Forget Frugality: Focus on Earning More

by Ramit Sethi

Sunday, May 1, 2011

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Think of the last 10 pieces of personal finance advice you've read. Do any of these sound familiar?

• Cut back on lattes!
• The world's top 10 coupons
• Don't go on vacation this year!

If you boil all the advice down, there are just two ways to improve your financial situation: earn more or cut costs. So why don't more personal finance experts talk about earning more? Because most of them don't know how.

More from NYTimes.com:  • The Emotions That Get Lost in Budget Discussions  • The Craigslist Gym • Kicking the Costco Habit

And so we get lectures on frugality, giving us obscure advice like how to save on paper towels. With each tip, we get diminishing returns. And we start to believe that personal finance is about "No, No, No!" No, you can't spend money on lattes. No, you can't go on vacation. No, you can't buy those ans.

It's no wonder that most Americans simply ignore their finances. We don't want someone constantly lecturing us on what we can't do.

I believe personal finance should be about saying "Yes."

Yes, you can afford that extravagant coat, or iPhone or even a trip to the Bahamas. In fact, I believe in conscious spending, or spending extravagantly on the things you love -- as long as you cut costs mercilessly on the things you don't.

Once you've cut on the basics, the single best way to live a rich life is to earn more money.

The Myth of Frugality

Let's take a look at a typical person who tries to cut back to save money.

Jack has to cut back on a lot of things in order to save significant amounts of money.

What he does	Monthly amount saved
Drink 1 less latte per week	$20
Buy groceries in bulk	$30
Go out 4 fewer nights per month	$200
Cancel cable	$50
Eat out five times a month instead of eight	$100
Total:	$400

Not bad. $400 saved. But at what cost? Each morning, Jack has to decide if can buy that latte. He has to consciously cancel his cable. He has to decide if he can afford that dinner out. On and on -- and he has to do this every month.

Jill can focus on one thing to get the same result:

Action	Amount Earned Per Month
Finds an area she likes, spend five hours each weekend and charge $20/hour	$400
Total:	$400

Jill found something she was good at, turned it into a small side business, charged a reasonable amount and found a client willing to pay.

Cutting back may be easier for the first month. But it's likely unsustainable. After all, there's a limit to how much you can save. But there's no limit to how much you can earn.

Earning More: The Numbers

Let's consider three goals for your personal finances. If you could charge $25/hour for your services and work enough hours each month to generate an extra $500/month after taxes, what could that additional money do for you?

Let's say you're paying off a $10,000 credit card debt at 15 percent interest and want to add that $500 to your payment.

If your monthly payment isÂ…	You'll pay this much interest	Over this time period
The minimum	$11,979	35 years and 4 months
The minimum + $500/month	$1,085	Only 16 months

That's over $10,000 in savings on interest alone.

Invest the Extra Money

When you earn more and invest the extra money, the results are incredibly powerful. Here's what extra income can do for your investments.

Additional income	Value if invested for 40 years with a 6 percent annual return
$100 / month	$156,122
$300 / month	$468,367
$1,000 / month	$1.5 million

Pay off a mortgage

Putting even $100 extra per month toward your mortgage can dramatically decrease the amount of time it will take you to pay it off.

Additional monthly mortgage payment	Mortgage will be reduced byÂ…
$100 / month	3 years, 8 months
$300 / month	8 years, 8 months
$1,000 / month	16 years, 11 months

*Based on a 5 percent, $300,000, 30-year fixed rate mortgage.

How to Earn More Money

The simplest way to earn money on the side is to turn your existing skills into side income. Nearly everyone has skills that others would pay for. Can you play an instrument? Consider being a music instructor. Are you obsessed with personal organizing? Hire your services out as a personal organizer. Do you have expertise in Excel, Web analytics or even free-lance writing? Many employers would love to hire you as a free-lancer.

This is a new way of thinking, and it makes many people uncomfortable. "That's ridiculous," they say. "Nobody would pay me $25 per hour."

To them, I say two things:

1. You already pay service providers for things you could do yourself. Have you ever eaten at a restaurant? Changed oil? Gotten your hair cut? We all pay others for their services. Now, I want you to flip this around and charge for your own services. People will pay -- as you already pay others.

2. You don't know if your offer of services will work until you test it.

Twelve months ago, I declared it the year of earning more money and wrote a series ofposts on the topic. I then launched an online course on earning money, in which I took hundreds of people from around the world and taught them how to turn their skills into side income.

Dean Soto was one of them. He has a wife, two children and a demanding full-time job. How could he find enough time to earn money on the side? Dean went through several exercises to determine which of his skills would be profitable. He realized that the information technology skills he used at his day job could also earn him money on the side -- if he found the right clients. But his side income needed to be worth giving up his scarce time with his family.

Once he figured out a potential idea, he used his network to meet people and ask what their needs were. He found his first client by accident. When he heard Dean's asking rate -- $30/hour -- he scoffed and insisted Dean charge more.

To account for his busy schedule, Dean used a clever retainer technique, which lets him work flexibly as long as he gets the work done. "I come home from work around 5 p.m.," he said. "Then I spend time with my family until about 9 p.m. and spend about an hour a day on my side work."

"I never thought I could do something like this," he said. "Now I'm like a boxer, looking to take little jabs and see where there's an opening."

Last year, Dean earned $22,700 on the side. He raised his hourly rate from $30 to $60 and then $150 per hour. The best part? "My wife loves it," he said. "She's able to stay home, which is her dream, and my kids have their mother all day."

There's nothing unique about Dean. But he is remarkable for taking action instead of being blinded by the frugality brigade that so permeates personal finance.

Frugality is important -- to a point. But after we cut back to a reasonable level, our biggest win will come from earning more money.

___ 

MILLIONS MADE SIMPLE

Take five steps, retire rich. Our in-house financial guru shows you the way

By Ben Stein, Photographs by Ture Lillegraven, Posted Date: March 12, 2007

When I was in junior high school, I was bullied by two large, nasty kids. I took up weight lifting to make myself stronger. It was boring and tedious, but it worked, and I was never bullied again by those creeps. You're probably too old to be bullied by eighth graders, unless you have children. But you will surely be pushed around by two thugs who are far harder to deal with: financial insecurity and its evil brother, retirement insecurity.

It's my job, as I approach my 63rd birthday, to help you bulk yourselves up so you will not be saddled with fear--or, worse, a bad financial plan. When I started lifting, I was told by my mentors in the gym that if I took it slow, I would get there. Likewise, we're going to take it slow. But if you execute this five-step plan, you'll reach financial nirvana.

Step 1 : Figure out how much you'll need to retire.

There's no one-size-fits-all answer to the "how much" question except "more than you think." As a general guideline, you'll need 90 percent of your preretirement income until age 80. If you're 30, your pre-inflation salary will roughly double by the time you reach 65, thanks to your increased productivity and seniority. (If you're in a field like law or finance, it may rise even more than that.) Then, the effects of inflation will probably triple that figure during that time.

So, if you're 30 and you're earning $50,000 a year now, it's quite possible that by the time you reach your mid-60s, your salary will have reached $300,000. To live comfortably after retirement, you're going to need about $270,000 a year for 15 years. Or, slightly more than $4 million. That seems like a lot now. It won't then.

Step 2 : Determine how you'll amass that kind of dough.

There are dozens of retirement calculators online that can tell you exactly how much you'll need to save each year to reach your goal. One of my favorites, because it's so simple, can be found at retireonyourterms.org. Plug in how much you make and how much you've saved, and it'll tell you if you're on track.

But remember: The earlier you start saving, the easier it'll be to reach your goal. If you're in your 20s or early 30s and not saving at least 10 percent of your pretax income already -- putting it into a 401(k) or IRA—you should increase your contributions, like, today.

Step 3 : Pick your investments.

The key? Keep it simple. Few investors can beat the overall stock market by choosing individual stocks, so don't bother trying. In fact, few Wall Streeters can beat the market for more than a few years in a row.

I like index funds—mutual funds that approximate the return of the total stock market. Vanguard and Fidelity, the big 401(k) managers, both offer them. So do other companies. Total index funds keep you well-diversified among large, middle, and small-company stocks. They're a solid, unexciting choice. Which means they're perfect.

Another good option: a mutual fund that tracks the S&P 500, or the 500 largest companies in America. It's a slightly less risky choice because of the large-company focus, but the potential for gains isn't as great, either.

A third option is a fund that mimics the Dow Jones Industrial Average, which tracks 30 of the largest companies in the country, from General Electric to Citigroup. These stocks tend to fluctuate less than the overall market, and they pay pretty nice dividends.

You can buy the Dow 30 in an exchange-traded fund, which is like a mutual fund but is traded in real time, like a stock. One major benefit is that the management fees are far less than those of most mutual funds. For more info about exchange-traded funds, go to ishares.com.

Step 4 : Diversify internationally.

You should invest roughly a third of your money in foreign stocks. But again, avoid individual stocks. Pick an index fund that tracks large foreign stocks in Europe, Asia, and Australia, such as the MSCI EAFE index.

You might also want some exposure to less-developed nations, such as China, India, Brazil, and Russia--these economies still have plenty of room to grow. If so, purchase a fund that tracks indexes, like the MSCI Emerging Markets Index or the Bank of New York Emerging Markets 50 ADR Index. You'll also find more information about these international investments at ishares.com.

Step 5 : Forget about it.

A century or so ago, the great investor J.P. Morgan was asked to predict the future of the stock market. His answer was "It will fluctuate." The portfolio I outline above will fluctuate. But over years, if history holds, your portfolio will rise 8 percent or so per year. That means it'll double every 9 years, and that's not bad at all.

Some years, of course, it will go down. When that happens, keep on buying. Some years, it will go up a lot more than 8 percent. Keep on buying. When the commentators on TV say we're heading into a period of staggering inflation, keep on buying. When the pooh-bahs of Wall Street say the market's way overpriced, keep on buying.

Over decades, broad indexes of stocks outperform real estate, bonds, and cash. They outperform art and coins and gold. Just keep buying. Put it on autopilot. Have the investments debited automatically from your paycheck or checking account. Just keep buying.

Don't worry about billionaires and their hedge funds. Don't worry about oil speculators or penny stocks. Just keep saving in those broad indexes and you'll get there. It's not exciting, but then neither is lifting weights. But pretty soon, the specter of financial insecurity will look as pathetic and puny as an eighth-grade bully.

You can do it yourself. But only if you start doing it now.

Penantian nafas panjang

Bismillahirrahmanirraheem,

Manusia itu sediakala mempunyai fitrah yang telah ditentukan dek Allah SWT. Fitrah manusia itu banyak sekali seperti keperluan untuk makan, berkumuh, bersosial, berpasangan dan yang paling penting, BERTUHAN.

Alhamdulillah, buat masa ini, kita dikurniakan dengan dua kemuliaan iaitu IMAN dan ISLAM. Namun tiada siapa boleh menjamin kekalnya dua nikmat ini di dalam diri kita, melainkan Allah SWT. Namun, dalam tulisanku kali ini, aku mahu menyentuh sedikit berkenaan tuntutan fitrah yang kini sedang melanda diriku dan rakan-rakan sebaya dengan ku iaitu tuntutan BERPASANGAN.

Antara dalil yang biasa kita dengar berkaitan tuntutan fitrah ini termasuklah:

"Dan di antara tanda kekuasaan Allah ialah Allah menciptakan isteri-isteri bagi kamu dan dari jenis kamu sendiri, agar kamu dapat hidup tenang bersama mereka. Kemudian Allah menciptakan kasih sayang di antara kamu."

"Dan tiap-tiap jenis Kami ciptakan berpasangan, supaya kami dan mengingati (kekuasaan kami dan mentauhidkan Kami)."

“Dikahwini wanita itu (untuk dijadikan isteri) kerana empat perkara iaitu harta kekayaannya, keturunannya, kecantikannya dan agamanya. Maka utamakanlah (dalam

pemilihanmu itu) wanita yang beragama, nescaya sejahtera hidupmu”

"Seseorang lelaki itu tidak akan mendapat apa-apa kebaikan selepas bertakwa kepada Allah selain daripada isteri yang salihah; jika disuruh oleh suami ia taat, jika suami melihat kepadanya ia menyenangkan; jika dicumbuinya ia dapat membuktikan kesucian dirinya dan jika ditinggalkan pergi oleh suaminya ia akan menjaga diri dan harta suaminya."

Dalam nak mengulas perkara ini, kita semua perlu sedar bahawa sebarang tuntutan fitrah, tidak akan dapat lari daripada tuntutan fitrah paling utama iaitu tuntutan BERTUHAN. Dengan erti kata lain, sebagai seorang MUSLIM, kita semua wajib beri’tiqad bahawa ISLAM itu adalah AD DEEN yang merangkumi semua perkara termasuklah tuntutan berpasangan.

Sifirnya mudah, untuk melunaskan tuntutan berpasangan, manusia disyariatkan BERNIKAH. Tatkala sudah mampu dan mencukupi syarat, inilah penyelesaian yang TERBAIK. Tapi jika masih belum cukup syaratnya, Rasulullah SAW menganjurkan pengawalan diri dengan BERPUASA. 

Cuma seorang guruku pernah berseloroh kepada kami. Katanya," Kamu berpuasa bermula terbit fajar hingga terbenamnya matahari. Selepas itu? Kamu nak buat apa?"

Di benakku timbul rasa setuju dengan pernyataannya.... 

PERASAAN DI HATI

Hati gundah gulana. Persaan membuak-buak, mahu berumahtangga. Calonnya mungkin si dia? Lunas-lunas ketentuan nabi dijadikan ukuran.

Keturunannya baik.

Hartanya sederhana.

Kecantiknya menyejukkan mata.

Dan yang paling penting, agamanya sudah ku-redha.

Malah ditambah lagi dengan ciri-ciri lain yang menambahkan lagi keyakinan bahawa mungkinkah si dia itu, SOULMATE yang ditunggu-tunggu, yang sudah ditentukan ALLAH semenjak di alam RUH lagi. Wallahua’lam bissowaab. Hanya ALLAH-lah sebaik-baik perancang. Dia MAHA MENGETAHUI, lagi MAHA BIJAKSANA.

************

Hahaha, seronok melayan perasaan. Tapi penantiannya teramatlah menyeksakan. Ditambah dengan seorang demi seorang kenalan yang melangkah ke gerbang pernikahan. Meninggalkan kami si bujang berbual-bual soal kahwin hampir setiap kali bersua. Yang terus memarakkan rasa bergelora di dalam dada. Namun, perlulah aku berpijak di bumi nyata:

Bahawa aku seorang pelajar yang masih dalam pengajian

Dan kesediaan si dia yang masih lagi aku tunggu 

Serta diriku sendiri yang masih banyak kelemahan dan kekhilafan yang perlu diperbaiki

Maka paling kurang DUA tahun lagi sebelum aku tamat pengajian. Cuma takkan mahu begini sepanjang masa. PASTINYA harus kita sedari bahawa SYAITAN itu senantiasa mengintai peluang menyesatkan manusia. SI MUSUH opportunis yang berlegar di sebalik setiap KEJAYAAN dan KEGAGALAN kita. Ternanti-nanti untuk memasukkan jarum yang menusuk hati yang LEKA. Supaya bersamanya di dalam NERAKA. 

"A'UDZU BI KALIMATILLAHITTAAAAMMAATI MIN SYARRIMA KHALAQ"

Jalan Keluar

Dalam mencari penyelesaian kepada permasalahan ini, mahu tidak mahu perlulah kita kembali kepada ALLAH. Dialah yang menciptakan manusia mempunyai fitrah-fitrah yang aku sebutkan di atas. Dan dia juga telah menyediakan AGAMA yang sempurna, yang pastinya mempunyai JALAN KELUAR kepada setiap permasalahan manusia. 

Di sini aku ingin membentangkan beberapa persoalan dan bagaimana harus kita menanganinya: 

Hati yang terus berangan-angan mahu berumah tangga: 

Hai kawan, perkahwinan itu belum pasti!! Tapi ada sesuatu yang telah DIJANJI. Itulah MATI!! Tiada diawalkan sedetik dan tiadalah dilambatkannya. Bila ketentuan ILAHI sudah sampai, akan diambllah nyawa makhluk itu sekalipun dia belum bersedia. 

Jadi insaflah. Buat apa terus menerus berfikir dan berbual mengenai benda yang kecil dan belum pasti. Sedangkan MATI dan AKHIRAT itu jauh lebih menggerunkan dan memberatkan. Sangatlah rugi dan bodoh kita ini kalau jarang memikirkan fasal MATI. Kerana sabda Rasulullah bahawa orang yang paling bijak di kalangan kita adalah seorang yang senantiasa mengingati mati. 

Bila orang berbual fasal kahwin, tak mengapa kita bersama. Cuma jangan!! Jangan sesekali lupa... bahawa MATI itu boleh terjadi BILA BILA MASA. Dan mati itu memutuskan kita dengan DUNIA. Janganlah nanti di alam barzakh, tatkala seorang diri di liang lahad, menyesal tak sudah dengan kekhilafan-kekhilafan yang pembaziran yang dilakukan dalam KEHIDUPAN. 

Bagaimana kalau aku tak dapat SI DIA?:

Mungkin mudah orang mengatakan, "Bunga bukan sekuntum". Cuma lumrah manusia pabila sudah FIXkan matlamat dan kecintaan pada sesuatu, sukar untuk merubahnya dengan kadar yang segera. Ini juga satu fitrah. SUKAR BERUBAH BILA SUDAH SELESA. 

Maka perlulah diyakini rukun iman yang KEENAM. Bahawa nasib kita di dunia sudah DIQADARKAN (ditentukan) oleh ALLAH. Tinggal QADHA-nya (pelaksanaanya) sahaja yang masih belum berlangsung. Cuma rahsia ini membuka peluang seluas-luasnya untuk manusia berusaha. Kerana kita takkan pernah tahu apa qadar ke atas diri kita. 

Penyelesaiannya dalam kata yang paling mudah - berUSAHA DAN berTAWAKKALlah. Serta hendaklah redha dengan ketentuannya, sekalipun ia tidak sehaluan dengan kehendak kita. Allahu Allah.

Bertahun lagi mahu berumah tangga?:

Jagalah amalan seharian. Anggaplah ini masa yang diberikan oleh ALLAH untuk membolehkan kamu bersedia dengan sebaiknya sebelum melangkah ke gerbang rumah tangga. Cuba fikirkan semula persoalanku:

- Cukupkah penguasaan ilmu kamu dalam urusan fiqh wanita, fiqh rumahtangga dan ilmu tarbiyyatul awlaad sebelum kamu diamanahkan dengan isteri dan anak-anak dalam kehidupanmu?

-Cukupkah penguasaan kamu terhadap Al Quran dan berapa banyak ayat yang telah kamu hafaz dan kamu amalkan dalam kehidupanmu?

-Cukupkah ilmu kamu menangani manusia sebelum perselisihan dalam rumahtangga yang pasti berlaku antara suami isteri? Sebelum kerenah anak-anak menjadikan dirimu hilang pendirian?

-Adakah kamu sudah melaksanakan tanggungjawab kamu terhadap keluarga kamu sekarang sebelum kamu mempunyai keluargamu sendiri? 

-Adakah kamu sudah menyuburkan ISLAM dalam kalangan adik beradik dan kedua orang TUAmu? 

********

Realitinya masih banyak perkara yang sepatutnya difikirkan di sebalik melayan perasaan mahu bernikah. 

- Usaha dakwahmu untuk menegakkan Islam masih banyak yang belum selesai

- Pengajianmu dalam bidang perubatan masih banyak yang belum selesai

- Amanah yang dikurniakanmu terhadap manusia masih terlalu banyak yang masih belum selesai

- Tuntutan mencari ilmu selain perubatan, khasnya ilmu berkaitan ISLAM yang masih belum selesai

-Tuntutan memperbaiki akhlaqmu selaku seorang muslim, yang masih terlalu jauh daripada yang telah diajarkan oleh Rasulullah

-Hubunganmu dengan ALLAH? Bersediakah kamu untuk menemuinya sekarang? Kerana jemputan itu akan datang entah bila.

Penantian kahwin mungkin mengisi benak jiwa. Tapi bangkitlah dari angan-anganmu kerana hidup kamu sekarang masih ada. Jangan sia-siakannya. 

Wallahua'lam bissowaab.

"Rabbana hab lana min azwajina wa dhuriyyatina qurrata A'yunin waj'alna lil-muttaqina imama."

"Our Lord! grant us in our mates and offspring the joy of our eyes and make us patterns for those who guard against evil." (25:74)

 

Mencari Jalan Keluar Daripada "Futile Cycle"

Bismillahirrahmanirraheem....

Hidup makin sia-sia. Masa yang dikurniakan Tuhan dibuang bak sampah yang tak berguna. Dihabisi dengan selang seli. Kadang kala dengan ceramah dan nasyeed. Tapi yang banyaknya adalah dengan yang lagha. Muzik, Youtube, Facebook dan Twitter. 

Ya, bukan aku seorang yang tersekat dalam "futile cycle" ini. Ramai lagi manusia yang terjerat. Tapi mereka mungkin tidak tahu mana mahu dicari jalan keluar daripada pusaran maut ini. Tapi aku? Penyelesaiannya sudah jelas terbentang luas di hadapanku. Tinggal mahu ikut, atau tidak.

Apakah dia?

Kembali kepada Allah dan Rasul. Back to the basics of your Islamic Teachings -That time is a sword. It's either you cut it, or it cuts you. In my case, I'm sliced into pieces thinner than my hair for wasting soo much time over all these crap. 

Well, despite jalan keluar yang dah jelas terbentang ini, satu ramuan penting is missing!! 

MUJAHADAH!!!

Allah!! Nak commit ni punya susah.. Mujahadah!!! Fighting my own nafs, that's the hardest part. You know all the solutions. All you need is mujahadah. 

In my humble opinion, Mujahadah can be achieved internally as well as externally.

To do mujahadah internally, I need to apply these basic stuff:

1) Renew my iman everyday by saying Lailaha Illallah

2) Take care of my amal harian, wajib dan sunnat (buat sebaik mungkin)

3) Zikr setiap masa. Basahi lidahku dengan zikr padamu Ya Allah

4) Mulakan setiap sesuatu dengan bismillah, akhiri dengan alhamdulillah. Simple. Too easy to forget. 

5) Learn new knowledge in order to apply it

Externally?

1) Be with good friends

2) Initiate the question," Apa cerita iman kamu?"

3) Hadiri program yang menambah iman

Ni nak buat benteng. Tapi all those eroding factors pon kena lah di-handle jugak kan?

Hoho.. 1st step taken.. disabled my facebook account.. Tengok lama mana boleh tahan

Still on the list:

1) Naruto manga and anime. (Okay la, seminggu sekali je, tak dela teruk sangat)

2) Twitter (not as serious as facebook)

3) Harakahdaily (dah kurang siket dah)

4) My blog? links to other blogs mainly

5) YOUTUBE!!! the giant killer of time

6) Angan-angan kosong!!! another GIANT KILLER

7) Google browsing (sometimes can be critical)

8) Picture editing 

9) Guitar playing

10) Music downloading

Well, with all these stuff still on the list, I really need to create some healthy alternatives. Kalau tak mati kutu kebosanan la aku!!

1) Baca buku (Bawah katil berlambak lagi tak bace). Gilir2 la, bace novel, baca buku agama, buku falsafah, sejarah, biografi)

2) Draw? Lame tak lukis macam dulu

3) Dengar ceramah? (Well, easily to divert to other stuff. Gune website "Pesanan untuk Ummat" kot, not Youtube

4) STUDY!!! Exam 4 minggu lagi weyh!!!

5) Read journals, menarik gak sebenarnye

6) Learn new stuff. Arabic? usul fiqh?

7) Masak (kena spend duit sikit kat rumah baru nanti untuk beli bahan mentah)

See? Banyak je benda produktif yang ko boleh buat. All you need is some MUJAHADAH!!! 

Allahumma arinal haqqa haqqa warzuqnattiba'ah. Wa arinal batila batila, warzuqnajtinaabah !!

Istajibillahumma du'a-ana Ya Allah

Wallhua'laam,

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Improving your blood taking skills

Daniel Sado, who is an experienced phlebotomist, gives some tips

As future doctors you can all expect to take venous blood (venesection) from many patients during your career. As junior doctors you will probably take blood nearly every day. But venesection is not given any priority at medical school. The adage of "see one, do one, teach one" could not be applied to a better procedure. Unfortunately, you need only to look at the arms of patients on hospital wards to see the results of poor venesection technique. Many of them will have extensive bruising. Although some of this bruising is inevitable, there are ways to try to limit it.

I was taught to take blood in an outpatient clinic in my local district general hospital (this is an excellent place to learn because the patients are "well" and so have good peripheral blood supply). After this, I worked as a phlebotomist at Northwick Park Hospital for three months in an outpatient clinic where I took over 2000 blood samples. For the past two years, I have been employed as a venesector by the medical directorate at Southampton General Hospital.

My tips are not evidence based because there is little in the published literature about venesection technique. What I aim to do is to make some suggestions that I have found useful in improving my own venesection technique that you may wish to try out yourselves. I have assumed that everyone who reads this article has had some experience of taking blood.

Introducing yourself to the patient

Always shake hands with the patients and ask them if it would be all right for you to take blood. If the hand is very cold ask the patient to open and close it a few times to try to increase the peripheral blood flow.

If the patient seems to be very nervous, use a butterfly needle as this is shorter and so looks less intimidating (see below).

If the patient is unconscious, get a helper to hold his or her arm down to ensure that it does not jerk up when you insert the needle.

Where to take blood from in order of preference

Antecubital fossa of the arm: the veins here tend to be big and stable. You should be able to get blood from about 90% of your patients at this site.

Forearm or back of the hand: it is particularly worth checking to see if the patient has a good houseman's vein (fig 1).

Feet: a good vein can often be found anterior to the ankle.

Central line: seek more experienced help before doing this.

Peripheral venous line: seek more experienced help before doing this.

Femoral stab: insert a needle just medial to the femoral pulse in the groin.

Vacutainer, syringe, or butterfly?

Vacutainer

The advantages are:

• No blood spilt.
• Decreased chance of needlestick injury.

The disadvantages are:

• No flashback of blood to tell you when you are in the vein; therefore you are reliant on feel.
• You can use only a 21 gauge green needle (see below).
• If the vein is missed much bruising will often occur if you probe around.
• The pushing force required to insert the vacutainer blood bottle on to the needle may cause the needle to be pushed through the back wall of the vein. Therefore it is vital to keep the needle still when using this method.

Figure 1: The houseman's vein

Syringe

The advantages are:

• Choice of needle sizes.
• Flashback of blood into the syringe can be seen when the vein is penetrated.

The disadvantages are:

• The pulling force on the plunger needed to withdraw the blood may cause the needle to move.
• There is an increased chance of needlestick injury compared with the vacutainer method.
• Sometimes a small amount of blood will be spilt when the needle is withdrawn from the skin.

Butterfly

The advantages are:

• It is useful in a nervous patient because the needle looks smaller (even though it is still 21 gauge!).
• It is useful for the nervous operator because the needle does not need to be held still once it is in the vein.
• It is useful on the back of the hand where there is nowhere to rest your supporting hand against for the other two methods.

The disadvantages are:

• Same as the second and third disadvantages of the syringe method.

Which needle to use?

Most operators use the 21 gauge green needle. You can use the smaller 23 gauge blue needle with the syringe method.

Blue is useful because (a) its smaller diameter will cause less damage to the vein. Therefore there will be less bleeding and bruising after venesection--this is particularly useful for patients on anticoagulation treatment--and (b) it will cause less pain to the patient.

The main disadvantages are that blood will come back more slowly and there will be a slightly increased chance of haemolysis.

How to make the procedure less painful for the patient

• Use a shallow angle (about 10 degrees) to give you more margin for error (fig 2).
• Insert the needle as quickly as possible to minimise the pain felt as the needle penetrates the skin.
• Make sure that you pull the skin tight before inserting the needle, or else the vein may move and you will find it more difficult to penetrate the skin, particularly in patients with loose, fragile skin.

Figure 2: Correct approach

After the procedure

• Place cotton wool over the venesection site.
• Apply pressure only to the cotton wool after the needle has been withdrawn from the skin.
• Press down on the cotton wool firmly to encourage the vessel to stop bleeding quickly.
• If you get the patients to press down on the cotton wool, encourage them to press as firmly as possible on it.
• Final thought: remember that practice makes perfect.

Daniel Sado, fourth year medical student, University of Southampton, and venesector, medical directorate, Southampton General Hospital