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So what the heck does a transfusion nurse do?

The CSTM is very excited to introduce a new feature on our Blog! Clare O'Reilly will provide posts of interest from the perspective of a transfusion safety nurse. Clare is the Transfusion Safety Nurse Clinician at the Children's And Women's Health Centres in Vancouver and is a Registered Nurse with a Graduate Certificate in Transfusion Practice. We look forward to Clare's posts and invite you to comment and discuss her blogs. As well, we welcome anyone else as a guest blogger - if you would like to contribute a blog post, please contact [email protected].

And now here's Clare:
So what the heck does a transfusion nurse do?
First, it's been a fascinating experience for me to begin blogging for the CSTM. Thank you to everyone who responded to my request about your roles as transfusion nurses. I enjoyed reading all the emails and hope that I will eventually meet some of my fellow ‘Transfusion Nurses' from across Canada.
As background, transfusion nurses are a relatively recent development in transfusion medicine ( see Further Reading). In previous decades there was a heavy emphasis on improving the quality and safety of blood; however, more recently the focus has shifted to transfusion/patient safety. Indeed, nurses specializing in transfusion are much needed because of the complex nature of transfusion process and nurses are on the front line of transfusion practice.

Many developed countries have hemovigilance programs e.g. UK, Ireland, France, Netherlands, Australia and New Zealand. Probably the best hemovigilance system is the UK's SHOT. See, for example, references to the critical role of nurses to transfusion safety in the 2014 UK SHOT report (p. 44):
  • SHOT recorded 10 ABO-incompatible red cell transfusions in 2014, all caused by clinical errors, but only 1 with serious harm. This shows little change compared to recent years (9 in 2013, 12 in 2012).
  • In 7/10 cases there was a failure in correct patient identification, with no bedside checks performed.
  • Actions taken by the institutions varied but in one case 2 nurses were dismissed; in other instances the staff are supported, retrained and their environment modified.
  • Good root cause analysis aims to determine why the mistakes were made, and to look for systems errors rather than apportioning blame.
  • SHOT has cumulative evidence that staff do not follow the protocols and procedures and we need to understand why. Do we need to change the procedures?
So, given that nurses play a key role in transfusion safety, here is what I have learned about Transfusion Nurses in Canada.
Job Titles

Most respondents had similar titles ‘Transfusion Safety Nurse/Officer/Leader'. Other titles were 'Clinical Resource Nurse (CRN) for IV Therapy” and 'Clinical Coordinator'. This variation in job title is common internationally, e.g., Transfusion Safety Officer /Nurse, Haemovigilance Officer/Nurse and Transfusion Practitioner.

Transfusion Nurses have a broad range of responsibilities, which include, but are not limited to the following:
  • Investigate and report transfusion reactions;
  • Report and follow-up transfusion incidents;
  • Educate staff;
  • Develop policies and procedures;
  • Develop educational resources for health care professionals and patients;
  • Conduct audits;
  • Develop/maintain transfusion medicine websites;
  • Ensure compliance with standards;
  • Serve on transfusion committees and other hospital committees; 
  • Liaise between lab staff and clinical staff.
My favourite personal description of what I do is “liaise between lab staff and clinical staff” because I think it is important to try and bridge the gap between the lab and ward/unit environments.
Some nurses’ job descriptions are not exclusively related to transfusion medicine and safe transfusion practice. Their responsibilities also include clinic work and “everything to do with IV Therapy.”  I know from talking with some nurses that it is very challenging when a job description is ‘all encompassing’ as there simply is not enough time to do everything.
Previous Work Experience

Most respondents have been nursing for many years, but thankfully there are also some more recent graduates choosing to work in this field of nursing. I say 'thankfully' because continuance of expertise and succession planning is needed in all nursing specialties. 
Respondents have practiced in ICU, PICU, PACU, Medical/Surgical, Hemodialysis, Apheresis, Homecare/Rural care, Laboratory Instructor and Tissue Bank Coordinator. Nurses are excellent at applying skills learned in one job/specialty to new situations, and when needed, adapting to new roles. Transfusion safety nurses bring the knowledge and skills acquired from such diverse aspects of health care and apply it to their current roles.

Education and Training

So how does one prepare to be a transfusion nurse? There is no specific course for Transfusion Nurses in Canada. One respondent stated that there was a training package for Transfusion Nurses in Quebec. Others mentioned there was no specific “on the job training”, which is far from ideal.
However, nurses (being the resourceful bunch that we are) have pursued courses in Project Management, Quality Improvement, and Health Literacy to name a few. Other nurses mentioned that they attended conferences, seminars, and symposiums and completed self-directed learning.
There is a “Graduate Certificate in Transfusion Practice” course on offer by the University of Melbourne. This online course is suitable for RNs and Laboratory staff. Melbourne University plans to introduce an additional module on Blood Management.  In the past, there was a similar course in Ireland, but this course is no longer available.
It would be interesting to know how many Transfusion Nurses would be interested in pursuing education specific to their role and if there would be enough demand for a course similar to the course on offer in Australia. I completed the Australian Graduate Certificate in Transfusion Practice course a few years ago and loved it.
Challenges and Joys of the Job

 “Changing practice” and “getting staff to follow policies” were given as challenges of the job. I can identify with those challenges and, if anyone has hints or insight they would like to share, I would welcome them.
The list of “joys of the job” is almost as long as the list of responsibilities and was far longer than the list of challenges. Aspects that nurses enjoy include:
  • Ensuring best practice;
  • Promoting patient safety;
  • Problem-solving;
  • Investigative nature of the job;
  • Working with an interdisciplinary team;
  • Working with people who come up with ideas to improve the process;
  • Never knowing what I am going to face each day;
  • Learning new things every day;
  • Flexibility and autonomy of the job.
Who wouldn’t want a job that offered all that?

I hope this has helped shed some light on the role of ‘Transfusion Nurse’ and the role we play in ensuring safe transfusion practice and improving patient safety. I would like to invite other nurses to write a blog on a subject of their choice, or offer suggestions for future blogs. It would be wonderful to hear from other nurses who are members of CSTM.
FURTHER READING              


Thanks Clare - nice to hear what is happening in Canada. Also great to hear that you enjoyed the Grad Cert in Transfusion Practice that is facilitated through the Blood Matters program.
ISBT launched a Transfusion Practitioner (TP) forum at the recent congress in Dubai. The forum is to promote the role and value of TPs within the international blood sector. The forum will provide a platform for international TP collaboration; sharing knowledge, experience and tools to support and assist the implementation of patient blood management and haemovigilance initiatives. For further information about the TP forum please contact myself (Linley Bielby) or Rachel Moss through the ISBT Central Office - [email protected]
The next international congress will be in Toronto Canada 2-7 June 2018 so it would be really great to meet up with Canadian TPs there, and it would be really great to have some involved in the congress planning.
I look forward to further blogs and hope to hear from you.
Cheers Linley
9/25/2016 6:03:57 PM

Pat Letendre
Thanks for the blog, Clare. Loved your comment:
'My favourite personal description of what I do is “liaise between lab staff and clinical staff” because I think it is important to try and bridge the gap between the lab and ward/unit environments.'

So true. For years there's been tension between the transfusion lab and nursing, as discussed in this article:
'Working with Nurses to Make Our Systems Safer' (AACC, Oct. 2015)

In particular see the 'Us versus Them?' section, which outlines the misconceptions that sometimes occur among health professionals. One of the best things that's happened in transfusion medicine is for nurses to become transfusion specialists.

As in life, so in the transfusion world. Once folks get to know each other and appreciate each other's strengths and concerns, progress gets made as people work towards a common goal, in this case patient transfusion safety.

Cheers, Pat
9/25/2016 5:46:43 PM

Gwen Clarke
Thanks Clare,

what an interesting introduction! I've recently been at the ISBT meeting where I heard about the University of Melbourne graduate certifcate in transfusion practice prgroam that you mentionned (and that you have taken)... I think it would be wonderful if one or more Canadian Universities offered such a program.
9/20/2016 9:32:16 AM

Thank you Clare!! Well written and informative.
9/6/2016 9:29:52 PM

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