Canadian Blood Services (CBS) is proposing to eliminate nurses from the initial screening of all blood donors. They will be replaced by workers with only eight weeks’ training. Nurses are concerned the change could impact the safety of Canada’s blood supply.
CBS should have consulted widely with Canadians about this change but they have not done so. Nurses have developed this website to give Canadians a forum for discussion on this public policy issue of national importance.
June 18, 2010 at 8:43 am |
It’s interesting to note that the American Red Cross is now being fined $16 million dollars for sloppy screening of donors. Don’t the American’s use multi-skilled workers? In the article it states a group representing the nurses, alleges, staff shortages, excessive work scheduling and mismanagement are responsible for many of the mistakes.
Please visit the msnbc website for this latest news article.
http://www.msnbc.msn.com/id/37764943/ns/health-health_care/from/ET
June 18, 2010 at 8:39 am |
It’s interesting to note that the American Red Cross is now being fined $16 million dollars for sloppy screening of donors. Don’t the American’s use multi-skilled workers? In the article it states a group representing the nurses, alleges, staff shortages, excessive work scheduling and mismanagement are responsible for many of the mistakes.
Please visit the msnbc website for this latest news article.
March 8, 2010 at 9:14 am |
I am very concerned about the proposal from Health Canada and have written letters against the proposal to Health Canada. As a nurse who works for CBS, based on my nursing knowledge, I often find that a ‘no’ answer is ‘yes’ and the donor is deferred from given blood, or information from their doctor is required. If I had not questioned the donor further and only relied on his answer, it may not have been safe for the donor or safe for the recipient to give blood.
Justice Kreever stated that a very careful screening process is important to maintain the safety of the blood supply and may be expensive, but important to maintain.
The Canadian public should be very concerned if this proposal is approved.
Thanks.
February 24, 2010 at 1:18 pm |
I lost my Dad to the Hep C Blood scandal and I think this move would be a recipe for disaster. I am also a former employee of the Red Cross, a previous blood donor and currently a registered nurse. There is no doubt that the screening should stay in the hands of the specialists in this field. Can any of us afford to have another disaster occur to our family members because of a screening error? The potential is there. Money should be invested in keeping the Canadian Blood Service safe, not risk Canadian’s lives because of “cut backs”
Judy Nelson RN
February 24, 2010 at 2:16 pm |
I completely agree with you, Judy.
It’s incomprehensible to be forced into a decision so closely similar to a previous error resulting in the lives of those trusting health care professionals to keep our blood banks clean.
The lives of those lost, like your father, cannot be replaced.
But learning from our history shouldn’t be an option.
If the higher-ups can’t see how destructive a vote in this direction would be, we should let them know.
February 20, 2010 at 9:30 am |
I am a registered nurse, currently employed by Canadian Blood Services. Let me say first and foremost that I have much respect for my co-workers (i.e. clinic assistants and phlebotomists) and I consider them my friends but really, this isn’t about them and it really isn’t about nurses either. The main issue here is the safety of the Canadian Blood supply. As a person involved in the collection process, I presently would feel completely safe with any of my family members receiving a blood transfusion. However should the screening process be performed by anyone other than a nurse, my confidence level would greatly decrease.
Screening a donor can seem very straight forward to the untrained employee. However it is the nurse’s acute assessment skills and critical thinking that are imperative to assure the screening interview is thorough and complete. I personally have had many situations where because my acute assessment skills that I have learned of issues that would prevent a person from donating, that a non nurse would never have picked up on. This is not meant to degrade the multi skilled worker in any way-I believe that the MSW has a place in CBS – just not in the screening process. My nursing experience and education has afforded me the ability to detect the most subtle of issues and to question further when necessary. I have had many situations in the screening booth when my nursing intuition has caused me to simply probe a little further, knowing that there was more than meets the eye. Such skill comes only through education and experience.
As a blood donor, a nurse, a blood recipient and as a Canadian, my concerns go above and beyond trying to save my job. I truly and sincerely am concerned for my fellow Canadians and the safety of our blood supply. Those who require transfusions are often in a state of poor health as is – surely we cannot allow such citizens to be even further at risk by compromising the integrity of our blood supply. As a nurse, it is my responsibility to advocate for my patients/donors and as although many readers will see this as an attempt to save my job, it is so much more than that.
Have we not learned through our past mistakes, Canada? Really. We are a more intelligent nation than that. Let’s be world leaders in the safe supply of blood – let’s not be followers!
Nurses ARE critical to maintaining the integrity and safety of the Canadian Blood supply.
February 19, 2010 at 4:59 pm |
RE: Kaylee’s comment: ….and taxi cabs, couriers, airlines, and buses remain the form of transporting the blood.
April 7, 2010 at 5:35 am |
Re: CBS employee
Once the blood is collected ( and donors have been screened by a registered nurse), it is transported by taxi cabs, couriers, airlines and buses – but the collection process is completed then – the blood is safe. Precautions are taken (i.e. proper shipping and tamper proof tags) to keep the blood safe then. Our concern is the intitial process of collection, not transportation. Let’s not confuse the two issues. We, as nurses, are concerned with keeping the blood safe during the collection stage.
February 19, 2010 at 7:36 am |
As a former employee of Canadian Blood Services I am not at all suprised that they are trying to reduce the cost of blood collection…at the cost of blood safety.
Until a group of determined CBS employees went on strike a few years back they used to send collected blood by taxis across our province.
Imagine, all the trouble the organization goes through to ensure blood safety then they turn around and stick what is so generously given in the back seat of a cab. None of these drivers had any training…they just came at a cheaper price than their own transport employees.
CBS has no regard for their employees. They are seen as a means to an end…and if that means can be accomplished in a cheaper…even if it isn’t safer or reduces safety, they will.
Don’t let CBS pull another fast one…lives are at stake.
February 11, 2010 at 6:15 pm |
It is evident CBS is misleading Health Canada.
CBS has been trying to ‘sell’ the “multi-skilled worker” concept to Health Canada by claiming it is essential to replace nurses with e.g. all of our clinic assistants (whether the clinic assistants feel comfortable with it or not), because of a “nursing shortage”. However many, if not all, CBS blood collection centres in Canada have difficulty attracting and retaining nurses because they are reluctant to offer them attractive positions (in our centre over 1/2 of our nurses would like full-time positions, which are basically foreign concepts @ CBS). Furthermore, it was only last month that CBS finally removed the 2 year waiting period for part-timers to join the pension plan, which was another big retention/recruitment issue (except in Manitoba, due to Provincial laws).
Which brings up another confusing fact: CBS wants Health Canada to be concerned that because of a nursing shortage, CBS has been or will be having difficulty collecting enough blood. What is confusing about this is CBS is conveying various communications indicating we have enough, even ‘too much’ blood. Apparently many centres’ blood collection targets are being met & for the most part exceeding last year’s (2008/2009). Also last month they decided to revise the collection schedules in the upcoming fiscal year by reducing the blood collection targets & reducing the # of mobiles we will be going on. Apparently the hospital demands have been “less” than previously predicted. Why should Health Canada be worried about not having enough nurses to collect the blood needed?
As far as convincing Health Canada that the DSCM (health screening reference manual) is a ‘piece of cake’ to use: It isn’t ! Not only are many health conditions not listed, but for many of them you need to know alternate terms for them, and hence look alphabetically under a different letter. It is not very ‘user friendly’. We often find ourselves playing ‘charades’ with the donor as they are trying to tell you what tests or medications they had. Some tests require dyes which all have varying deferral periods. Often donors exclude info on their record of donation which is revealed by the nurse’s acute assessment skills. CBS is content the donor is responsible for their own actions when they answer “no” to questions on their questionnaire to e.g. medications/physician care/diseases etc..- the donor is putting their signature to their truthful statements, after all. A nurse needs to ensure the donor actually meant to answer questions “no” when they meant “yes” to help ensure blood safety that much more, because many donors either make errors in this process or rely on the nurse screening them to clarify things for them. Often a donor will say, “Oh it’s nothing, really” (e.g. re: tests or medical conditions or medications) – and could easily convince a non-health professional of such – which could lead to a compromised blood product, or blood donor. CBS of course is trying to convince Health Canada our DSCM reference manual is self-sufficient, and anyone can use it with a little training- I am afraid this is very untrue !
February 7, 2010 at 8:43 pm |
krystal – I would beg to differ about your staff nurses “not being true nurses”. The art of nursing goes well above and beyond numerical measurements!
I’ll give you an example. Some details are changed to protect the information on behalf of a donor.
Say you have a donor come into your screening room who fills out the questionnaire. All of the correct boxes are filled in, and the medication the donor is on is acceptable per the DSCM (donor criteria selection manual). When asking why the donor is on the medications, the donor states that he/she doesn’t exactly know, the doctor just prescribed them.
Now, it might be simple enough for you to devise that the medications are acceptable, so there should be no worry.
What if the medication taken was for a cardiac condition, unknown to the donor (this happens A LOT, and that’s IF the donor can even remember what medications they take!). The donor proceeds to the beds to donate, has a cardiac “event”. Who is liable in that case? What if the donor were to take legal action against you as a DCA? Where are you going to come up with the liability insurance?
As an RN, we at least have some coverage and availability of legal assistance through the CNA and our license. If you screw up, you could be liable on your own.
Nursing assessment is a huge, giant, elephant that goes to the microbiological level. I don’t have a microscope in my screening room, I don’t have an ECG, I don’t even have access to the patients medical information. All I’ve got is my four years of nursing education and my work experience. I still need to verify my assessments with senior nurses on a very regular basis. On every busy mobile, you will see us conference several times and make decisions based on both the safety of the recipient and the safety of the donor.
Krystal, I think you’re probably a very smart person. I think you’re very skilled at starting a needle, checking over the RD and following all of the SOP’s you’ve been meticulously taught. I applaud your response, but I’d like you to seriously think about what kind of a position your employer is putting you in. You are going to be making decisions that could put a donor at RISK for needing blood, as well as jeopardizing the safety of the blood supply! No eight weeks of training will ever replace a registered nurse.
Personally, I respect my co workers and I have come to learn that many of them have a great deal of experiences that may go above and beyond an off-the-street unlicensed provider. I’ve even trained unlicensed care providers in another job to administer medications and assess residents in a private care home setting – and I would trust them to make appropriate decisions based on their scope of knowledge.
I truly wish that our co workers had greater respect for our professional designation. As far as I have come to know, there are many kinds of nurses out there from all races, creeds, experience levels, and training programs. But in order to maintain our license to practice, we do have to show that we’re in touch with best practice for our areas as well as take part in learning activities to expand our knowledge base. Personally, I read journals, scour websites and blogs, and make it my personal goal to become a generalist in health matters so that I can stay current within my field. That’s all part of being a nurse, it’s far more complex than I could ever write on a blog comment.
Please, phlebotomists and clinic assistants – I urge you to think long and hard about the consequences of a near miss to our blood supply and to our donors. Also, take care of each other and your co workers. This isn’t about starting a battle or splitting sides. We care about you too.
February 5, 2010 at 4:55 pm |
I am currently employed by CBS a a phlebotomist and our nurses at CBS are not true nurses, they simply ask wuestions and take n automated blood pressure and automated temperture, as a phlebotomist I register a donor including hemoglobin determination, assess the donors arm for a vein, I label a unit of blood and take great care of my donor, watching for an adverse reaction ie fainting nausea and vaso vagal effect. I do blieve there is a reason to have nurse supervisors on every clinic and to have a few other nurses around to ask the difficult questions regarding donor selection criteria, but to have ten on a clinic all making 40 or more an hour is ridiculous in my opinion for asking questions, as most of the nurses on clinic do not know how to do venepuncture or will even put a band aid on a donor, so as a phlebotomist I am more than capable to handle questions and yes they are to be handled with the utmost of care. I am a health professional and am certified by the OSMT as Labtechnician
February 6, 2010 at 2:05 pm |
Sorry to hear that you feel this way… You probably don’t realize what questios and extra questions beeing asked behind thos booths. By the time you get the donors on your bed, those donors are fully screened, and many of those donors need to be questioned about other issues that whats on the question form.
Nurses have their education in years not in 8 weeks… Automated blood pressure and temperature taking does not mean that anybody can decide if that donor is truly eligible to donate and the public receive safe blood.
It sounds to me that you have issues over salary other than safe blood.
Phlebotomist can be anyone, they train them for venipuncture in weeks, that is a skill that someone can learn.. Nurses do more that phlebotomy, they have more than skills, they have complex MEDICAL KNOWLEDGE that noone can learn in only 8 weeks!
Am a regular donor, and I see whats in the booth and whats on the beds.. Keep the blood safe, and if it takes nurses to do the screaning and pay them over $40 then so be it, they have spent many hours- years learning what they know and what keeps every one of us safe out there…
January 31, 2010 at 4:39 pm |
I am a volunteer with Canadian Blood Services. As a blood donor, I want the screening process completed by qualified professionals for both my sake and that of the recipient of the blood. I realize that some plebotomists are as good at taking blood as are nurses but I would think that one would be hard-pressed to argue that anyone would be better qualified than an RN to conduct the screening procedure.
Should I ever again become a recipient of blood product, I want to know that the donor of that blood was adequately and thoroughly screened at the point of donation. A potential donor may not think this statement or that fact is important but a nurse in face-to-face contact generates a level of respect and hopefully illicits truthful responses that protect our national blood supply.
January 28, 2010 at 8:38 pm |
I’m not going to relive every single moment of my nursing education, but yes – I took an ENTIRE course on assessment, an ENTIRE year of anatomy and physiology down to the cellular level, Microbiology, Nutrition, Statistics, PLUS a two year stint in a bachelor of arts program pre-nursing. Plus numerous other courses related to the physical “art” of nursing, and not to mention a snippet in actual clinical nursing. I also took an entire year of counseling in my nursing course, which included delving into at least eight different counseling modalities in both theory and practice.
I think Andrew needs to go to a University website and look at all of the classes that a degree nurse is required to take. I think Andrew needs to see that nursing education starts at 7 am and ends at midnight when your textbook closes, for four years.
My nursing education wasn’t the greatest, and I certainly wasn’t at the top of my class. But if you want to talk qualifications for a position – registered nurses are extremely qualified. What better position for a nurse to be in to use all of her skills! I am a newer graduate of a school of nursing education and working at CBS out of school would NOT have been ideal, but my five years employed with other areas of nursing has come in extremely handy in the screening room.
My line of questioning in catching potential deferrals is not just a precaution as a risk to the blood supply, it’s also to protect the safety of the donor. Yes, we have very good screening practices and SOP’s in place – but you still can’t ever replace the skill and intuition that comes with being a nurse!
Andrew, I challenge YOU to take your bachelor of science in nursing and then come back here and let us know how that supposed non-existent assessment course was.
January 28, 2010 at 6:18 pm |
Thanks to Justice Krever’s recommendations, Canada has finally achieved the safest blood supply in the world (since the tainted blood scandal of the 90′s, which cost the Canadian government, and tax payers, millions of $$$). I am surprised Canadian Blood Services would risk losing the public’s confidence again, by abandoning Justice Krever’s recommendations of not waiting for scientific certainty to reduce risk. He recommended preventative measures such as careful screening as a precautionary measure. He also recommended safety should not be influenced by cost. CBS is now serious about considering abandoning these safety measures: foolishly thinking it will reduce their operating costs by having highschool educated persons replace RNs.
It is a nurse’s knowledge not just of terminolgies, but also of what is involved in medical tests, surgeries, disease processes, and medications that influence our navigation through a health screening interview
of potential & existing blood donors. Our education and experience cannot be duplicated with CBS’ “multi-skilled worker” proposal. Because of our extensive training and experience our knowledge helps us to recognize and explore the frequent omissions & errors made by some donors on their record of donation. We are also a valuable resource to give valid explanations regarding the signifance & relevance of the various issues which concern a blood donor’s donation. These are all regular occurrences during the health screening process. How many donors think that because we test the blood @ CBS, that it doesn’t really matter if they answer the questions wrong on their record of donation? Many donors do not understand ‘window periods’/'incubation periods’ in which positive disease markers may not reveal themselves until months later. This is why a health professional such as a registered nurse (physicians in some countries) should remain health screeners, and not a ‘multi-skilled worker’. I fear it will cost CBS (Canadians) more than it will save.
January 28, 2010 at 1:55 pm |
As an adult (47 yrs) I have undergone over 25 major surgeries and medical intervention which included blood transfusions. I trust in our system to have the best screening methods available and to ensure that the persons hired to do such screening are qualified and TRAINED. Not just ” paint by number” checklists. Only those healthcare professionals that understand that other factors contribute to the proper screening…IE: persons lifestyle, mental health concerns, other health related illnesses that put the blood donor at risk of giving blood that is unsafe.
Just my thoughts
January 27, 2010 at 3:12 pm |
This is obviously a website to support nurses working in the Blood System, but I must respectfully disagree.
What courses do nurses take in school that make them uniquely qualified for this position? Is there a course on blood donation? I don’t think so. Can a nurse put in a needle? Sure! But so can Phlebs, and they are not nurses. They are trained to do this task. Is there a course on assessment? Not really, but you do learn a head to toe physical assessment. This is not the type of assessment that is given to CBS donors. Councillor/questioning/reading people? Not nursing courses either. Perhaps the proper people to have in the booth are psychology graduates, police officers or professional poker players.
The fact is that the skills required to do a health assessment are taught by the employer. Experience? Sure, learned on the job!
There is a shortage of nurses in Canada, so lets get those nurses in the hospital dealing with the sick people who really need their help. They do not need to be sitting in a booth all day asking questions which any rational and trained person could do. If it is a very sticky situation, there will still be nurses on site and doctors that can be called.
Sure working only day shifts and not having to work with sick people is great, but is that really a nursing role?
Lets give CBS some credit. They were created after blood scandal and have made vast improvements to the reliability of the blood supply and its safety. They are implementing change to both save money and more likely to increase flexibility on clinics and therefore reduce wait times. CBS has an excellent track record for safety. Why do we think they are going to try to blow that now? Maybe they do know what they are doing. Have they given us any reason to believe that safety, reliability, and increased ease for donors is not their number 1 priority?
January 28, 2010 at 1:11 pm |
Comments from Andrew’s post
There is a shortage of nurses in Canada, so lets get those nurses in the hospital dealing with the sick people who really need their help. They do not need to be sitting in a booth all day asking questions which any rational and trained person could do. If it is a very sticky situation, there will still be nurses on site and doctors that can be called.
Andrew misses the whole point of what nurses are saying, and here’s the question: how will MSWs with only 8 weeks training know when there’s a sticky situation?
And that’s the point .. they probably won’t, and therefore they won’t know when to call the on-site nurse for help
February 2, 2010 at 1:42 pm
I guess I would answer by saying, How do nurses know?
We’re not talking about cardiac arrest, nor broken bones, nor major trama. We are talking about asking questions, and looking for signs of fatigue, or pale skin. Nurses are trained by CBS on what to look for. The new people asking the questions will also be trained.
February 5, 2010 at 5:59 am
How can a nurse know the signs and symptoms of every illness? They cannot.
Not to mention to be employed to draw blood for CBS only requires an 8 hour course at a lab. Not everyone is a certified lab tech, so if they can be trusted to come at me with a needle, they can ask the questions.
CBS is an important and much needed organization, if cutting costs is what’s needed to keep CBS going then then that is what’s needed to be done.
February 7, 2010 at 2:09 pm |
In response to Andrew’s comments:
Yes, there is a course in the BN program whereby nurses are trained to counsell, question/interview, and “read” people. In my program it was called “Caring Relationships” and it was 2 full year courses. It was designed to integrate all aspects of a physical health assessment, a health history and the techniques of an effective interview to acquire a better knowlege of the client’s health status. It has come in very handy in the screening booth. You and other Canadians have me and the other nurses to thank for a safe blood supply. CBS have their guidelines that we must follow, but We have our knowlege and yes, experience to know when to put those guidelines into effect.
January 23, 2010 at 8:09 am |
I am new to nursing, and have worked in many different skill sets – each working with delegated staff. I’ve met some wonderful people along the way who are well educated individuals working in underpaid positions for various reasons. I do not doubt the skill of every MSW coming to the position.
At times there are donors I have screened who really don’t require an RN to approve their donation, so I can understand where CBS is coming from. However, the donors who I have deferred usually do not fill out the questionnaire properly (actually, 90% of donors I’ve saw do not fill it out properly), or just require a line of questioning to get to a deferral.
I hope the health minister rejects this proposal. Please help us get the word out. There are other ways to make things more efficient and cut costs, if all we are as nurses is just a dollar sign.
January 22, 2010 at 10:44 am |
In the light of a new Science Journal article citing the discovery of a new infectious retrovirus associated with chronic fatigue syndrome, prostate cancer, lymphomas, autism, fibromyalgia, atypical MS, and other neuro-immune disease I urge the government to rethink their action to remove nurses from the front lines.
http://www.sciencemag.org/cgi/rapidpdf/326/5952/585.pdf?ijkey=m3wzKT4yJqEyk&keytype=ref&siteid=sci
Our blood supply may not be safe at the moment considering that the Lombardi study reports 4% of the healthy control (n=218) tested positive for this retrovirus. There is a US taskforce that is testing the blood supply at the moment and investigating the need to screen all potential donors.
The Canadian Government should learn from previous experience (HIV, Hep C) that it doesn’t pay to cut the corners and cut the cost. It may come right back at them.
January 21, 2010 at 5:45 am |
As a nurse for 33 years, I am appalled that this could happen. The minimum requirement for many years at CBS was 5 years of nursing experience, and that guideline was strickly adhered to. In addition, the employer also required a university level Physical Assessment Course prior to hiring an RN at Red Cross/CBS.
Now….nothing…..come on over…..we’ll hire you…you worked in a shoe store…that is OK, you have customer service experience. No need to be a medical professional!!!!!!!!!!
January 19, 2010 at 12:56 pm |
The health of Canadians is suffering due to the fallacy of “budget restraints”. Put another way, “budget restraints” are simply decisions about what is important, and what is not. I think blood supply safety is very important, and trying to cut costs at the front end will cost the health care system more when history repeats itself in terms of tainted blood. How much did CBS spend in legal costs due to the tainted blood scandal? How much did it cost Canadian health care? An ounce of prevention….
January 19, 2010 at 11:59 am |
Hi fellow nurses, We must keep up the “press” to stop this idea that CBS can take a group of lay people, give them a few classes and turn them into people who will be able to determine for the rest of the population that this person is donating a safe blood donation – one that you or I or a loved one may well need. Aside from the emotion of it all – daily as I assess a potential donor for their eligibility to donate, I am able, because of my years of experience and training, discover that this person’s blood may pose a significant risk to a recipient or that the actual donation process may pose a risk to themselves. As nurses, we know the question to ask behind the answer, often reading in body language or something the person is hinting at, that there is something needing to be addressed beyond the “yes” and “no” carefully shaded boxes.
January 18, 2010 at 2:27 pm |
Hi, Debra.
“Thinking like a nurse” has allowed me to prevent Donor’s from causing harm to themselves by gleaning information in a screening booth that a non-professional would never have been able to get to. I even go so far as to say that I don’t think even recent graduates should be working in CBS screening. It is my opinion that new graduates should be working in the regular health care field for a number of years before bringing their skills to CBS. It’s that broad-based knowledge that helps each nurse screen more comprehensiveldy than what the health questionnaire allows.
January 15, 2010 at 12:22 pm |
Thinking like a nurse will make health minister’s decision easy
A nurse’s first responsibility is to care for patients and promote what’s best for their health. Rigorous blood donor screening is essential if we’re going to keep Canada’s blood supply safe. Any one of us could get sick or injured at any time – so we all need a safe blood supply.
The Krever Commission was adamant that careful donor screening is essential to maintain a safe blood supply. Canadian Blood Service’s proposal to eliminate nurses from initial donor screening and replace them with unskilled workers doesn’t move our blood service in the direction of increased safety. It goes in the opposite direction.
And that may be the reason CBS has not consulted Canadians widely about the proposed change.
I urge Federal Health Minister Aglukkaq to think like a nurse. Think about safety. Think about the consequences of tainted blood entering the system because an unskilled worker couldn’t spot symptoms of an unreported illness.
If our Minister Aglukkaq thinks like a nurse then rejecting CBS’ proposal becomes an easy decision.
Debra McPherson, RN
President, BC Nurses’ Union
January 18, 2010 at 2:28 pm |
Great. Our national blood agency wants wants the equivalent of wal-mart greeters to screen blood donors. It’s a brilliant idea.
February 24, 2010 at 1:23 pm |
Well said Debra!