Essential job functions of an ER nurse? - page 2

by XmasShopperRN 6,632 Views | 18 Comments

The obvious come to mind: assessment, lifting, medication administration, documentation, education, etc. But in an environment in which it is commonplace for nursing technicians, paramedic students (once competency has been... Read More


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    To the OP: I feel very bad about your situation...I can't even imagine how I'd feel if I were in a similar one. If I, due to some sort of disability, were unable to start an IV or obtain blood work, I would be quite peeved if I had to give up my job. However (and I realize it is easy for me to say this, not being in that situation), IV starts are an essential part of the job for the ER nurse. There are some shifts when there is no tech available or care will be delayed until someone can be found to start your pt's IV. If an RN is physically unable to perform IV starts, the ER is not the place for them. I know it stinks to hear (it stinks to have to say that). None of us here are going to be able to judge if you are or are not capable of starting IVs. Sadly, your ER says your are not. It is very unfortunate, but it is going to mean giving up your job at that ER.
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    Or find a job in a ER that will take a different view of your abilities. Maybe less of a hard line.
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    Don't apologize for the long post and thanks for giving us more background info to your post. Sorry to hear you are in this situation. Like others said, it seems the issue is the disagreement between occupational health and you regarding your ability to start IVs. Did you get to see a copy of your job descriptions? Sounds like it might be time for legal help if you want to keep your job.
    hiddencatRN likes this.
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    In terms of employment in general, an essential job function is determined to be as such by the specific employer, not industry standards or "what everyone else does." Just because a skill is important and necessary for an ER nurse to have doesn't automatically make it an essential job function; that is, the position of an ER nurse does not exist solely to place IVs or to draw blood. The most significant factors that affect what tasks hospital units classify as essential versus marginal are staffing and patient acuity. I can't speak personally as to the way that other ERs operate, but I can attest to the fact that given the high patient acuity level that this ER consistently maintains along with an ample staffing of nursing techs, IV placement is a task frequently delegated to nursing techs; while phlebotomy tasks are routinely assigned to the ER phlebotomist. My point being that while Hospital A may designate the physical act of obtaining vascular access as an essential ER nursing function doesn't mean that Hospital B will too designate IV placement as an essential nursing job function for the purpose of job qualifications. Furthermore (and probably my biggest point of contention), an ER nurse was allowed to return to work s/p CTS surgery. She was assigned to flex care (4s and 5s) while wearing a thumb spica splint and was able to delegate all of her patients' IV and venipuncture tasks to the unit's tech and the other RN in flex care that day, ME!
    In my particular situation, although I was able to demonstrate full competency to start IVs and draw blood, OH played the "What If" card to justify their position that I wasn't able to perform essential job functions. "What if your hand fatigues, and you require assistance with an IV?" Their hyper-vigilance in regards to hypothetical safety issues was in no way based upon any objective findings to suggest that hand fatigue was for guaranteed; rather, this was the perfect cover for the hospital "cleaning house" and retaliating against an employee for requiring a medical leave of absence.
    I really appreciate the words of encouragement and expressions of empathy. I really, really liked my job, so being terminated through no fault of my own has been a tough pill to swallow. From one nurse to the next, the position that I find myself in today is and will continue to be a position that many nurses face: just because you did an awesome job yesterday and many days before that, having a job tomorrow depends on how the bean counters calculate your worth today.
    This experience has educated me about the ridiculous disparities that exist between nursing responsibilities and the rights of nurses. Without violating allnurses.com's legal policy, One1, I certainly don't plan to go down without a fight. The hospital was served by the EEOC last week.
    And lastly, in response to remarks made regarding where and why I posted this thread because of it being non-emergency nursing related: I am an ER nurse to whom this happened. As silly of a question as it was whether or not IVs or blood draws are essential nursing functions, imagine being given that as the reason why you're no longer qualified to perform a job that you've performed for 3+ years and for which you remain fully capable of performing.
    Esme12 likes this.
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    I never said that you shouldn't have posted on this board, just that what you seem to be after is not something we can offer. We can't give you your job back, we can't change your employer's policy. We also can't really say that IV skills aren't essential to an ER nurse, at your hospital or any other.

    We CAN sympathize with your situation and be a sounding board if you need to vent, but you keep presenting it as either a general discussion on IV skills and their importance to an ER nurse OR your very specific grievance with your employer and hey your IV abilities are just fine anyway.

    Your specific concerns are more suited to a lawyer than the internet. It sounds like you are already pursuing that avenue in which case you probably shouldn't have as much specifics online in a message board as you do.
    Susie2310 likes this.
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    It doesn't matter how the topic is presented.......the point is the hospitals do not want anyone who might cost them money.

    OP.....I am so sorry you are going through this. I wish I could offer you encouragement....but I can't. Hiddencat is right.....we cannot offer legal advice as per the Terms of Service and if you are going to be seeking legal representation it probably is a good idea not to post intimate details on an public internet web site.......it is easier than you think to discover who someone is by what they post.

    My input is personal. As a life long (35 years) emergency nurse, who was stricken with a chronic auto immune debilitating neuro muscle disorder, I have experienced this myself. In the beginning I was able to move on to another department/facility.....but it will follow you eventually and will catch up with you.....I stayed pretty incognito, for I spoke about it to no one ANYWHERE.....taking one job or another depending on my energy to hide my secret. I was actually "let go" from orientation for a supervisor position because I had been "outed" so when administration confronted me I admitted the truth .....they rescinded their offer...... for not being forthright and that was not an attribute they wanted in their administrative staff.

    They essentially called me a liar. The application/medical OCC health questionnaire asked ....is there any medical condition that will prevent you from performing the position applied for...the answer was no. Then when asked are you presently taking any medications? the answer was no....I was taking a hiatus from meds for a couple of months....I wasn't presently taking anything. Security showed up at our "meeting and showed me the door......from orientation. The VP of Nursing at my old job who had "laid me off" with a severance package upon my outing.....used to be the VP at this facility. Yes, they talk. Yes, they gossip. Yes, they technically break the law at every *ONE (*States name* Organization of Nurse Executives) meetings...I've heard them.

    Why am I so out now? I am in a wheelchair, most of the time, so there is no hiding any more. After 34 years the profession I so loved abandoned me when I needed it the most......I am no longer accepted in the hospital circle of friends. But that's ok. I understand seeing someone once so full of vigor.....is difficult.....and they have their lives to live. I did the legal route....it is expensive. But it's More money than I have....... to try to make the hospital/hospital administrators accountable. The EEOC? It's free......and an arduous process.....with the typical government run machine pitfalls. The outcome? Unpredictable.....the facility, if no priors, usually get off with a slap on the hand....close scrutiny for a few months and apology to the EEOC and you.....But you never know.

    A word of caution.....you need to make a decision....is it worth taking this difficult road and being know as the nurse with the lawsuit....the hiring black hole? .....further placing more obstacles in your path? Is being right that important? Even if you win.....it won't be to get your position back (usually)....it will be financial and they will pray you will move on. If you get your position back....it will be inordinately difficult to work under those conditions..... for I promise you will have a bulls eye on your back.

    So, I come to AN! and have found a non judgmental family for they can't see my chair.....they can only see my mind. I wish you the very best in all that you do.....and I am sorry another nurses heart is broken by the machine. I wish you the very best.
    Last edit by Esme12 on Dec 4, '12
    nuangel1, prettymica, catlvr, and 3 others like this.
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    Esme12, thank you so much for your reply and sharing your experience with me. To say that your story leaves me with a heavy heart is beyond an understatement! Wow, 35 years of emergency nursing experience seems to me would be more valuable than gold for any hospital, especially for the purposes of nursing education, coordination of PI for Joint Commission, etc. It just goes to show you that ignorance and intolerance is everywhere, and no one is immune to it.
    For me personally, this has been very eye-opening experience. Had I been more cognizant of the abuse that many dedicated nurses are forced to endure, I don't know if nursing would've been as appealing. For as long as I can remember, I've always had a propensity and desire to care of for others. When my best friend from grade school and I reconnected after more than 15 years, she wasn't the least bit surprised to learn that I was an RN because even at 10 years old, I was known to carry a stash of bandaids with me for when other neighborhood kids skinned their knees and elbows (lol, obviously I was a little too young to grasp the importance of wound irrigation and standard precautions!)
    I love being a nurse, but especially in the ER. That's all I've known. Of course some days more than others. I frequently functioned as nurse and detective as my knowledge and assessment skills often played vital roles in patients' diagnoses and treatments. As a whole, the ER attendings valued and relied upon their nurses' judgements and opinions, and treated them as their equals. The knowledge and experience that emergency nursing imparted to me makes me confident that, while I don't know what other field of nursing will prove to be as valuable and rewarding for me as emergency nursing was, wherever I end up next, I will have the knowledge and competence to be a great nurse.
    I've done a lot of soul searching over these last few weeks about many things, namely what I want to walk away with from this experience. Despite my broken heart and bruised ego, I still want to be a nurse. I want to enjoy what I'm doing. I want to feel like I'm making a difference. I want to feel the camaraderie and respect from my coworkers that I felt as an ER nurse. I want to continue expanding my knowledge about the human body, how it works, how it fails, and how to fix it.
    Since my termination one month ago today, I've been very proactive in my job search. I updated my resume; search daily for position openings online; have contacted numerous recruiters; and have submitted at least 30 online applications. Despite my diligence, I haven't received a single reply.
    A few days ago, I reached out to one of the recruiters who also happens to be a friend in hopes of gaining a little more insight into what I'm doing wrong or could be doing. His reply: turn my clock back and don't get terminated in the first place. Apparently, while my 3+ years of ER experience added to the excellent performance reviews that I received are all great, the mere fact that my only nursing position ended with my termination is reason enough for many healthcare organizations to pass me over. It seems that I can plan to encounter great difficulty when applying for any RN positions unless I lie on the applications when asked if I've ever been terminated from a position. And that's just not something I'm willing to do.
    Faced with the bleak reality that I very well may never work as a nurse again has put into perspective that I ultimately have two choices: accept what happened to me as being unfortunate but not worth the aggravation to address; or go out on a limb and do whatever I need to do to keep from being blacklisted as a nurse who was fired because "she must've done something wrong." I'm not sure which is worse: the nurse who got canned, or the nurse who fought back. I am a nurse, and I want to work; so the only outcome that I'm seeking is a change in the classification of my employment status. Call it laid-off, reduction in workforce, elimination of position, whatever; but do not call me "terminated".
    And the irony of the whole situation is that despite me no longer being an employee of this hospital and the poor way I was treated, my opinion of the hospital remains unchanged. It is a phenomenal hospital that saved my dad's life in the midst of a STEMI, and should my family or friends require emergency or specialty care, I will recommend this hospital to them until my dying day!
    catlvr likes this.
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    I wouldn't pretend to be able to understand your experience, not having been through it myself. I can imagine it must be frustrating, frightening, etc. on many levels. One thing I do know that ED nurses are good at, though, is flexibility. This might seem simplistic, but what about urgent care? Many of the same ingredients as the ED, without IV placement. Many urgent cares have phlebotomists for lab draws. Granted, different facilities in different states, etc. have different practices. I am sure somewhere out there your experience and skills would be valued, and could be put to good use.
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    ED18yrs, great minds think alike I've submitted my resume numerous times and filled out god who knows how many of those online employment applications. Urgent care being one of them. But the issue that I'm running into is having to disclose that I've been terminated for any reason. Most frustrating to me is that I was never given the opportunity to demonstrate that my IV skills hadn't suffered. (Mind you, prior to my surgery, 2 ER docs suggested that I pursue IV therapy because my IV skills were really good.) Maybe it's sick, but I really enjoy sticking people... In any event, I'll keep my options and eyes wide open and hope for a job in the very near future!


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