. We have been treating our travelers essentially the same as other new hires - just speeding things along a little more. Here they get an employee ID on their badge same as actual hires and that info uploads to QML for me when their elearn is completed. I activate them for all sites for glucometer as soon as the educator emails me. Because all their info is built for me, it's a quick process so I've been able to set aside a couple days a week to do this. When their contract is over, the elearn interface terminates them and inactivate them as an operator.
The using anothers badge is always a battle - not alone to just travelers I guess. It's always been a policy but I know that it doesn't always get followed among regular employees either. I just drive it home as much as I can. I created a statement that I had added to the traveler onboarding information - tells them about this, what the activation process is so they stop trying to contact IT/LIS/education departments at all hours for access, and my contact info.
Thankfully we do not train RN travelers on iSTAT as that is a whole different set of issues. We do have RT travelers but they tend to stay much longer so again we treat them as regular employees.
What is bothering me the most is the sample collection issues and errors I think are coming from new or travel RNs and showing up in my iSTAT quality check codes. Most of my iSTAT operators are not the ones who actually collect the samples - they are handed the sample by nursing. I have some new operators who are showing upwards of 35% error rates but their observed techniques are fine! Then they tell me stories about what they are being handed - full of air, clotted, being taught to push clots out, etc. That's what I'm trying to figure out how to tackle. But it's walking a fine line because everyone including manager/supervisors/educators/staff are tired and stressed and there seems to be no time or patience for extra learning. We're stuck!