[Nursie2k7]

Hi I am a new LPN in dialysis (inpatient at a hopsital) and our techs are pretty great but they can get their attitudes and treat the RN's and LPN's bad some days....Coming for a floor where I had to do rotating shifts deal with constant codes and have 9 patients I was very surprised when my manager said that she can't keep nurses I mean who wouldn't want to work straight days every other saturday and no major holidays without taking a pay cut......well after a month of working with a few techs with attitudes I understood....we have some great techs but we also have some lazy ones and the whole thing is as a nurse we can work every body system while their license just keeps them in dialysis (so I think)...well I told my manager that the techs treat the new nurses bad and they probably just transfer to a different unit...and in an hospital setting only nurses can do the assessments pass the meds and deal with complications so some days you can be working your tail off and they will just sit there and talk on the phone or browse the internet and you look and there is still a ton of labs that need to be done things that are within their scope and if you ask them to do it it's like now you have an attitude... but my kids love seeing me and I don't miss working the floor so if they are trying to run me off eventually they will get tired of it......

Enough said for a first post

[DeLana_RN]

Originally Posted by Nursie2k7

Hi I am a new LPN in dialysis (inpatient at a hopsital) and our techs are pretty great but they can get their attitudes and treat the RN's and LPN's bad some days....Coming for a floor where I had to do rotating shifts deal with constant codes and have 9 patients I was very surprised when my manager said that she can't keep nurses I mean who wouldn't want to work straight days every other saturday and no major holidays without taking a pay cut......well after a month of working with a few techs with attitudes I understood....we have some great techs but we also have some lazy ones and the whole thing is as a nurse we can work every body system while their license just keeps them in dialysis (so I think)...well I told my manager that the techs treat the new nurses bad and they probably just transfer to a different unit...and in an hospital setting only nurses can do the assessments pass the meds and deal with complications so some days you can be working your tail off and they will just sit there and talk on the phone or browse the internet and you look and there is still a ton of labs that need to be done things that are within their scope and if you ask them to do it it's like now you have an attitude... but my kids love seeing me and I don't miss working the floor so if they are trying to run me off eventually they will get tired of it......

Enough said for a first post

Welcome to this board, and welcome to dialysis! I work in an inpatient unit as well; however, we have no techs (they used to have one who was laid off when they had to cut costs years ago; apparently, she was good and had a great attitude and everyone hated to see her go). Most of us are RNs; one reason for that is, LPNs can only take PD call, and call is of course a fact of life in acutes.

I have to admit that one of the reasons I was attracted to acutes is the absence of techs; I had quite enough of the battles and bad attitudes in the clinic. Yes, there are some wonderful techs, no question about it; however, there are also some very difficult ones - passive-aggressive, undermining the nurses - and the blurred roles in outpatient dialysis seems to encourage this kind of behavior and attitude (obviously, being able to give some meds and do other things unheard of in acute care makes some techs believe that they do exactly the same as the nurses, but are paid less). BTW, techs do not have a license - and they don't really work under yours (the employer is responsible that they are competent and properly trained, and in some states also certified. Your license is only at risk if you delegate tasks to them that they are not qualified or allowed to do.)

What is your manager's attitude about the lazy/insubordinate techs' behavior? How do the other nurses handle this?

I wish you well, inpatient/acutes is (IMO) the best area of dialysis. Hang in there, and don't let anyone run you off.

DeLana

[silly RN]

the war continues in NC!!!
can't we all just get a long?

[starbin]

I am cuurently working with FMC, sub-acute (nursing home program). I recently completed my dialysis training. I was precepted by a Tech who has 15 yrs of dialysis experience. She is just great. She knows her job very well. Now I am the charge nurse (we have a one nurse, and one or two tech team with the nurse being the charge), and my preceptor is my Tech. My preceptor was upset that I got less training than I was supposed to, and believes that I will not be able to handle the situations. I am new to dialysis and I know there is a lot to learn. But I just feel that unless I am given the opportunity to handle the situation, I will never learn. If I show confidence in anything..my preceptor/tech would say,,,, "I would not dare being that confident with just few months of training". I must admire that she knows a lot, but she has very much hard time accepting that other people also know as much. When a patient admired me for doing a good job, she told the patient to "give her some time because she is very new in dialysis". A patient was very comfortable with me, letting me do everything until she told the patient that I had no dialysis experience and I had just been trained by her. Next day the patient asked me if I knew what I was doing.
I am 30 years younger than her, and new to dialysis. It seems like she is just not comfortable with the way I deal with things. I am clam most of the time, dealing with difficult patient or trouble shooting. I don't panic..thats just me. If I say I will take care of something...she tries to scare me. She has been repeatedly telling that when she goes on vacation, I may not have as strong tech. as her..and I might be in trouble. I said "well, we will learn together". She was so disappointed that I was not even afraid. She doesn't directly say that she wants to see me anxious, confused, lost, but the way she puts on things...it looks like she just wants to instill fear about the dialysis. I think it is mostly because she always wants to have certain control over it.
I think after they train the nurses, techs have very hard time accepting the nurse as their charge. They probably want the nurse to depend on them.

[BellaCerraRN]

I am sorry to hear that you're having a tough time. After much thought and reading, I really think it's a bad idea for techs to be preceptoring nurses for ANY length of training. You'd never have an LVN preceptoring an RN, or an ADN preceptoring a NP. It's just ludicrous. I'm thinking about contacting out state licencing board to see what can be done about the situation.

The attitude only hurts the patients in the long run. Nurses and techs can always go get another job if it gets to be too much, but the patients are often chained to 1 center, unless in a huge metro area.

[Hellllllo Nurse]

Having been a nurse for fifteen years, I think it is a really big mistake to cow-tow to the egos of the techs who gave you an attitude. You are a nurse, call yourself a nurse and be proud. They are techs, and should call themselves techs and be proud.

Techs and nurses are not on the same level. You should certainly respect your techs, but not being able to refer to each other by your titles because it offends the techs is beyond rediculous.

[Hellllllo Nurse]

Originally Posted by DeLana_RN

Welcome to this board, and welcome to dialysis! I work in an inpatient unit as well; however, we have no techs (they used to have one who was laid off when they had to cut costs years ago; apparently, she was good and had a great attitude and everyone hated to see her go). Most of us are RNs; one reason for that is, LPNs can only take PD call, and call is of course a fact of life in acutes.

I have to admit that one of the reasons I was attracted to acutes is the absence of techs; I had quite enough of the battles and bad attitudes in the clinic. Yes, there are some wonderful techs, no question about it; however, there are also some very difficult ones - passive-aggressive, undermining the nurses - and the blurred roles in outpatient dialysis seems to encourage this kind of behavior and attitude (obviously, being able to give some meds and do other things unheard of in acute care makes some techs believe that they do exactly the same as the nurses, but are paid less). BTW, techs do not have a license - and they don't really work under yours (the employer is responsible that they are competent and properly trained, and in some states also certified. Your license is only at risk if you delegate tasks to them that they are not qualified or allowed to do.)

What is your manager's attitude about the lazy/insubordinate techs' behavior? How do the other nurses handle this?

I wish you well, inpatient/acutes is (IMO) the best area of dialysis. Hang in there, and don't let anyone run you off.

DeLana

I agree with all of the above with one exception: the tech does work under the nurse's license. I have an acquantance who is an RN and JD. She clarified this for me. Yes, the facility is reponsible for training and evaling techs- but the nurse is responsible for all of their actions or inactions- not just ones which are delegated by you.

[DeLana_RN]

Originally Posted by Hellllllo Nurse

I agree with all of the above with one exception: the tech does work under the nurse's license. I have an acquantance who is an RN and JD. She clarified this for me. Yes, the facility is reponsible for training and evaling techs- but the nurse is responsible for all of their actions or inactions- not just ones which are delegated by you.

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

[DeLana_RN]

Originally Posted by starbin

I am cuurently working with FMC, sub-acute (nursing home program). I recently completed my dialysis training. I was precepted by a Tech who has 15 yrs of dialysis experience. She is just great. She knows her job very well. Now I am the charge nurse (we have a one nurse, and one or two tech team with the nurse being the charge), and my preceptor is my Tech. My preceptor was upset that I got less training than I was supposed to, and believes that I will not be able to handle the situations. I am new to dialysis and I know there is a lot to learn. But I just feel that unless I am given the opportunity to handle the situation, I will never learn. If I show confidence in anything..my preceptor/tech would say,,,, "I would not dare being that confident with just few months of training". I must admire that she knows a lot, but she has very much hard time accepting that other people also know as much. When a patient admired me for doing a good job, she told the patient to "give her some time because she is very new in dialysis". A patient was very comfortable with me, letting me do everything until she told the patient that I had no dialysis experience and I had just been trained by her. Next day the patient asked me if I knew what I was doing.
I am 30 years younger than her, and new to dialysis. It seems like she is just not comfortable with the way I deal with things. I am clam most of the time, dealing with difficult patient or trouble shooting. I don't panic..thats just me. If I say I will take care of something...she tries to scare me. She has been repeatedly telling that when she goes on vacation, I may not have as strong tech. as her..and I might be in trouble. I said "well, we will learn together". She was so disappointed that I was not even afraid. She doesn't directly say that she wants to see me anxious, confused, lost, but the way she puts on things...it looks like she just wants to instill fear about the dialysis. I think it is mostly because she always wants to have certain control over it.
I think after they train the nurses, techs have very hard time accepting the nurse as their charge. They probably want the nurse to depend on them.

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

[Hellllllo Nurse]

Originally Posted by 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

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.