Beyond the Biohazard Door

It’s time to open the lines of communication between lab professionals and nurses

In most hospitals, the only thing connecting the unit’s medical staff to the lab is a phone and a pneumatic tube. Millions of samples are sent to the lab with little-to-no backstory on why they are requested. Thousands of phone calls are made between the unit and the laboratory by people who don’t have the patience to listen to one another. This results in misunderstandings, the possibility of raised voices, likely some accusations and probably comments like, “You won’t believe what this nurse/lab tech just said to me.”

Why do healthcare professionals treat each other this way? Most likely, it is because we are ignorant of what goes on outside of our professional bubbles. Lucinda Manning, BA, MT(ASCP), RN, assistant vice president and group manager of blood services at ARUP Laboratories, is one of the few people in the healthcare world that understands both sides. Manning started her career in a hospital-based lab, and after several years of working, she decided to go back to school for nursing. This decision was influenced by her time spent as a hospice volunteer, as well as the possible employment opportunities from being dual certified. Her knowledge and experience in both career paths have helped her to foster relationships between the two professions.

Manning understands why a culture clash exists between nurses and lab professionals. “Nursing is more of a practice, meaning there are multiple ways of performing certain tasks and nurses are given the freedom to perform those tasks the way they were trained,” said Manning. Nurses can also change their order of priorities to best suit their patients’ needs. In labs, there are protocols that must be followed no matter what the situation; laboratories are highly regulated and must not deviate in the testing and labeling protocols.

The difference in the amount of patient contact is also an issue. “Nurses walk into a patient’s room multiple times a day, and in many cases, they deal with that same patient day after day,” explained Manning. “Nurses feel they know their patients. This can sometimes lead to a ‘false sense’ that, because they know the patient, it is okay to make changes on a sample labeling, such as correcting an incorrect spelling of a patient’s name,” she added.

In the lab environment, there is little-to-no patient interaction. Lab professionals only get to know a patient by their name and ID number. Because of that, the protocol for dealing with a mislabeled sample is very different from what nurses think it should be. Redrawing a mislabeled tube is insuring patient safety in the lab’s mind, while it is considered to be a time-waster on the floors.

It is inappropriate to question a colleague’s motives based on your own professional ideologies. Both nurses and lab professionals care equally — the only difference is how they demonstrate it. There is no winner in this constant bickering and complaining between the two professions, but there is indeed a loser, and that is the patient. It’s time to stop turning to social media to vent your frustrations and time to start bringing more communication, education and interaction to both sides of the table.

According to Manning, the key to fixing this issue is communication and education. “Get laboratory professionals on the patient care floors and get the nurses into the laboratory,” said Manning. “Get upper management involved in pushing for a cohesive patient-care team that involves all departments.”

It is important to start fostering interprofessional relationships before students even graduate. Nursing and MLS professionals at Austin Peay State University gave interprofessional education (IPE) a try and shared their experience. Tanya S. Beard et al published “A Study of Interprofessional Collaboration in Undergraduate Medical Laboratory Science and Nursing Education1” in the spring 2015 issue of Clinical Laboratory Science. The program used scenarios that required nursing and lab students to interact and engage in clinical decision making. After the activity, students had an improved opinion of their own profession, and placed a greater importance on cooperation with members of the other profession. The study produced some interesting results when the students discussed how they felt about the way their respective field was viewed by the other profession. Survey responses showed that MLS students, in contrast to nursing students, did not feel their profession was highly valued in healthcare.

Jane Semler, one of the authors of the study, discussed why the MLS students felt this way. One comment she received from a student stated that the nursing students were busy with their own duties and did not have the time to really appreciate everything done by the MLS students. “This is not really a bad thing, but this is reflective of what happens in a hospital setting and further illustrates the need for IPE so, at least, we all have some idea of the pressures and work done by each group of professionals,” said Semler.

On either side of the biohazard door, it is very easy to lose your cool with someone and wonder why they just can’t understand, but those feelings will continue until we begin to communicate effectively. We have been educated on how to do our jobs, but we need to reach across the aisle and educate others. IPE is important in teaching healthcare professionals communication skills and teamwork, but it also helps save lives by creating a patient-centered environment.

On Facebook, I recently came across a comment from Jean Ruddell, MT(ASCP)SBB, a retired Lieutenant Colonel in the US Air Force, that really resonated with me. The nurses where she worked were upset because they believed the lab was hemolyzing their samples. To address the issue, the lab created a hemolysis prevention training program and shared it with the nursing staff. After the training was implemented, the number of samples that needed to be recollected due to hemolysis dropped. “We talk a lot about communication problems between the lab and nurses,” said Ruddell. “A lot of the problems never get resolved because we gripe about them amongst ourselves and they gripe about us amongst themselves.”

So, let’s open up the biohazard doors and start communicating and educating one another. Because griping, complaining and shaming just result in problems becoming lost in translation.


  1. Beard, T., Robertson, T., Semler, J., & Cude, C. (2015). A Study of interprofessional collaboration in undergraduate medical laboratory science and nursing education. Clinical Laboratory Science, 28(2), 83-90.

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