I'm fascinated by the recent CMS announcement.  We require ASCP (or equivalent) to work in our lab and I imagine many others do too.  Will CMS allowing nurses to do high complexity testing change much?  What drove this decision?  I have not know many nurses to come knocking on the lab doors trying to get in.

http://community.advanceweb.com/blogs/mt_2/archive/2016/07/31/cms-says-nurses-can-perform-high-complexity-tests.aspx

Holy Cow!  Something is wrong here!  The proposed rule by CMS as sent to CLiA inspectors states:

"In proposed § 17.415(d)(1)(i), a CNP would have full practice authority to provide the following services: Comprehensive histories, physical examinations and other health assessment and screening activities; diagnose, treat, and manage patients with acute and chronic illnesses and diseases; order, perform, supervise, and interpret laboratory and imaging studies; prescribe medication and durable medical equipment and; make appropriate referrals for patients and families; and aid in health promotion, disease prevention, health education, and counseling as well as the diagnosis and management of acute and chronic diseases."

 

So not only are these "super" RNs allowed to do lab tests, but also apparently radiology and other imaging, as well as diagnose disease? This can't be correct.  Something is being mixed up here in the reporting.

 

Scott

 

 

32 minutes ago, SMILLER said:

Holy Cow!  Something is wrong here!  The proposed rule by CMS as sent to CLiA inspectors states:

"In proposed § 17.415(d)(1)(i), a CNP would have full practice authority to provide the following services: Comprehensive histories, physical examinations and other health assessment and screening activities; diagnose, treat, and manage patients with acute and chronic illnesses and diseases; order, perform, supervise, and interpret laboratory and imaging studies; prescribe medication and durable medical equipment and; make appropriate referrals for patients and families; and aid in health promotion, disease prevention, health education, and counseling as well as the diagnosis and management of acute and chronic diseases."

 

So not only are these "super" RNs allowed to do lab tests, but also apparently radiology and other imaging, as well as diagnose disease? This can't be correct.  Something is being mixed up here in the reporting.

 

Scott

 

 

I sincerely hope you are correct Scott.

I have the utmost respect for nurses and transfusion practitioners (many of whom started out as nurses, but neither they, nor many haematology doctors (let alone general doctors) should be allowed anywhere near a blood transfusion laboratory, without extensive training and education - something that we have been exposed to for many years.

Note that the above excerpt is only part of the rule.  More info can be found here:

https://www.regulations.gov/document?D=VA-2016-VHA-0011-0001

This is being promoted as good for veterans, and seems to be pushed primarily by nursing groups.  If you look at other summaries and comments regarding the proposed rule (the comment period is now closed),  it appears that the rule-writers only sought out advice from various nursing organisations -- no mention of contact with ASCP or any other clinical lab group for that matter.  

It also looks like this is being driven by the recent revelations of poor turn-around times in VA care in the US.  The idea being that if any CRNA with a BS or BA is allowed to run lab and radiology tests and do things like perform anesthesia, that somehow this will improve care for our veterans!  (Also, it opens up a several new departments in the hospital where they can stick a RN in as a director!).

Scott

BTW Malcolm, anything like this in the UK?

Scott

3 minutes ago, SMILLER said:

BTW Malcolm, anything like this in the UK?

Scott

NOT AT ALL Scott!!!!!!!!!!!!!!!!!!!!!!!!!!

Here's hoping that after we in the US tally up 70 years of socialized medicine, we will have it all settled out, too!

Scott

ASCLS has provided feedback to CMS regarding this issue.  I'm more than a little distressed about this as a direct comment on the medical technology profession as a whole.  As an SBB, I'm qualified by education to perform as a general supervisor only for my high complexity reference laboratory and yet an RN can function as my director?  I respect every nurse I've ever come in contact with, but their education is not focused on laboratory testing to the same extent ours is.  They are part of the health care team, but they are not laboratory scientists.

I've attached the ASCLS Government Affairs Alert.

Government Affairs Alert.docx

7 hours ago, dragonlady97213 said:

ASCLS has provided feedback to CMS regarding this issue.  I'm more than a little distressed about this as a direct comment on the medical technology profession as a whole.  As an SBB, I'm qualified by education to perform as a general supervisor only for my high complexity reference laboratory and yet an RN can function as my director?  I respect every nurse I've ever come in contact with, but their education is not focused on laboratory testing to the same extent ours is.  They are part of the health care team, but they are not laboratory scientists.

I've attached the ASCLS Government Affairs Alert.

Government Affairs Alert.docx

Like you Jeanne, I have huge respect for most nurses (although there is always the odd "bad apple", as, indeed there is in our own profession), but I do hope that nurses in the UK do not get any bright ideas from reading this!  I would hate to get into any arguments with them!

 (Also, it opens up a several new departments in the hospital where they can stick a RN in as a director!).

This is actually happening! My facility is a large university medical center. During a recent administrative re-organization, our Laboratory Director (18 yr employee, SBB, MPA, 8 yrs in current position) had to re-apply for her position. She was replaced by an RN whose previous position was the manager in charge of the lactation program. TRUE!

Evidently the career ladder for Medical Technology stops a little shorter than it used to:)

2 hours ago, Moncada said:

 (Also, it opens up a several new departments in the hospital where they can stick a RN in as a director!).

This is actually happening! My facility is a large university medical center. During a recent administrative re-organization, our Laboratory Director (18 yr employee, SBB, MPA, 8 yrs in current position) had to re-apply for her position. She was replaced by an RN whose previous position was the manager in charge of the lactation program. TRUE!

Evidently the career ladder for Medical Technology stops a little shorter than it used to:)

That is utterly disgusting.

Unbelievable! I'm just hoping the more stringent state regs here in California do not change to allow this. Sadly, laboratorians vs. RN's are a real David and Goliath story. Lab Scientists seem to lack the lobbying power to hold our ground. 

23 hours ago, Moncada said:

 (Also, it opens up a several new departments in the hospital where they can stick a RN in as a director!).

This is actually happening! My facility is a large university medical center. During a recent administrative re-organization, our Laboratory Director (18 yr employee, SBB, MPA, 8 yrs in current position) had to re-apply for her position. She was replaced by an RN whose previous position was the manager in charge of the lactation program. TRUE!

Evidently the career ladder for Medical Technology stops a little shorter than it used to:)

My medical director and I discussed this just Wednesday. He says...just wait, the wheels will come off the wagon in a hurry. Of course, how much harm will be done before that happens.

It's a bit ironic that CLIA has so many regulations and requirements to insure laboratory testing quality and then flips it on it's head and grants non-laboratorians purview.

11 hours ago, dragonlady97213 said:

It's a bit ironic that CLIA has so many regulations and requirements to insure laboratory testing quality and then flips it on it's head and grants non-laboratorians purview.

I'm not sure "ironic" is the word I would choose, but I don't think Cliff would allow me to use the word of which I am thinking!!!!!!!!!!!

Horrible idea.  The existence of Lab Assistants is becoming more popular too; and their range of duties is expanding (outside of CLIA regs of course).  We are one of the only medical professions that seems to want to "dumb itself down".  Physician therapists, pharmacists, PAs, have all raised the bar for themselves by requiring higher degrees and certifications.  In my state (NY) that has licensing, some labs are trying to get around it by using foreign workers on temporary work visas; get them in and out before anyone notices.  It's getting crazy due to the shortage here, but I feel like the worst thing we could do is get more lax in who we allow to result lab tests.

53 minutes ago, tbostock said:

Horrible idea.  The existence of Lab Assistants is becoming more popular too; and their range of duties is expanding (outside of CLIA regs of course).  We are one of the only medical professions that seems to want to "dumb itself down".  Physician therapists, pharmacists, PAs, have all raised the bar for themselves by requiring higher degrees and certifications.  In my state (NY) that has licensing, some labs are trying to get around it by using foreign workers on temporary work visas; get them in and out before anyone notices.  It's getting crazy due to the shortage here, but I feel like the worst thing we could do is get more lax in who we allow to result lab tests.

Does NY state provide a grace period for unlicensed technologists from out of state (country)?

Att All:

 On behalf of pathologists and laboratory professionals, ASCP is urging the laboratory community and other interested individuals to Sign the Petition urging the Centers for Medicare & Medicaid Services (CMS) to reconsider its position that nursing is a biological science for purposes of performing laboratory testing. We ask that you forward this petition to all of your colleagues.

http://cqrcengage.com/ascpath/app/sign-petition?0&engagementId=239813

Here is the link to sign this important petition!

 

I signed the petition yesterday.

I had more success getting to the petition with this link (an ASCP Advocacy site):

http://content.site01.ascpmail.org/emessageIRS/servlet/IRSL?v=5&a=10140&r=14242&m=57126&l=2&e=2&x=2457723.0

Scott

Here's the latest news on this issue:

https://www.ascp.org/content/Newsroom/epolicy-news-October-2016#1

And resurrecting this topic from the dead pool, there is good news from the VA about nurses performing laboratory testing in VA facilities: https://www.ascp.org/content/Newsroom/va-sides-with-ascp-laboratory-professionals-on-nursing-scope-of-practice?utm_source=Facebook&utm_campaign=VAP16&utm_medium=Social&utm_content=DEC1#NewsroomGrid 

Thanks for the update Jeanne.  This has been an issue that has been under the radar too long I think. It looks like those dues of mine to the ASCP are actually being used for something!

On the more negative side, with Trump and congressman Tom Price as the next HHS director, we can expect the ACA to be gutted pretty soon.  Next year I do not think it is going to be any easier to stop rules like these that cut corners.

Scott

 

Resurrecting this dead topic:
https://www.ascp.org/content/functional-nav/boc-newsroom/epolicy-news-april-2017?utm_source=Facebook&utm_medium=Social&utm_campaign=ePolicy17&utm_content=APR3#3

It appears that CMS will not reverse it's stand on a nursing degree being equivalent to a laboratory science degree.  It's an insult to the profession.

Edited April 27, 20178 yr by dragonlady97213

16 minutes ago, dragonlady97213 said:

Resurrecting this dead topic:
https://www.ascp.org/content/functional-nav/boc-newsroom/epolicy-news-april-2017?utm_source=Facebook&utm_medium=Social&utm_campaign=ePolicy17&utm_content=APR3#3

It appears that CMS will not reverse it's stand on a nursing degree being equivalent to a laboratory science degree.  It's an insult to the profession.

I hope they are prepared to be taken to court for any deaths.