Most phlebotomists spend their entire professional careers in the laboratory/hospital setting. Few have the opportunity to work in a long-term care environment. While nursing homes have a number of similarities to the hospital/clinic locale, there are also a number of dissimilarities of which the phlebotomist must be aware and appreciate.

1. A nursing home is actually a collection of homes. The room in which each resident stays is not a hospital room; it is their home. This is where they live. The phlebotomist should be mindful of this and always knock on the door and wait for an invitation before entering. It's a courtesy you afford to those who live on your street; homes in long-term care facilities should be afforded the same consideration. If an invitation to enter isn't issued, consider the resident may be hard of hearing, asleep, on the commode, not prepared for a visitor, or not even in the room. Enter carefully and respectfully.
   
   
2. Never assume that all elderly individuals are suffering from hearing impairment. Some do, but others can hear perfectly. Communicating to everyone in a loud voice may be welcomed by some, but irritating to others. Determine your patient's hearing ability and adjust the volume and tone of your voice accordingly. Speak distinctively and make eye contact when you are speaking to them. Even if they have difficulty hearing, many can understand what you are saying by reading your lips.
   
   
3. Always present a pleasant and professional image in your appearance and disposition. People don’t like to be stuck with a needle, particularly if it includes being aroused from a peaceful sleep. Patients won’t be any more the lighthearted if the phlebotomist sticking them is an old grouch. Add a complement if appropriate. If they have flowers in the room, or have on a pretty bathrobe, a compliment might brighten their day.
   
   
4. Often the aging process results in “tissue-paper” skin and fragile capillaries. It is important for the phlebotomist to make sure the tourniquet doesn’t pinch the skin by tightening it over clothing. Since many of these patients are on anticoagulants, it is vital that you make sure that there is no bleeding or blood seepage at the venipuncture site prior to bandaging. The standards require at least five seconds of observation. Make it 15, just to be sure. Consider using a non-adhesive wrap instead of an adhesive bandage for less trauma to the skin and more comfort to the patient.
   
   
5. Dementia and loneliness can present both problems and perplexity for the phlebotomist in a nursing home. It is important to always approach both situations with a professional and sympathetic demeanor. Sometimes elderly men may reach out and touch female phlebotomists in an inappropriate manner. Many times they are simply reaching out for a human touch and don’t have any idea that the touch was inappropriate. The appropriate reaction on your part is imperative. In most cases, you can quietly take their hand into yours and hold it for a moment; then tell the person that you need for them to keep their arm in a certain position so you can get their blood. If this fails, calmly remove the person’s hand and quietly leave the room. Explain your problem to the nursing staff and seek their assistance. Avoid overreacting. The person may already be confused and this will only aggravate the problem.
        On the other side of the spectrum, some individuals don’t like to be hugged or touched by strangers. Be cautious about your physical conduct. Addressing the resident is also significant. Always call the occupant by their name, for example, Mrs. Smith, or Mr. Jones, NEVER as “Sweetheart,” “Sugar,” “Darling,” or some other affectionate name. It may not be welcome.
   
   
6. Remember that you are an ambassador for your employer. When you come in contact with both nursing home residents and the nursing staff, they should see a person who is professional, competent, caring, and who’s integrity is beyond question.
   
   
7. Last but certainly not least, be considerate. If you have an infection, particularly an upper-respiratory one, stay away from the nursing home. Elderly patients usually have an impaired immune system. It doesn’t take much for them to become ill and the illness can become life-threatening.
   
   Adapted from an original article by Garland Pendergraph Ph.D, SM(ASCP), author of Phlebotomy and Patient Services Techniques.