Tech vs. Nurse War

Specialties Urology

Published

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 training and my preceptor is a tech and a DAMN good one at that. I have no problem with her being a tech. I understand I have to learn the nuts and bolts of dialysis before I can go on and it is my understanding that I will go on to be preceptored by an RN later in the game. That said, of course I'm excited about being an RN and wanting to jump in with both feet but know I have to take baby steps as boring as I might think some of them are.

Today I had my first evaluation and my FA and preceptor said I had an attitude about my being an RN and that the techs weren't happy. I was blown away! I thought all this time I'd been showing, if not telling them how great I thougth they were blah blah blah...

I'm beginning to think that it's the other way around, that the techs have an attitude about me being an RN but not knowing much of anything about dialysis.

I'm interested to hear from other dialysis employees, both techs and nurses. I'd like some pointers on how I can avoid saying anything in the future that will piss them off. I hate offending people and this really has me upset.

The only thing I can think of is to never use the term tech or nurse again and stick to our companies term of "teammate" or refer to them as crew memebers, but that seems a little silly to me because after all there IS a difference in training, licencing etc, otherwise the state of Texas would licence us all as "Dialysis Peoples".

HELP!

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

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

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 :lol2:

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.

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.

Specializes in Critical Care.

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.

Specializes in Nephro, ICU, LTC and counting.
I said it before, and I'll say it again - techs precepting nurses is just a bad, bad idea - unless for a brief time (maybe two weeks), just dealing with the very basics (in conjunction with a nurse, the "official" preceptor) - and your post is just another example of why this is so.

Your tech of course knows a whole lot more about dialysis than you do; my suspicion is, she likes it this way. Of course, she knows that eventually you will know just as much - and more, the whole picture, as a nurse (not in every way, though - she may always be able to stick better, after all she has years of experience). She knows this as well and, I suspect, resents it.

It's a good thing that you have a quiet confidence in your abilities - and ability to learn (which is obvious from your post), because this is what you need in a situation like this. Others would be easily intimidated (and believe that they didn't get enough training - you got enough training, you just need experience, and that comes with time).

Keep up what you have been doing, eventually she'll understand that she can't get under your skin and, I suspect, will respect you for it.

Best of luck to you,

DeLana :)

Thanks.

The funniest thing is the tech(my preceptor) was most annoyed because I didn't ask her a single question about dialysis. She said she felt like she was just pushing her knowledge. I heard her trying to give few illogical, unscientific rationales about a lot of things, and I decided she is not the best person to answer my questions. So I stopped asking anything. If I was in doubt, I would come home, search on internet or journals. Get my own reliable information. According to the tech (my preceptor) me not asking her any question about dialysis was just insulting to her knowledge. I said- "this is science, and I believe in getting the information from a written source or books than words of mouth". I respect her experience. she knows her job, and sticks to the company policy. I just didn't believe that a tech is the right person to give me scientific knowledge, i learned the skills from her, she is good at that.

Her answers were too illogical like- "there is not as much recirculation with catheters as they think there is." I was like- "that is the documented fact, that is proved by researches, why do you think that the research findings are incorrect?".

Sometimes, I think that some techs just make stuff up, then they start believing what they are saying.

Specializes in LTC, FP office, Med/Surg, ICU, Dialysis.

I agree to everything you mentioned, DeLana. Thanks!

Nephro RN,

I'm sorry you are experiencing this, but unfortunately this is a HUGE problem in chronic/outpt dialysis. Why? More so than in other areas of nursing, the perceived roles and responsibilities of nurses and techs/PCTs are very, very blurred. Of course, PCTs (with the exception of student nurses, but those don't normally cause a problem) have no idea what additional responsibilities nurses have. On the other hand, PCTs know that nurses make much more $. Therefore, the "same job, more money" perception will lead to resentment (yes, there are exceptions - excellent PCTs with great attitudes who are never subordinate - but I've encountered very few in chronics). Sad, but true.

Usually, nurses and PCTs are even trained together. Personally, I think it's a very bad idea for a subordinate to train a nurse, even in the more technical aspects of the job (not because PCTs are not competent at their jobs - in some areas, such as cannulation, they are often better because they get more practice). Only nurses should train nurses! How will the PCT later respect a nurse that s/he got to "evaluate" (and obviously, in your case, told lies about?!) Bad, bad idea.

It seems obvious that your are dealing with resentment/envy/attitude issues here. If I were you, I would speak to the FA in private to see if you can work with your nurse preceptor from now on. There is nothing that a PCT can teach you that a nurse cannot. Explain why - you don't have the "RN attitude" (LOL, that's a favorite one) but if the PCTs think so, then it's not a good idea to continue the training relationship. If you have any problems with the FA - and/or the PCTs - think long and hard whether you want to continue working there. Yes, it will probably get better once you're no longer being precepted, but dialysis has a long learning curve and other workers can truly make your life miserable if there are unresolved "issues".

I'd better get off my soapbox now (you can tell, this is one of my pet peeves although I'm no longer in chronics and we have no PCTs in acutes). I hope you can get this resolved. Despite some problems, dialysis is a very rewarding nursing specialty - you will get to know and have meaningful relationships with your patients.

Best of luck to you!

DeLana

Specializes in Hemodialysis, Home Health.

This is sad, because the techs are the backbone in dialysis and can be of tremendous value to the nurses. If nurses and techs could/would agree to work as a team, all would go very smoothly.

I always found that techs will bend over backwards for you if they are treated with respect, acknowlegement, and appreciation.

I also took every chance to teach them something along the way about the disease itself, and non "tech" things.. they always appreciated that, and everyone benefits from it. :)

Specializes in LTC, FP office, Med/Surg, ICU, Dialysis.

Honestly, I think some units can be breeding grounds for this type of animosities between techs and nurses. Managers should take care of these problems ASAP. Also, I think the bigger the facility is, the more chaos there will be. I'm glad that I belong to a smaller unit and most of the so-called "troublemakers" are already weeded out.

This is sad, because the techs are the backbone in dialysis and can be of tremendous value to the nurses. If nurses and techs could/would agree to work as a team, all would go very smoothly.

I always found that techs will bend over backwards for you if they are treated with respect, acknowlegement, and appreciation.

I also took every chance to teach them something along the way about the disease itself, and non "tech" things.. they always appreciated that, and everyone benefits from it. :)

Specializes in Dialysis.

as a tech, (my boss' "favorite", everyone says) I am asked to train or "let them shadow", the new staff who come into our unit. A tech at first, no problem. I showed her how we did things, she had simply come from another company. Then the new nurse comes in. I have to show her how to use the computer, how we document vitals, giving NS for cramps, etc. No problem, except that the whole time I feel like SHE must be thinking, "what a bore, show me something real!" I felt bad bc I was expected to show her the ins and outs of our computer system, but from me, all she could get was "tech stuff". Med administration, assessments, these are to be taught by the other NURSES. I felt bad. I don't know. I felt kind of like I was expected to perform for her and show her everything, when all I wanted to do was get my patients on, get them off, then go home. I actually asked her to set up machines for me! I felt awful.. what else was I supposed to do? I got theough it, and then i asked my boss to show me the money for all this training I do. I am the least-paid tech doing all the extras for the boss.

I can't wait to be an LVN!

Kudos to all the nurses who put up with the "techs with attitudes." We have some of those. and trust me, the attitudes come to us, also. not just the nurses. i work with some unpleasant folks. just complaining to complain.,

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