Editorial: Should Registered Nurses have the Ability to Analyze Clinical Laboratory Tests? A Response to the Centers for Medicare and Medicaid Services’ (CMS) Request for Information

Editorial

The Centers for Medicare and Medicaid Services (CMS) have recently been urged to disallow nurses from analyzing lab tests. This is an interesting issue that has arisen seeing that it is now affecting nurse educators and nurses’ view of their scope of practice. During the presidency of Barack Obama, a regulation was enforced that allowed nurses to analyze clinical laboratory tests. Now the CMS is making a request for information on whether personnel requirements need to be updated. Commentary by Baylor Scott and White Health Testing explained that some staff do not hold the educational requirements necessary to analyze laboratory tests. It was stated that clinical judgment of laboratory results cannot be made by the laboratory scientist of they have no understanding of molecular biology, genetics, and polymerase chain reaction testing. This is where nurses are affected. There are mixed responses by nurses. Some states that they have undergone a large amount of biology education and felt qualified to read lab tests. However, contrariwise, others contested that only those registered nurses who hold a bachelor’s degree have the ability and possess the necessary training to analyze laboratory results. As a result, the CMS is calling into question rather the current regulation should be amended to reflect that a nursing degree of any kind is equal to a biological science degree OR that specific nursing degrees be added as a separate qualifying degree to the current list of approved qualified degrees. In addition to calling into question what nursing degrees qualify a nurse to analyze laboratory tests, CMS is also calling into question what is appropriate laboratory training, experience, and skills that determines if a nurse is qualified to meet CLIA requirements. Furthermore, documentation to verify such training, experience, and skills is also being examined. Despite laboratory values being taught in most theoretical clinical courses of nursing and undergraduate nursing students often being called on to analyze laboratory values of their patients during clinical education, there is often no formal education that is focused on laboratory values alone in nursing education. These labs are often taught in light of conceptual or medical models while learning about medical conditions in terms of what labs would be examined in light of a diagnosis- rather its medical or nursing in nature. The author wishes to make a suggestion that during health assessment courses, the laboratory values are often overlooked. This would be an excellent place to start novice nursing students so that they have a better basis for analyzing lab tests. It could be covered conceptually in light of each body system with a medical or nursing perspective. For example, in terms of examining the urinary system or the concept fluid imbalance, the lab blood urea nitrogen could be discussed. This would be relevant for such broader topics. Most nursing students at Nursing & Healthcare International Journal

any level of education are aware of the meaning of this lab knowing that urea is a waster product of the liver as a result of protein metabolism. Ammonia is produced and converted into the waster product of urea. Blood urea nitrogen measures the amount of this substance in the blood. In most medical-surgical courses in associate and baccalaureate programs, this test is discussed in relation to kidneys disorders and dialysis. And this is only a single example of how these labs are taught to nursing students of all levels. Even before being eligible for such higher level nursing courses, most nursing students of all levels are required to take anatomy, physiology, chemistry, and microbiology courses as prerequisites so they can even understand such advanced concepts. Not only do nursing students receive training in the theoretical parts of their courses, but also in the clinical section as well. After learning about kidney disorders, students are often assigned clients with such disorders and are then asked to analyze and interpret the meaning of laboratory studies that have been completed on such clients. For example, if a patient is known to have chronic kidney disease, the student is expected to know to anticipate an elevate blood urea nitrogen. This takes the learning domain of such laboratory values to the next levels of application, analysis, and evaluation. Documentation and verification of such training in laboratory values can be seen in the passing of the National Council State Board of Nursing Examination for Registered Nurses (NCLEX-RN). In this entry to practice exam, any nursing student attempting to become a registered nurse must answer test questions that assess whether they are able to both analyze and apply nursing knowledge of laboratory values in the care of a client with a specific condition. This greatly reflects clinical practice currently where nurses are often called on to analyze laboratory values and communicate abnormal values that could adversely affect their clients to members of the healthcare team. Therefore, the answer to CMS is clear. All licensed registered nurses, regardless of their level of degree held, possess the training, experience, and skills to analyze laboratory results.