[starbin]

I had a traveler tech. who came to work in my unit about a week ago. She said she had 16 years of experience, which I thought will be a great help for a new nurse like me. Our company policy is to administer heparin 5 mins before starting the treatment. The tech.(who has been trained many times on that policy) cannulated the patient and started the treatment without even bothering to call me (only nurses are allowed administer medication in this state). I was just 2 feet away with another patient charting the vitals. When I turned my head I saw the patient was already started, and asked her why she didn't call me for heparin. She simply said- "It doesn't matter you can give heparin now, I can't stand here and wait for you for 5 minutes". It hadn't been even 2 minutes and I was standing right next to her, just charting the vitals on another patient. I told her- that is not the way this unit works. From next time, she was nice enough to call me for heparin.
Another incident with the same tech- I had a patient with catheter she was heparin free. The tech put the patient on, and when I was rounding after half an hour the patient had been on, I see the patients lines were reversed (our company policy is all trouble shooting for catheters have to be done by RNs, techs are not allowed to troubleshoot the catheters) but no documentation that says why the lines were reversed. I asked her why she reversed the lines but didn't inform me. She was like," What would you do even if I had told you? You would have reversed the lines too". I politely reminded her of the policy and made sure that she will not do it again. I didn't work with her after that. I respect techs for their skills but they should respect the chain of command. Years of experience doesn't make them nurse.

[Lacie]

Originally Posted by starbin

I respect techs for their skills but they should respect the chain of command. Years of experience doesn't make them nurse.

Boy did you hit that nail on the head!!!! I'm currently leaving Davita for many reasons and this is one of the primarys. I have expressed over and over I dont like being micromanaged by others with much less experience and education. In fact I have been a nurse longer than anyone in my facility with a great deal more experience in my little finger than most have had in thier entire career. I respect thier experience but when it comes down to safety, legality and the pt as a whole - move out of my way! Our FA now has the LPN and a PCT doing the monthly staff scheduling and the pt care assignments!! What happened to the charge nurse responsiblities? They push the heparins (against our nurse practice act and law), they dont communicate and further more wait until the pt has a problem rather than prevention. Not everything is related to ESRD nor just a result of hypotension from dialysis. Pt's have other health issues going on not just the previous stated. When they can start providing rationals with the pathophysiological basis behind them with the education to back that experience then they can step into that role.

[cavergranny]

Hi Lacie - I'm going to leave Davita too, after only being there for three months. Isn't going to look very good on the old resume, but I've got many years of ICU and ER experience. I really thought that I'd like dialysis and the outpatient clinic idea appealed to me. I just wasn't prepared for this Davita mentality. The techs of course routinely give heparin (although by law they aren't allowed to). Today at work I overheard two of the techs talking about one of our patients . One tech asked the other "You didn't give him his heparin did you ? You know he bleeds a long time." So they do or don't give heparin, depending on whether they want to or not. And the saline boluses - the techs just do that whenever a patient "feels bad". Do they bother to mention it to me as the charge nurse? NO. So I don't even know the volume they give. I don't think Davita management even pretends to care if the RNs are happy - they pretty much make it clear they think the techs run the show. I know the money bottom lilne is the top priority, and to me, the goofy CEO appears to be a nut-case. Should I report these violations to the state ? Of course, I better get another job first !

[Natkat]

Part of the problem with techs, as I see it, is that even though the nurse does the tech's job, the tech never does the nurse's job. I had someone say to me once that "it's better to start as a tech before they're a nurse so they'll understand what the tech goes through."

I said "The problem is that even though the nurse can understand what the tech goes through, the tech will never understand what the nurse goes through because they'll never do their job."

This person is a nurse and, for some reason, feels that the tech's opinion matters more to her and so has gotten on board with the "techs versus nurses" on the techs' side. I feel that her priorities are screwed up. My priorities for making people happy are.....

1. The board of nursing
2. The patient
3. The clinic manager
4. Me
5. The techs

I worked as a tech before I got my LVN license so I've been there. But having been there I never felt like I knew more than the nurse or that nurses gave me attitude. My observation has been that if a nurse gives a tech attitude, there's usually a good reason.

I get along with everyone in my clinic, but we have an unusually great bunch of people, and I realize that our situation is rare. I've helped out in clinics that had a terrible work environment and I never went back. We are fortunate that the techs we have do their jobs well and take their responsibility seriously. They are clashes between nurses and techs, but nothing like what I've heard described here.

[wnf3]

Hi all,

I am a Tech in England and I have been reading all your comments, I found them interesting as nothing like that happens here. Both Techs and Nurses are educated about the workings of the machines by our Engineering Techs. These guys do a great job and as they repair and upgrade the machines who better to learn from.
As for the clinical side, the Nurses are taught by Nurses and Techs by Techs.
We all work and learn of off each other as a team for the benifit of the patient.
Our unit works well together but don't get me wrong there are a few arguments, but they soon get resolved. Our unit also has a ward attached and the staff there are great and the Nurses do a 6monthly rotation between the ward and unit.

[mesa1979]

I am a Tech in Oklahoma, and we are allowed to push Heparin, do Caths (after six months and theory), cannulate, and give NS up to a certain amount. I am currently in nursing school, and I give my nurse respect and I make sure she is ok with my actions, I even make sure she is ok with my break and lunch time.

I want to be treated with the same respect when I graduate. We do however have one tech, that is also a nursing student, who thinks she is God's gift to dialysis. She yelled at the nurse the other day, and she bosses the other techs around. She thinks if its not done her way, that it's not right.

I have only been with Davita for about 2 months, (I was with Gambro for 1 1/2 before moving) but the first time she did it to me, I put her in her place. I don't have time to be stressed out by idiots!

[corinej2007]

I know that this posting is late, but I have been in dialysis for 3 years and I started out as a tech and you guys are right once I became a nurse I was no long one of the girls. All my decision are always being question and I am unable to play the role as a nurse because the tech look at you as just a high paid tech. There is a constant battle to prove ones self. I can never said the right thing in their eyes. I the best thing for me is to keep quite do my job and let those who are in charge delegate. I have worked for both FMC and now Davita and it the same because the people move from on company to the other.

[shinynurse]

I am so sorry for your situation. Just reading your letter brought back old feelings of frustration that occurred years ago while training in a chronic facility. Please understand that this type of "teammate" struggle occurs in many occupations with nurses, ie. flight nurses; paramadic vs. RN, CCT nurse; paramedic vs. RN, LVN's vs RN's. It's truly very sad and oh my gosh, so very frustrating!
It's all about ego trips and shoulder chips. Also, I'd bet big bucks that your FA isn't an RN. If your FA was truly an RN (or maybe a good FA) that was trained in dialysis, she/he would have never made this an issue with you because more than likely it would have been something that he/she had experienced throughout their personal dialysis years. Also, if your FA had participated in any of your training (ie. weekly evals) and would have actually taken just a touch of participation in your training, the FA would have been able to see for his/herself that nasty RN additude you were carrying.
However, telling you this isn't going to make your situation any easier. Please just remember your years of RN education and be proud of your title and of who you are. There was another nurse that responded telling you to basically not let them bring you down because that is what they're trying to do. They're trying to just put you in your place before you ever even get out the gate. They're trying to show who's the boss.
I've had techs override UF and sodium modeling orders just because they could!???? Setting an SV as high as 150. Then they wonder why the pt. comes back hypervolemic? Do they understand that they were the ones that sent that pt. home thirsty? Exactly how much do techs understand labs and the effects of their highs and lows? What do they understand about the underlying diseases these pts. also have? What do they know and understand about CHF, cardiomegaly, cardiomyopathy, diabetes, etc. and how these diseases can behave during txs.? They know they have to remove fluid and keep those vitals stable. Techs and nurses both can become very number focused and task oriented. Dialysis is very individualized. Believe me, their are some very intelligent dialysis technicians out there that really know their stuff. The techs that do, though, have total and complete respect for an RN's training and their knowledge base. Also, it takes at least a good 3 years of hard chronic time under your belt to be able to pat yourself on the back and to be able to say that you know that you know what you know!!! If a tech wants to rule the roost, then they need to go to school, pay thousands of dollars out of their pocket or in school loans, give up how many years of their lives to be able to take the state boards and obtain their nursing degree.
Keep your head up high, a smile on your face and take no abuse!!!! This behavior is based hugely on ignorance. They have no idea what your responsibilities involve.
When you get really good at your job, move into acutes and then you can really shine. Then you can really save lives!! It's an awesome feeling!
Good luck in your challenges and be strong! Remember you gave up many years to become a professional and that's what you are. Remain just that!!!