Showing posts with label nurses. Show all posts
Showing posts with label nurses. Show all posts

Sunday, February 28, 2021

I will remember you (Musings on healthcare heroes during COVID-19 pandemic)

 Updated: 1 March 2021

February's blog is about healthcare workers who have been infected and died from COVID-19 worldwide, and who have made many sacrifices for us all.

INTRODUCTION
The idea for the blog was stimulated by  a series of news items posted in TraQ's Feb. newsletter (Further Reading). Also by the fact that so many healthcare professionals have put their duty to patients above the safety of themselves and their families. COVID has also highlighted invisible health professionals such as medical laboratory technologists/biomedical scientists who have shone with dedicated work to test for COVID-19 infection. Plus
Emergency Medical Services (EMS) emergency medical technicians Also those who work for low wages in long term care facilities, often immigrants who need several jobs to make a go of it, and  personal care workers. 

I could also focus on many non-healthcare heroic workers during the COVID-19 pandemic. If I've missed any, please send a comment. Examples (Some in Further Reading):
  • Hospital cleaners and maintenance staff
  • Daycare workers
  • Teachers, teachers' aides, school janitors
  • Apartment housekeeping & maintenance staff
  • Meat plant workers (often immigrants) who are often housed in close contact with other workers
  • Grocery and food retail workers
  • Food delivery drivers
  • NEW: Transit workers who transport essential workers to and from work (Thanks, Penny)
The blog's title derives from a 1995 Sarah McLachlan song.

THE EVIDENCE
Folks, there is overwhelming evidence that health professionals and many others have stepped up to the plate during the coronavirus pandemic. I do not need to belabour the point. The aim of this blog is to celebrate their contributions around the globe at great personal cost to themselves not just dying but also anxiety and depression.
  • While the numbers of those dead due to COVID-19 are overwhelming, it's key to remember that each of these folks are individuals, someone's 'significant other', child, mother, father, brother, sister, aunt, uncle, cousin, friend. 
  • As of 12:39 pm Central European Time, 1 March 2021, there have been 113,695,296 confirmed cases of COVID-19, including 2,526,007 deaths, reported to WHO. (Further Reading) 
  • See stories of some folks who have died from COVID-19 (Further Reading)
  • Note that people of colour are more likely to get COVID-19. (Further Reading)  
I encourage you read the items in Further Reading to gain a perspective on what we owe these heroes. Also to see affected people as individuals.

As always, comments are most welcome and there are some below.

FOR FUN
Chose this song because I hope we will all remember the heroes who put their lives at risk during the COVID-19 pandemic. I certainly will, as my husband with a serious lung disease went to the Emergency Dept. by ambulance in Dec. 2020 & spent a week in hospital.
FURTHER READING

Wednesday, October 30, 2019

I will remember you (Musings on gender in transfusion medicine)


Updated: 2 Nov. 2019

October's blog is short. The idea was initially stimulated by two 'from the archives' papers in TraQ (Further Reading). The topic of the papers was perceived gender discrimination by healthcare professionals. The initial purpose of October's blog was to get readers to assess if they perceived gender discrimination exists in their disciplines and workplaces.

After reflection, I decided to change the focus to highlighting how many great female physicians there are in transfusion medicine, many of whom I've been privileged to know personally. And, sad to report, one recently died. 

The title derives from a ditty sung by Canada's Sara McLachlan.

BACKGROUND 
Historically, medicine has been male dominated, whereas both nursing and medical laboratory technology/science have been female dominated, at least in Canada. That's been my experience in transfusion medicine but it has changed significantly over the years, especially in transfusion medicine.

TIDBITS Since I moved to Edmonton in Nov. 1977 to teach in University of Alberta's Medical Laboratory Science to the present, Oct. 2019 (42 years), top jobs have been held by men: Medical Directors of UAH's Dept. Lab Medicine and Chairs of the Dept. of Lab Med and Pathol (Faculty of Medicine and Dentistry, University of Alberta).

Individual UAH lab specialties have been held by women, including I am especially pleased to say the transfusion service, which is currently headed by one of my Med Lab Sci 'kids', who also holds higher regional positions. Across Canada, many female physicians hold significant transfusion medicine positions.  

Nurses vs physicians remains an ongoing saga and perhaps sometimes it's just about power, not gender. Suspect it gets more dicey when scope of practice is involved, which also adds pharmacists to the mix.

Canada's blood suppliers are a mixed bag. CBS had had a male CEO from the get-go, though many female physicians are CBS medical directors across Canada. Héma-Québec began with a female CEO. Parts of CBS are male top-heavy

Over the years I've seen female transfusion Drs. bullied by what I perceived as pompous male colleagues in rounds and at conferences. As the cliché goes, women must be way better than male colleagues to succeed. Is it still true?

FEMALE TRANSFUSION MEDICINE PHYSICIANS
Transfusion medicine is blessed with many exemplary female physicians in top positions. Some examples of ones I've known personally and met F2F (alphabetical order):
Interesting that so many of these Canadian female transfusion medicine docs have held major positions (as above) and won awards. To name a few: 
  • CSTM Ortho award recipients:
    • 2002, Francine Décary (CEO of H-QISBT President 2004-6)
    • 2007, Heather Hume (Executive medical director, CBS)
    • 2010, Susan Nahirniak (Chair of NAC)
    • 2013, Debra Lane, Medical  Director of CBS's only joint transfusion service/ blood supplier in Canada)
    • 2014, Lucinda Whitman (Chair of NAC)
Of course, Canada has many outstanding female transfusion medicine Drs. I've never met F2F but know via social media like Twitter or via e-mail. Ex:
  • Dr. Jeannie Callum (who kindly contributed to CSTM blog on Ana Lima )
  • Dr. Yulia Lin: CSTM Ortho award recipient, 2016; 2019 AABB President's Award, 'In recognition of her role as a master educator in the field of transfusion medicine, particularly through her contributions to the education of junior doctors through the Transfusion Camp program.'
  • Dr. Elianna Saidenberg who died far too young on Oct. 20, 2019 (Further Reading) 
Special note on Elianna Saidenberg, Never met her except via her tweets, and she kindly liked many of mine.Thought she was a wonderful human being as I suspect did all who knew her up close or from afar. Clearly, Dr. Saidenberg made a difference in her all too short time on planet earth. Twitter remembers Elianna

So...what do you think? Does your country have many fabulous female transfusion medicine physicians as Canada does. Is gender an issue in transfusion medicine, whether related to physicians, nurses, medical laboratory technologists?

FOR FUN 
I've chosen Canadian Sarah McLachlan's song for this blog, one I've used before:

I will remember you 
will remember you, will you remember me? 
Don't let your life pass you by 
Weep not for the memories.
As always, comments are most welcome and there are several below you may enjoy. 

FURTHER READING 
In Memoriam: Dr Elianna Saidenberg (21 Oct. 2019)

Blau G, Tatum D. Correlates of perceived gender discrimination for female versus male medical technologists. Sex roles 2000 Jul;43(1):105-18. | Related:

Blau G, Tatum DS, Ward-Cook K, Dobria L, McCoy K. Testing for time-based correlates of perceived gender discrimination. J Allied Health. 2005 Fall;34(3):130-7.

Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, et al. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet. 2019 Feb 9; 393(10171):560-9.

Saturday, February 25, 2017

Take chance on me (Musings on transfusion professionals collaborating)


Stay tuned: Revisions will occur
February's blog was stimulated by the planned transition of an informal mailing list of Canada's Transfusion Safety Officers (TSOs) to the CSTM website. I've been the list manager and moderator since the list ('transfusion')  was created in 2000. The blog is shorter than usual, which is likely a good thing.

As part of the move, we did a survey of 'transfusion' subscribers, many of whom do not have the job title of TSO, but perform many of the same functions. Historically, mainly for financial reasons, most subscribers are Canadian but we've had a few foreign subscribers, including ones from Ireland, Switzerland, UK, and USA.

What is this blog about and why might you want to read it? Many other transfusion-related communication mechanisms (workshops,conferences) exist but today it's often electronic communication, such as websites with discussion forums. In transfusion medicine, PathLabTalk comes to mind, whose BloodBankTalk participants are mainly USA and UK medical laboratory technologists / medical lab scientists. 

Similarly, professional associations like AABB and BBTS offer discussion forums and my experience is that most posts are by technologists.

In contrast, Canada's TSO list includes medical laboratory technologists and transfusion nurses, including blood conservation nurses, and even a few physicians.

That's a huge advantage because transfusion service laboratories and nurses who administer blood transfusion really do need to learn more about each other and appreciate the role each plays.

The blog's title derives from a 1978 ditty by Sweden's ABBA.

HISTORICAL PERSPECTIVE
For decades I've been privy to the views that med lab techs/scientists have on nurses, based on anecdotal experience in hospital transfusion services.

Common themes (misconceptions?) are that RNs do NOT
  • Understand quality control procedures and lack competence to do Point of Care Testing (POCT)
  • Truly dig the importance of patient identity and understand what can go wrong. Hence they're not that concerned if patient identities on specimen labels do not EXACTLY match those on blood transfusion requisitions, because, hey, they took that sample and know it's the patient.  Hence they think the lab is being anal-retentive on what they see as minor. 
It's possible that nurses have views of their colleagues in transfusion laboratories that are not always complimentary and may be based on sterotypes. I'd love to hear some. 

PARTICIPATION
Transfusion nurses have come relatively late to transfusion organizations. But physicians have belonged for ages, indeed from the get-go. They tend to dominate proceedings as evidenced by talks at annual meetings.

Yet few physicians participate in transfusion lists and forums, or on Twitter. Why not? My guess is that some think of social media such as forums, lists, and Twitter as beneath them. Perhaps some can't be bothered to interact with the hoi polloi, meaning lab techs and nurses or is that too harsh? 


Or, unlike the laboratory and nursing trench workers of the transfusion community, most physicians are too busy (can't bother?) to talk to anyone but other physicians, and only at medical rounds, conferences, etc.? Please advise. 

Three Transfusion Pros Walked Into A Bar
To illustrate my point about stereotypes among transfusion professionals, I created a joke. Yes, it's satire with a smidgen of truth.
A female doctor, medical lab technologist, and a nurse walked into the bar. Oh, great said the bartender, we have a contest tonight and you are just the ones to play it. Out came 2 glasses and the bartender said, 'Guess which one is British and which is Canadian.'
The doctor considered herself a beer aficionado and passed on asking the age and history of the brews. Feeling more knowledgeable than her colleagues, and somewhat infallible, as she often did at work, she immediately stated, based on her gut feeling: Pale lager is Canadian, dark is British.
Canada

Britain
The nurse took and recorded the vital signs, including colour and temperature. She recalled Canadian beer was more likely to be pale yellow and served cooler and that Britain had dark ales. Her guess was the same as the doctor's: Pale lager is Canadian, dark is British.
The lab tech asked if a historical record existed of the samples in the glasses and which bottles they came from, and then demanded it. When told that would be cheating, the technologist replied, 'Sorry, we in the lab don't guess about identity.'
Correct identity thanks to the lab technologist (You knew this was coming):
Canada
Britain

BOTTOM LINE
If only med lab techs/scientists, nurses, and physicians could get to know each other better, transfusion medicine would be a better world. I've been lucky in Alberta, Canada, thanks to the Med Lab Sci program at University of Alberta, to have taught several students who went on to become hematopathologists. Their lab background is a huge plus. 

And I know from the TSO 'transfusion' list that technologists and nurses have benefited from learning the issues and challenges each has.

For interest: In 1994 when the Internet became available at my workplace, I created a mailing list 'MEDLAB-L' for medical laboratory professionals of all disciplines. I could have gone with a transfusion list but am so glad to have opted to be inclusive. Over the years lab professionals (med lab technologists / scientists, PhD level scientists, and physicians) in all clinical labs have benefited from learning about each others' issues.

FOR FUN
The song I chose is a 1978 ditty by Sweden's iconic ABBA. It's meant to say to nurses and med lab techs and physicians to talk to each other on social media, break down stereotypes, trust each other, because we're all in this together.
As always, comments are most welcome.

Thursday, September 12, 2013

I will remember you (Musings on realities for nurses and residents)

Updated: 13 Oct. 2013

September's blog was stimulated by recent personal experiences in a local inner city hospital with ~700 beds, treating ~ 450,000 patients/year. I spent much time in the hospital over 5 days and came away impressed with frontline health care staff. 

In contrast, I happened upon a news item about a lawsuit that did not impress: 
  • SmithKline Beecham vs Abbott Laboratories: Abbott removes juror because he's gay in suit over hiking HIV drug price
The blog's title derives from an iconic song by Canada's Sarah McLachlin.

First the good news. Being naturally curious and a people observer, during the recent encounter with our health system, I learned many tidbits about work realities for Drs (surgeons and residents), RNs, LPNs, pharmacists, occupational therapists, respiratory technologists, nursing aides, cleaners, and more.

In brief, I have an enhanced appreciation of colleagues in the front lines of the interdisciplinary health care team. They work under incredible pressure, yet those I observed invariably put the patient first and were caring professionals. 


As background, as a medical laboratory technologist who worked in a transfusion service lab for many years, I've encountered many nurses, those I call 'pitbulls', because they aggressively challenge 'rules' the blood bank has related to identity that are designed to ensure patient safety. That makes my new found appreciation all the more sweet.

Thank you surgeons, residents, RNs, and all staff at Royal Alexandra Hospital (Nursing Station 31), Edmonton, Alberta, Canada.

Some things I observed:

  • RAH entrance: 2 security officers holding what could be a homeless man with a beaten face, him screaming, 'I f*ckin' did nothing, you bastards.'
  • Signs say 'No smoking on RAH property' but 'patio' outside main entrance always full of patients smoking. Not similar at University Hospital. Perhaps a losing battle in inner city?
  • Most memorable image of RAH: Emaciated male exits nursing station 31 with fag in mouth, going for a smoke.  Frankly, despite being one of those ex-smokers who is now fanatically anti-smoking, I don't begrudge him his smoke. 
  • Exiting RAH elevator on 3rd floor: Mother angrily screams at ~12 yr old girl that she needs to say something when asked a question. Mom walks towards the ward area and screams, 'Where the f*ck are we?' Then mutters, 'Wrong floor', and stomps away leaving child to follow. My heart ached for child. Mother obviously stressed but no excuse to abuse child. Miracle if kid survives a mom like that. 
  • Respiratory technologist attaches a BiPap to patient in respiratory distress in ward's special 'observation room' (2 RNs for 4 post-op patients), all the while training a student. As a longtime blood bank clinical instructor, I was impressed by his expertise and patience. Later one of the RNs asked the respiratory tech if respiratory could give an in-service on use of the BiPap. Good stuff. 
  • Patient in observation ward for those who need observing carefully post-surgery, and who are attached to many monitoring instruments (and where every few minutes machines beep loudly  - sleep is impossible in the  hubbub of activity) screams, 'Shut up! I'm trying to sleep.' Another patient comments, 'Stuff him in the closet' and he replies, 'Yes, please.'
  • Elderly gent on observation ward, post-surgery, keeps screaming, 'Let me outta here. They've kidnapped me. I've got to go home' and tries to rip off his monitoring equipment. His elderly wife patiently says, 'No dear. You've got to stay.' 
  • Several times a day a patient leaves the observation room for a regular hospital room and a new patient comes in. This is when two staff members enter and strip the bed, then wipe down (disinfect) every part of the bed, tables, and any surface the patient may have touched. It's a frenzy of cleaning, hard grunge work, but it's got to be done and quickly, to prepare for the new patient. 
You get the idea. Every day is total chaos but residents, nurses and all staff maintain their cool and keep caring for all their patients no matter how difficult they and the environment may be.

INDUSTRY
Now the bad news. Watching nurses and docs perform under trying situations makes me all the more disturbed to see how industry colleagues continue to put their interests ahead of patients and seemingly use every tactic to maximize profits and win lawsuits.

Indeed, I could recite many cases that definitively show that Big Pharma routinely behaves badly but I'll limit it to a current case.

Smithkline Beecham (SKB) v. Abbott Laboratories (USA)

SKB v Abbott is about whether it is permissible for a lawyer to 'strike' (remove) would-be jurors from a case because of sexual orientation.  In this antitrust lawsuit involving HIV medications, an attorney for one of the companies exercised a so-called peremptory strike, effectively removing a possible juror because he was or appears to be, could be, homosexual.

The case involves Abbott challenging the only known gay juror during voir dire
for a trial in which SKB challenged Abbott's controversial 400% price increase for an HIV medication.

In other words, Abbott wanted to get rid of a gay juror presumably because it believed he would be biased against them for their exorbitant price for HIV meds.

How did Abbott know he was gay?
When the judge asked how they knew he was gay, Abbott pointed to his mannerisms, his residence in West Hollywood and his previous work as a freelance screenwriter.

What to say? Jesus wept? Oh, give me an effing break? Geez, if you're 'straight' what cases does that preclude you from?

Be aware that SKB is no better than Abbott. Name any Big Pharma company and it's easy to discover how they routinely behave badly. For example,

BOTTOM LINE
Frontline health professionals work under incredibly stressful conditions and yet put patients first and remain cheerful and helpful. 


As someone who has worked in a transfusion laboratory and taught all my working life, I have new respect for the nurses. They carry the burden of dealing with patients who often are close to impossible to handle and may go into a life-threatening crisis at any time. To say nothing of the many bodily fluids they have to clean up with a smile and kind word.

As to Big Pharma, it seems the bottom line is all that matters. Frankly, drug and diagnostic reps are often fine 
colleagues. But they're at the mercy of their employers. 

For Fun
To all the nurses, residents, and other health professionals at RAH, Nursing Stn 31, in Edmonton, rest assured,
Further Reading
As always the views are mine alone and comments are most welcome.

Friday, June 14, 2013

In my life (Musings on the challenges of transfusion medicine education)

Updated: 16 June 2013 (see Resources & Literature)

This month's blog is a sampling of impressions from the CSTM conference in Edmonton, June 7-9, 2013. These days I don't often attend conferences, but the CSTM made me an offer I couldn't refuse. 

The blog's title comes from a favorite Beatle song.

CSTM CONFERENCE

Why should you continue to read if you're not Canadian? Mostly because the blog's content relates to transfusion medicine professionals everywhere. I hope that impressions and musings will resonate with your experiences and provide food for thought.

Any errors or misinterpretations are strictly mine. I did not take notes and musings are based on highlights recalled one week later. For reference, I attended only one scientific session but came away with many insights and reflections. Suspect if I'd attended the entire conference, my brain would explode.

Demographics
Most delegates I saw were 'mature', meaning more than 40 yrs old. The demographics fit with my hypothesis that today mostly senior staff receive whatever sparse support exists to attend conferences. And young staff, who may not feel particularly appreciated these days, are unlikely to take funds away from family obligations for CE.

Or did I simply notice more older attendees because they're the ones I know, similar to noticing VW beetles everywhere once you own one?

Competency
The sole session I attended (not quite true, but almost) was a 4-person panel on 'Strategies for Health Care Education, Training and Competency.' Musings on 
what struck me most...

1. Two presenters (Shelley Feenstra RN, a transfusion safety nurse educator in Vancouver, BC and Rodrigo Onell MD, FRCPC, program director of the Hematological Pathology training program at the University of Alberta, Edmonton) confirmed what is well known in TM circles, namely that undergraduate nurses and physicians receive very little transfusion-related education

Surveys show that basic TM instruction is often only one lecture and graduates often cannot recall much about it. Some MD programs, such as the one at the University of Alberta, include transfusion medicine lectures and small group case studies but this is not the norm.

2. Whereas student medical laboratory technologists in Canada must pass multiple competency-based objectives in a transfusion service lab to graduate, i.e., solve real problems to an acceptable level, similar requirements to demonstrate on-the-job competency in blood transfusion practice for undergraduate RNs and MDs do not exist.

This suggests that graduate medical laboratory technologists with general certification from CSMLS who work in transfusion service laboratories are much more competent in transfusion practice than clinical colleagues (RNs and attending physicians) on the wards.
3. Dr. Onell, who has the advantage of having a BSc in MLS and working in a transfusion service for several years before becoming an hematopathologist, noted that residents in 4-year hematopathology programs may be passed from one year to the next simply by supervisors asking, "How's Joe (or Jane) doing?" If the resulting discussion is more or less, "Okay", they typically progress to the next year.
In other words, historically and in many places today, residency programs have been time-based, i.e., spend 4 years and, unless you totally screw up , you've probably got your specialty. Unless, of course, you fail the Royal College of Physicians and Surgeons of Canada examination.
Dr. Onell said that on-call hematopathology residents are put on call early in their training (within a few weeks) and typically consult supervisors for months. 
He also half-jokingly said that on-call residents, if they are smart, first ask medical laboratory technologists what they would do, then follow the advice.
4. In a reply to a question from the audience, Dr. Onell allowed that, although it's unlikely, it may be possible for a hematopathology resident with questionable competency to pass the Royal College of Physicians and Surgeons of Canada examination. The oral exam may serve as a key filter, but it's not foolproof.

5. Fortunately, residency programs such as hematopathology at UAH, Edmonton offer many resources to residents to help ensure competency, inc. The Hematopathologist.

6. In reply to a question, Shelly Feenstra, RN mentioned that the long-ago move away from hospital-based nursing programs to college and university programs had an unexpected, significant impact.

Most notably, now hospitals are barraged with multiple requests for clinical placements and struggle to fill them. In contrast, when hospital-based RN programs existed, they received priority because they were in-house and the hospital felt responsible for them.
With nursing shortages and ongoing cutbacks to healthcare, I suspect that RN training conditions are far from ideal. When busy nurses can barely devote sufficient time to patient care, training student RNs from outside is low priority. As with other health professions, the competency of graduating RNs is adversely effected by changes to the education model and cost restraints.

7. Wendy Lau, MBBS, FRCP(C) presented  on competency initiatives of the Royal College of Physicians and Surgeons of Canada (RCPSC). Dr. Lau stressed the College's new initiatives on Competency-based medical education (CBME) to be phased in over several years.

Rather than competency-based objectives per se (required for med lab technologists), the RCPSC opted for 'competency milestones' grounded in real-world needs. Milestones are the abilities expected of a physician or trainee at a defined stage of development.

[My guess is that milestones are similar to general educational goals (as opposed to specific objectives) that may or may not be measurable by direct observation due to their relative vagueness. Still, it's a start and may be all that's possible given the lack of time that physician educators have to spend  - or want to spend - on trainee assessment.]
8. Shanta Rohse, BSc, MDE, a medical laboratory technologist by background, and currently an educational specialist who manages transfusionmedicine.ca and bloodtechnet.ca for CBS spoke on the importance of feedback and human interaction in developing and improving educational initiatives.

Shanta mentioned Transfusion Quest, one of the winners from the 2011 Bloodtechnet competition, as a fun way to assess technical knowledge.

A question from the audience noted a disconnect between the importance of human interaction vs the isolation of computer-based Internet learning. 


Dr. Lau had also mentioned the benefits of Internet educational devices for physicians. She thought that hand-held technology offered real advantages but joked that you'd not want a resident in the ER looking up how to treat a massive hemorrhage on a cell phone.

The question led to a discussion of how one of computer learning's strength is its ability to track educational progress.

[As a long-time TM educator, I noticed that the panel did not discuss how instruction and assessment should correlate to the type of learning, e.g., it's difficult, if not impossible, to teach and learn oral, F2F interactive communication skills on a computer. For some things you need living, breathing humans.]
LEARNING POINTS

1. Medical laboratory technologists, i.e., clinical lab scientists, medical lab scientists Down Under (NZ and Oz) and in UK and USA, are definitely ahead of nurses and physicians in the TM competency game.

And it isn't just because some clinical skills are more complex than medical laboratory technology/science skills and therefore harder to assess, which they often are.

For example, physicians deal with bleeding patients in the ER, where split-second decisions are life and death, and the doc needs to rapidly assess history, signs, symptoms, laboratory and diagnostic imaging information and decide how to treat before the patient exsanguinates.

However, competency of complex clinical scenarios can be assessed, if there's a will to do so. Unfortunately, a will to educate and assess competency requires resources.

2. That few educational resources exist, that education is NOT a priority, speaks to the hypocrisy especially rampant in government Departments of Health and Faculties of Medicine. Today it's all about research and bringing in mega-bucks from industry to pay for research and professor salaries, given that government support dwindles.

Sadly, one result is that what research is done follows industry's agenda, not what's best for the public.


3. Competency is essential for all members of the TM team. A cliche, but true: We're only as strong as our weakest link.

The 2011 UK SHOT Report emphasizes 'back to basics'.

Key competency-related recommendations:

EDUCATION AND COMPETENCY in blood transfusion safety remains a key issue in patient safety.

Competency assessment must be underpinned by an adequate and assessable knowledge base for both laboratory and clinical staff at every level. 
KNOWLEDGE OF TRANSFUSION MEDICINE AND OF PRESCRIBING/AUTHORISING of blood components are essential core requirements for any practitioner (medical and nursing) who prescribes or authorises blood components.
For example, recommendations in 2007 and 2009 SHOT reports still apply: 
2007 - Education of doctors and nurses involved in transfusion must continue beyond basic competency to a level where the rationale behind protocols and practices is understood. Transfusion medicine needs to be a core part of the curriculum.
2009 - The existence, and the importance, of special transfusion requirements must be taught to junior doctors in all hospital specialities. Local mechanisms for ordering and prescribing components need to facilitate correct ordering, and remind clinical and laboratory personnel where possible.
Other back-to-basics SHOT recommendations:
CORRECT PATIENT IDENTIFICATION should be a core clinical skill. Errors of identification impact on every area of medicine. The use of a transfusion checklist across the complete transfusion process is recommended to ensure correct completion of each step.
CLINICAL AND TRANSFUSION LABORATORY HANDOVER templates should be improved to include information about diagnosis (particularly haemoglobinopathies), irregular antibodies and special requirements.

Patients are vulnerable with the increase in shared care between hospitals, within a hospital particularly between shifts, and between hospital and community. (Handover toolkit for acute care)
[In other words, TM professionals must communicate with each other to protect patient safety. Doh!]
See full SHOT Report for all the gruesome details

FOR FUN
Attending the conference, brought to mind one of my all time favorite Beatle songs (after Hey Jude), In my Life.
The song is 23rd on Rolling Stone's "500 Greatest Songs of All Time" and 5th on their list of the Beatles' 100 Greatest Songs.

There are places I remember 
All my life, though some have changed
Some forever not for better
Some have gone and some remain 
Though I know I'll never lose affection
For people and things that went before
I know I'll often stop and think about them
In my life I love you more
RESOURCES and LITERATURE (added 16 June 2013)
Today many resources exist to train graduate health professionals, inc. nurses and physicians, in best transfusion practices. A small sampling:

Australia

Canada
UK
Literature
Again, just a small sampling. 


Graham J, Grant-Casey J, Alston R, Baker P, Pendry K. Assessing transfusion competency in junior doctors: a retrospective cohort study. Transfusion 2013 Jun 13.  [Epub ahead of print]

International Forum. Education in transfusion medicine for medical students and doctors. Vox Sang. 2013 Feb 14. [Epub ahead of print]

Louw VJ, Nel MM, Hay JF. Factors affecting the current status of transfusion medicine education in South Africa. Transfus Apher Sci. 2013 Jun 3. [Epub ahead of print]

Pirie ES, Gray MA. Exploring the assessors' and nurses' experience of formal assessment of clinical competency in the administration of blood components. Nurse Educ Pract. 2007 Jul;7(4):215-27. Epub 2006 Oct 11.
As always, comments are most welcome.

Thursday, May 10, 2012

I've been everywhere, man (Musings on fast-tracking those with foreign credentials)

This blog is a revised version of a recent personal blog, 'Want to work in Canada as a medical technologist? Forget it!'
Last updated: 16 May 2012 (see Addendum below)
 As a promoter of international job mobility, it has long saddened me that foreign-trained medical laboratory technologists from English-speaking nations such as Australia, NZ, and the UK face so many obstacles when seeking work in Canada. 
Do physicians and nurses face similar obstacles? Perhaps not, because everywhere in Canada, I hear physicians with British, New Zealand, South Africa, and Aussie accents. And since 'Down Under' countries are always holding job fairs in Canada for nurses, I suspect that mobility may be reciprocated, i.e., Aussi and Kiwi RNs can work in Canada without too much difficulty. But for medical technologists, it's a different story. Working in Canada is onerous, indeed.
If you are a physician or nurse, I encourage you to read (even skim) the technologist-related details below to assess how job mobility for your profession compares.
This blog derives from a Dark Daily report: "Medical laboratory technologists with foreign credentials to get fast-track acceptance in Canada."

Its title derives from an old Hank Snow ditty, I've been everywhere, man.

I love Dark Daily, but its headline and article are misleading. If I were asked about foreign-trained medical laboratory technologists from AU, NZ, UK, and USA, where English as a second language is a non-issue, and where education and training are world class, my response would be:
  • All the fast-tracking in the world won't help.
As background, Canadian employers (mainly government-funded health regions) are always moaning and groaning about the shortage (soon to become worse with impending retirement of baby boomers) of nurses and physicians, as well as other health professionals such as medical laboratory technologists and diagnostic imaging technologists. In response, governments have created various fast-track schemes that supposedly will allow faster immigration and employment of qualified needed health professionals. 

USA GRADS
First, USA grads do not qualify because their general certification does not include histotechnology. In Canada, besides clinical chemistry, hematology, clinical microbiology, and transfusion science, general certification requires education and a clinical rotation in histotechnology.

Second, obtaining subject certification for USA grads in the other 4 main disciplines is out because Canada offers subject certification only in clinical genetics and diagnostic cytology.

Reasons that CSMLS does not offer subject certification in other disciplines include
  • Cost (subject exams are costly to maintain) 
  • Employer preference for flexible grads who can work in all disciplines
  • Fear that employers may use those with subject certification to work in lab sections for which they are untrained
Accordingly, the path to employment in a clinical laboratory for a USA-educated and trained medical technologist / clinical laboratory scientist is a torturous path:
  • Step 1: Attend an educational institution (Canada or US) and take a course equivalent to an histotechnology course taught at Canadian institutions. For example, see MLS 250 at the University of Alberta.
  • Step 2: Convince a potential employer to provide a clinical rotation in histotechnology. In Canada this is ~4 weeks. And it's next to impossible because employers can barely offer clinical rotations to Canadian-trained students.
  • Step 3: Apply to CSMLS for a 'Prior Learning Assessment'.
  • Step 4: If eligible, arrange to write the CSMLS general certification exam (based on a competency profile) covering the five disciplines specified on the CSMLS website.
AUSTRALIA, NEW ZEALAND, UK

Background
In my experience, education and training 'Down Under' and in the UK are excellent and in some ways exceed that of the typical Canadian graduate, since Canada rejected the BSc as entry-level several years ago.
This decision created barriers for Canadian medical laboratory technologists to work outside Canada. 
People who did not support the BSc were employers and bureaucrats in provincial government departments of health. Reasons for rejecting the BSc varied but included:
  • They perceived the BSc as entry level for nurses  as credential inflation leading to increased salaries without sufficient return on investment and they were determined to stop this happening for medical laboratory technologists.
  • Employers wanted the cheapest possible medical laboratory technologists, those who could be 'turned out' as quickly as possible and paid as little as possible. 
  • In their short-sighted view, with the move to increased laboratory automation and centralized testing, who needed a technologist whose education and training took 4 years?
Exception
Canada has two programs that provide both a BSc and professional certification by CSMLS:
All other programs are 2- or 3-yr diploma programs at technical institutes or community colleges (equivalent of USA 'associate degrees').
For interest, UA MLS grads enjoy international job mobility. They are eligible to write the American MT(ASCP)* exams and many have. (*To change once the ASCP's Board of Registry and NCA merge to form a single USA certification agency.)
This allows UA MLS grads to work in the USA and many did during the mid-90s when laboratory jobs greatly decreased in Canada and many educational programs closed.
As well MLS is the only Canadian program whose grads are eligible to work in NZ without writing certification exams. 
What about job mobility for technologists trained in other English speaking countries besides the USA? Can university educated and trained UK, Oz, and NZ grads easily work in Canada as med lab techs?;

Unfortunately, no. The main reason is that programs in these countries, while providing education in the 5 basic disciplines, do not require clinical rotations in all 5 disciplines.

For example, NZ graduates of university programs  are ineligible to work in Canada because they may do a year's rotation in only 2 disciplines, e.g., 6 mth clinical rotations in their 4th year in each of 2 disciplines (e.g., hematology and transfusion science or clinical chemistry and hematology, etc.), as in the Massey University program.

In contrast, a typical Canadian grad may spend 3 mths in a hematology lab and one month in a transfusion service lab, only one-third of the total time spent by NZ grads in these labs, and in the case of transfusion science, one-sixth as much. But NZ MLS grads are not eligible to write the CSMLS general certification exam without obtaining equivalent clinical rotations in all 5 disciplines.

Is this not nuts, given that NZ MLS grads clearly have more basic education than most Canadian grads, as well as more practical experience in at least 2 clinical laboratories?

OZ and UK grads are similarly stymied if they want to work in Canada because graduates of Australia and UK's university programs can specialize. Examples:
Why do these medical laboratory technologists face significant barriers to working in Canada? Is it all about protecting public safety by ensuring medical laboratory professionals meet Canadian standards of education and training? Or is it about protecting Canadian jobs for Canadians?

And why do graduates of Oz, NZ, UK, and US programs who are certified by their county's professional body and have worked for years in one or more areas of a clinical laboratory, need to write the CSMLS general certification examination covering all 5 disciplines to work in Canada? Beats me.

CSMLS CERTIFICATION
If the educational programs of foreign-trained technologists are deemed equivalent to Canadian programs (or better), foreign-trained candidates must still write the CSMLS general certification exam to work in almost all Canadian medical laboratories.
Most Canadian provinces have regulatory bodies that de facto require that medical laboratory technologists be certified by the CSMLS as a condition of employment in a clinical lab that performs diagnostic tests on patients.
For lab professionals with experience (e.g., those who trained 10-15 yrs ago), and who have likely worked in one discipline (perhaps two) for years, writing an exam covering knowledge and competencies in 5 disciplines is not easy. And getting clinical rotations in Canadian labs is pretty much impossible.
MUSINGS
I personally know NZ-, UK-, and USA-trained lab professionals who are better educated and trained than many Canadian grads, have ample current experience, and would make valuable contributions to Canadian labs and be exemplary employees. But they cannot work here, despite the fast-track 'BS' of our governments.

True fast-tracking would allow
  • Different routes that don't require candidates to re-learn  specific disciplines (e.g., histotechnology), which they will never work in;
  • Restricted licenses to practice and work only in the area or areas for which they are well qualified.
The situation is different for those for whom English is a second language:
Besides becoming fluent in English, these technologists often need to upgrade their education and training to Canadian equivalency. As but one example, in transfusion science, the association of the Rh blood group system with severe hemolytic disease of the fetus and newborn would not have been taught in Asian countries where almost everyone is Rh positive.
Upgrading programs are rare but exist. If candidates pass English language competency tests, successfully complete whatever minimal upgrading is deemed necessary, write and pass the CSMLS general certification exam, they still may not be hired if their English remains weak. That's the reality of today's clinical laboratories where staff are stressed to the max, mainly due to under-staffing.  
If asked, I often advise foreign-trained grads to enroll in a Canadian medical laboratory technology program. It's a tough sell because they have to support themselves and their families. But in the end, this route can prevent much grief and frustration.

Not a pretty picture....

Talk of fast-tracking foreign-trained medical laboratory technologists / medical lab scientists / biomedical scientists is largely smoke and mirrors.

Your thoughts and experiences are valued. Please offer feedback anonymously (or provide your name in the body of your response) by commenting below.

 Whether medical technologist, nurse, or physician:
  • Is there an impending shortage in your country that would benefit from greater international job mobility?
  • Does international job mobility of needed health professionals work well in your country? 
  • Do foreign-trained workers face significant barriers? 
  • Is fast-tracking a reality? 
Similarly, have you tried to work in another country and what obstacles, if any, did you face?

For fun
'Golden oldies' by Canada's inimitable Hank Snow
And just because I love it:
 As always, the views are mine alone.

ADDENDUM (16 May 2012)

Thanks to 'Anonymous,' who left a comment but perhaps withdrew it:
Well, it seems that both nurses and doctors have to sit exams in Canada in order to work here.... I wonder if it is possible to flood the ears of those desperately in need of lab staff with credentials of American or Australian or New Zealand educated professionals, so that the potential employer is motivated to seek change in the requirements.
The comment motivated me to suss out the following info on foreign-trained physicians and nurses wanting to work in Canada.

PHYSICIANS
Source: Global Medics
The basic core requirements for medical registration in Canada: 
A medical degree from any country that is listed in the International Medical Education Directory (IMED)
GP or specialty training that has been completed in Australia, Canada, Ireland, New Zealand, UK or USA
Authentication of medical certification by the Physicians Credentials Registry of Canada (PCRC). 
Some provinces require full verification before they will issue your license. Others will allow you to complete PCRC verification after starting work in Canada. Most provinces also require completion of the Medical Council of Canada Evaluating Exam (MCCEE).
Before taking the MCCEE, internationally-trained physicians must apply to the Physician Credentials Registry of Canada (PCRC) and send a certified copy of your final medical diploma. The MCCEE is a computer-based examination available at 500 test centers in 72 countries. 
Also see Info for foreign-trained medical doctors

NURSES

See Info for foreign-trained nurses

Process is similar to that for medical technologists (assessment, national exam). Exam info:
Canadian Registered Nurse Examination

More....





Thursday, January 12, 2012

Stand by me (Musings on bullying by heath professionals)

Last updated: 22 Nov. 2018 (Updated links)

Bullying has always occurred in the schoolyard and workplace. Lately much news has focused on bullying in schools and cyber-bullying that sometimes leads to suicides by young people.

But I wonder if many people realize that lack of respect and bullying happen all the time between supposedly caring health professionals. Such bullying seldom leads to tragedies like suicide but has serious consequences.

Indeed, bullying among physicians, nurses, medical technologists and other health care providers has significant impacts and 'long tails' in terms of intra- and inter-professional cooperation and ultimately patient care.

Granted the vast majority of health professionals do not bully, but enough do to make it common. And it's so endemic, even entrenched, that we have come to accept it as normal. How sick is that? Even more so, because we are health professionals. 

The title of January's blog comes from the wonderful Rob Reiner film of 1986 with the same title (which took its name from the Ben E. King song). (See if you can pick out the Canadian star of 24 at ~ the 1:28 mark.)

The blog has several origins:
1. Last week I briefly chatted with a technologist working in a transfusion service. She reported an incident whereby a physician verbally abused the lab's technical staff and a medical director intervened.


Such abuse was all too common historically, but apparently still occurs in an era where inter-professional team work and respect are promoted.

2. A survey on subject certification for Canadian medical laboratory technologists by the CSMLS found that many technologists with general certification held extremely low opinions of those with subject certification calling them "dead weight" and similar derogatory opinions.
Some respondents were even miffed that those with subject certification were paid the same as them, apparently unaware that most with subject certification invest more time and money in their education than those with general certification.

Having subject certification, the report naturally caught my eye. And I wondered how technologists with general certification who hold such views treat "dead weights" with subject certification. Does workplace bullying occur, however subtle it may be?

While working in a combined transfusion service / blood centre many moons ago, I never experienced bullying, but the lab consisted mainly of technologists with subject certification. 

3. Being the founder and listowner of MEDLAB-L, a multi-disciplinary mailing list for medical laboratory professions at all levels, I am periodically struck by ongoing tensions between lab and nursing staff, suggesting a systemic lack of respect between the two groups.
According to laboratorians, nurses
  • Just don't 'get' quality control or anything with numbers (only slightly facetious )
  • Cannot be trusted to perform point-of-care laboratory tests without laboratory supervision because they don't understand what can go wrong (legislated in some locales)
Conversely, anecdotes abound on how clinicians (nurses and physicians) think lab staff are anal with their insistence on matching patient identification on blood samples and transfusion requisitions. 
  • "What? You need another sample because the sample reads 'Jonathan Smith' and the requisition reads 'Jon A. Smith'?
REQUEST
I ask readers to review a few resources on respect and bullying among health professionals and assess what, if anything, resonates.
1. Do doctors and nurses hate each other?
Medical laboratory technologists - Can you see parallels between physician - technologist relationships, made worse because historically technologists were the troglodytes in the basement?

2. Bullying in the lab: Have you been a victim?
Check the comments beneath the article. Just negative griping?
I've seen physicians regularly bully lab technologists in the transfusion service, and lab technologists in positions of power routinely bully subordinates.

Such bullying takes many forms, e.g.,
  • Clinician calls the lab and rants about lab incompetence (often leading to a longer delay in providing the requested blood component).
  • Some lab supervisors bully indirectly, i.e., they undermine staff by 'dissing' them to other staff. These supervisors don't comprehend Stephen Covey's common sense dictum that you build trust by being loyal to those who are absent.
3. Doctors, being at the top of the health care pecking order, have a long tradition of bullying nurses, medical technologists, just about anyone.
4. Nurse bullying show - "Nurses eat their young" (Dr. Brian Goldman's 'White coat, black art' on CBC)
If nurses eat their young, do some pathologists "eat" their students and newbie colleagues? Definitely yes. Same for medical technologists.

ANECDOTE
Fortunately, I've had incredibly supportive colleagues (medical technologists, nurses, and physicians) throughout my career. I could name these treasured gems but won't in the interest of privacy. They know who they are.

The one exception involved a somewhat paternalistic  physician who had a habit of glaring at subordinates menacingly in an effort to bully them into complying with his views. The tactic was comical (See Dilbert example) but it scared the bejeesus out of staff unfortunate enough to experience it, including me.

My incident involved having failed a student on a research project. Being young, I was intimidated and never did that again. I got the message. 
If something similar happened today, who knows? I'd like to think I'd resist being intimidated but you have to pick your battles carefully with those who have the power to make your life miserable.
For some levity, one of my favorite Dilbert cartoons on bulllying.

BOTTOM LINE
What can be done about bullying among health professionals? Given that it's usually practiced by those in positions of power, probably not much. Some would argue, "No big deal. We're strong and can handle it."
Still, it's worth a try, isn't it? Does anyone need to take such crap? Shouldn't we try to stop bullying in all its forms?

Many strategies exist, including
MUSINGS
Will reporting bullying be effective, even if a report framework exists? It's a challenge, especially if only only one brave soul does the 'blowing'. Whistle blowers are typically discounted, gain a reputation as trouble makers, and lose their jobs as soon as conditions allow it to be done surreptitiously under the cover of a surrogate reason.

Usually, persistent abuse on the part of one individual to another stops only when many (almost all) subordinates rebel. Systemic abuse by powerful health professionals to another group lower on the pecking order continues relatively unabated despite extensive education.

Of course, it's individuals who bully. Colleagues who see bullying may offer a sympathetic ear but typically do little to stop it, mainly because they cannot see how to help. 

Does it matter? Unfortunately, workplace bullying leads to many consequences, including 
  • increased absences
  • decreased productivity
  • mental health issues
  • job dissatisfaction
  • increased job turnover
On a personal level, it can devastate those experiencing it. Many learn to cope (albeit at a price), but some do not.
I encourage you to identify the bullying (minor, moderate, severe), whether intra- or inter-disciplinary, that routinely occurs in your transfusion service or blood centre. Then do something

If prevention and complaint resolution processes on bullying don't exist, develop them. If existing policies are ineffective, improve them. Don't be content with lip service - make the system, especially its leaders, walk the talk.

CBS has a donor slogan, "Blood, it's in you to give." The last part is the key - It's in you to give. You can make a difference.
As Margaret Lawrence said,
Know that although in the eternal scheme of things you are small, you are also unique and irreplaceable, as are all your fellow humans everywhere in the world.
In the worst cases, there's always hope of retribution, although this successful example is no doubt complicated by race:
FOR FUN
What music comes to mind?
  • 'Stand by me" by Ben. E. King ( Support colleagues who experience bullying. It could be you next.)
As always, the views are mine alone. Comments are most welcome BUT, due to excessive spam, please e-mail me personally or use the address in the newsletter notice. 

Addendum (23 Feb. 2012): 
Further Reading
Nice series on physician and nursing relationships with the laboratory (full free text on PubMed Central):
1. Butterly JR, Horowitz RE. Controversies in laboratory medicine: a series from the Institute for Quality in Laboratory Medicine. MedGenMed. 2006; 8(1): 47. 
Two parts, each with responses:
  • Top 5 issues that irritate physicians about the laboratory  
  • Top 5 issues that irritate the laboratory about physicians
2. Kurec A, Wyche KL. Institute for Quality in Laboratory Medicine Series - Controversies in laboratory medicine: nursing and the laboratory: relationship issues that affect quality care. MedGenMed. 2006 Aug 30;8(3):52.
Three parts:
  • 5 nursing concerns as viewed by the laboratory
  • 5 nursing concerns as viewed by [nursing] 
  • Beyond the complaints: working together to improve laboratory testing and services
Updated 14 Jan. / 17 Jan.  / 24 Jan. 2012 / 23 Feb. 2012