The current data at Memorial Sloan-Kettering, Ms. Gillens-White noted,
show that 85% of the referrals initiated to the hospital’s smoking
cessation program have been made by registered nurses. The implication for nursing, she said, is that nurses need to
initiate a smoking cessation intervention "at every office visit and
At Marshfield Clinic, about 5 years ago, a decision was made to alter the
traditional practice of requiring nurse clinicians to perform all of the
venous access device (VAD) blood draws and care. Instead, phlebotomists
would perform the uncomplicated VAD blood draws and site care. To implement
the decision, the nurses developed a VAD training program for phlebotomists.
"We had a system of nursing care where we were performing all the
venous access device draws and all the care and all the teachingand
administering all the chemo and telephone triage and symptom management.
What we had was a conflict," said Darlene M. Pawlik Plank, RN, MSN,
AOCN, oncology services manager at the Marshfield Clinic.
If nurses were performing VAD blood draws and dealing with minor
complications, they we were not available to give chemotherapy, she said. So
it made sense to have the phlebotomists perform the uncomplicated VAD blood
draws and site care.
"Our goal was to use the best skill mix of each profession to create
a partnership in the care of patients with VADs, and previously, the
phlebotomists’ training had not included VADs," Ms. Plank said. The
phlebotomists, she pointed out, "are skilled at accurately obtaining
samples, labeling them, and sending them to the lab." The nurses, with
their clinical expertise, focus on patient care, she said.
To implement the training program, the nurses developed simulation VAD
models using actual ports and catheters, and a skills checklist that
reflected policies and procedures. The model provided an overview of the
types of VADs, catheter care, and the signs and symptoms of catheter
During a clinical practicum phase, a nurse accompanies the phlebotomist
during the blood draw. The review made the process visible to all, Ms. Plank
said. "We had increased understanding of the role of each profession,
and we identified each other’s professional blind spots," she said.