Tech vs. Nurse War - page 3

by BellaCerraRN | 12,601 Views | 53 Comments

I am a new dialysis nurse, well a new nurse period, and until today I loved my job and the people I work with although they've been a little slow to warm up to me on a personal basis. Here's my delima.... I am in... Read More


  1. 1
    Quote from DeLana_RN
    That's obviously not how I understand it (and how it was explained to me).

    For instance, if Tech A - trained by the company and found to be "competent" - is working on the other team, with other nurses, how can I be held responsible for this tech's actions?

    And if it's "my" tech, working her own pod of four stations on the same team, who gives a pt an air embolus via the perm cath while I'm working with another patient (in my own pod of two stations), how can this be "my fault"? Surely I cannot be expected to watch (supervise) every move the techs make at all times?

    Could you clarify this liability/working under the nurse's license issue further?

    Thank you,

    DeLana
    If you're simply a nurse at the center, you would not be responsible for the tech's actions, but if you are charge nurse, it is up to you to make the daily assignments, and once you make the daily assignment you are thus delegating to the UAP their work for the day, and by doing that you are putting your licence on the line for their actions.

    As for your statement about one of your techs giving a pt an air embolus, at least in this state, a tech better not be touching a patient with a catheter so that wouldn't happen.
    LPN2RNn2011 likes this.
  2. 1
    I do hate it that techs can do "assessments" in TX. I've rarely seen an accurate one from a tech.
    LPN2RNn2011 likes this.
  3. 1
    In the facility the techs couldn't do pt assessments. Only the nurses.
    LPN2RNn2011 likes this.
  4. 0
    Quote from Nephro RN in TX
    In the facility the techs couldn't do pt assessments. Only the nurses.
    Good. In every TX unit I worked, techs do assessments.
  5. 0
    Quote from Hellllllo Nurse
    Besides talking about nurse liability w/ my RN/JD acquantance, my mil and I have talked about it a great deal.

    My mil is an RN, PhD. She teaches classes on nursing law and ethics, and she serves as a expert witness in court cases.

    The charge RN is ultimately responsible for the actions of all staff on the floor, techs and even licensed LPNs.

    Here is an example from a case my mil was involved in-

    In a psych facility, an LPN attempted to give a pt his meds, and he refused to take them. He was a pt who was admitted to the unit by his own consent. He was not a court-orderd pt. (Court ordered pts are not allowed to refuse meds or tx. All other adult pts are).

    The LPN crushed up the med in a cup of pudding and offered the pudding to the pt, and he ate it.

    Afterwards, the LPN informed the pt that he had consumed the med with his food.
    Since the pt had refused the med, and been "tricked" into taking it, this was considered an assault on the pt. The charge RN who was not even in the room when this happened was included in the indictment, because even though an LPN is licensed, the LPN was working under the supervision of the RN, and therefore the RN is ultimately reponsible for the LPNs actions.

    Here's an example from another case:
    A suicidal pt was put on continual suicide precautions and assigned a 1:1 CNA as a sitter. Facility policy stated that the 1:1 sitter could be no further than arm's length from the pt at all times, including when the pt used the restroom. The charge nurse informed the CNA of this. Later, the RN saw that the CNA was sitting in the hallway outside of the pt's room, which put her further than arms length from the pt. The RN reminded the CNA she had to be arms length away. The CNA became upset and said (paraphrasing) "I have worked here for 20 years. I think I know how to do a suicide watch."
    The RN went back to her duties- did not write the CNA up, did not inform the house supervisor, etc.
    Later that shift, the pt attempted to strangle himself with his shirt while in the bathroom. He did not die, but sustained brain damage. The pt's family sued, and the situation was investigated. Although the RN was in another part of the building when the incident happened, she was held liable for the CNA's actions. The state had declared the CNA competent by granting her a nursing asst certification. The facility had trained the CNA in suicide precautions, tested her and detrmined she was competent. However, the licensed nurse is responsible and legally accountable for the actions of any person under her supervision.

    This is why RNs must sign for the water checks, even if they were done by a tech. The RN is responsible. If the water failed a test, and the tech signed everything off as having passed, and the RN signed after, if something goes wrong, the RN is held responsible.

    The mistake is not the nurses "fault", but the nurse is legally accountable for the mistake.

    Nurses are trained/educated by colleges, and declared as "competent" by a state when they are granted a license. But the state is not responsible for the actions of the nurse- the nurse is.

    A company that employs and trains dialysis techs is responsible for determining competency. The licensed nurse in charge is responsible and legally accountable for the tech's actions once competency has been determined.

    I have also heard of a case in which an RN injured a pt in her care (med error), and both the RN and her charge nurse were held accountable.

    The facility is responsible for a tech's competency: The licensed RN is responsible for the tech's actions.
    Thank you for clarifying this. I have to say, although I can accept the legality, I don't necessarily agree with it. Here are my concerns:

    - The LPN put the meds in the pudding without asking the RN charge nurse. An LPN has her own license, which she thus violated. How can the RN possibly know that the LPN will do something she shouldn't do, and how can she therefore be held accountable? She can't possibly watch her every move. How was this case decided?

    - In the case of the suicidal pt, I guess the RN's failure was to discipline the insubordinate CNA or to follow up to make sure that she followed instructions. This makes a bit more sense, but what if the CNA had agreed to do as instructed and still failed to do so? How can the supervisor watch everyone at once?

    It's a scary thing, especially knowing what goes on in dialysis clinics. I guess if any of us know that the law is not being followed (e.g., techs are doing things they have no business doing), then we have to write them up.
    Those who play by the rules are worked to death, the rest - well, break the rules. They obviously don't think their license is at risk! One day, it'll catch up with them.

    Thank again for your explanation,

    DeLana
    Last edit by DeLana_RN on Oct 29, '07
  6. 0
    Quote from Nephro RN in TX
    If you're simply a nurse at the center, you would not be responsible for the tech's actions, but if you are charge nurse, it is up to you to make the daily assignments, and once you make the daily assignment you are thus delegating to the UAP their work for the day, and by doing that you are putting your licence on the line for their actions.

    As for your statement about one of your techs giving a pt an air embolus, at least in this state, a tech better not be touching a patient with a catheter so that wouldn't happen.
    I can see that if a tech puts on a pt with a permcath in a state where s/he is not allowed to do so, and the nurse is aware of this or even encourages it (a tech friend told me that other RNs made her do things she was not supposed to do), then the nurse should be held liable. But if the tech is allowed to put on a perm cath pt (as in my state), and the nurse is aware that the tech is competent and has observed him/her do it many times - but one time, something happens while the nurse is busy somewhere else - why would the nurse then be responsible? How can we be held liable for other people's actions/mistakes?

    For instance, if an office nurse makes a mistake, is the doctor's license at risk (never mind that s/he will undoubtedly be named in any lawsuit, as the employer)?

    There have got to be reasonable limits of liability, or am I naive?

    DeLana
    Last edit by DeLana_RN on Oct 29, '07
  7. 0
    Quote from Hellllllo Nurse
    Good. In every TX unit I worked, techs do assessments.
    This doesn't surprise me. I'm in another state, where techs are not allowed to do assessments, but in the unit I was trained at (I wasn't there for long, and still had no idea that they weren't allowed to do so) they most certainly did - management expected them to.

    Scary, indeed.

    DeLana

    P.S. "Management" (an "RN") currently does time for fraud... for not having a license. She surely didn't have to worry about losing it
    Last edit by DeLana_RN on Oct 29, '07
  8. 1
    I was reading on allnurses rececently about a case in which a pharmacy tech mixed up a dose of TPN incorrectly. The TPN was ordered for a premie in the NICU. The tech added 10X the ordered amount of zinc. The baby died.
    The case went to the pharmacy board. The two supervising pharmacists were disciplined by the board, but the tech could not be. Although the tech had been determined to be competent- he was trained, and was certified by the state, he was not legally liable for the baby's death.
    Although the pharmacists were not directly with the tech when he mixed the TPN, the pharm tech works under the license of a registered pharm.

    A member of the pharmacy board was quoted as saying he was upset, because the board had no power or authority to punish the tech in any way.

    Ironically, the baby's mother was an RN. she had been told she was infertal, and had been on fertility tx. She finally has a baby- and it dies as the result of a tech's error.

    I searched a couple of times for the article, but could not find it. Maybe someone here can find it.

    Why in the hell techs are allowed to mix TPN is beyond me.
    DeLana_RN likes this.
  9. 0
    Wow, that's a scary case. I agree with you, pharm techs should not be allowed to mix something as dangerous as TPN... or KCl added to IV fluid - should they be allowed to mix anything?! Unlike pills, there is no way to check after them...

    Likewise, it's very scary to think that dialysis techs are able to access central lines in many states... give heparin in others (in my hospital, two nurses have to sign off on the heparin dose before one of them gives it), and do other invasive, risky procedures under the license of a nurse. It's truly scary to work with UAPs if nurses will be held liable for their actions! Therefore I'm glad to work in an all-nurse acute unit now.

    Thanks for the info.

    DeLana

    P.S. After being an infertility pt myself, I cannot even imagine losing a child due to some medical error... how horrible.
    Last edit by DeLana_RN on Oct 30, '07
  10. 0
    I guess that was one good thing I could find with the unit in which I worked. Yes the techs gave heparin, but it came in pre filled syringes and every patient with few exceptions got the same dose, so there wasn't much room for error.


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