Has Anyone Worked A Strike? - page 7

Just wondering what it is like. Anybody have anything to say about the specific companies?... Read More

  1. by   caroladybelle
    No slam was directed at soldiers, but a point being made that what happens outside of the hospital setting is significantly different than what happens inside the hospital setting. And that a skill may be learned by an unlicensed person, might not necessarily be appropriate for them to practice in a quality hospital setting.

    As this thread is about strikes at facilities/hospitals, I presume that these skills are being practiced within said facilities.

    And as there is generally no MDs on most hospital units and they are not responsible for hiring, training or assessing the skills of staff in most hospitals (that is a nursing job) - it would be rather difficult for them to be thusly responsible in the general hospital setting. This also does not reflect what I have personally witnessed in hearings before the Nursing board.

    However, I only have licenses in 5 states - and have only attended court proceedings in two of them - and have only been an RN for 10 years - so I am giving you the benefit of my oh so meager experience. And , oh yes, I am well aware of my responsibility in holding those licenses.

    And, yes, in my nursing school, IV skills were taught quite thoroughly, and practiced, in Florida - I do not know about yours. But just as you can train anyone to do about anything does not mean that they should be doing that skill.

    I repeat that quality hospitals should staff adequate licensed personnel to perform invasive procedures - and if such staffing is inadequate - staff have a duty to take action to correct the situation and not accept substandard care. While I do not strike (as a Southern girl it does not appeal to me), I do vote with my feet and my hands - refusing to work at those facilities that staff poorly and accept a lower standard of care. And I do not cross picket lines.

    PS . If you want an unlicensed caregiver to start an IV and give you chemo...well, that's your choice. But when you show up in my hospital with an extravasation, or liver/cardiac damage, or life-threatening mucositis and dehydration, or neurologic damage because the proper teaching, followup and assessments were not done, well we'll take care of you right nicely.

    Carolina in the South
    Last edit by caroladybelle on Mar 12, '03
  2. by   Hellllllo Nurse
    Originally posted by RNonsense
    We don't use outside agencies here...it's our own union people (who have set out acceptable essential service levels months prior to a strike along with management) who take the turns on the pickets..then inside as staff nurses.

    Hogan, your original question of "Whocare for the pts when the nurses strike?"

    Was answered by RNonsense above.
  3. by   Hellllllo Nurse
    Hogan,
    Have you read this study about how RN staffing levels directly affect pt outcomes and rates of death?

    http://www.hsph.harvard.edu/press/re...s05292002.html
    Last edit by Hellllllo Nurse on Mar 12, '03
  4. by   hogan4736
    ms belle, i NEVER said unlicensed personnel would GIVE th chemo, only start the IV...

    and have you not heard of a PA practicing "under" an MD's license w/o the MD being there (rural communities)

    I never questioned your experience, only offering a different (seemingly in AZ) point of view...

    we have many MAs/CNAs practicing under an MD's license, and the MD isn't in the office...

    sean
  5. by   hogan4736
    Originally posted by Hellllllo Nurse
    Hogan, your original question of "Whocare for the pts when the nurses strike?"

    Was answered by RNonsense above.
    Hellllo,

    That's the first intelligent response to the posed question...it took about a week too

    though that's the ONLY question I really ever initially asked, and then everyone wants to pile on w/ "intelligent" self-fulfilling logic like "we're right because admin is wrong, and...uhhh...we're right!"
    Last edit by hogan4736 on Mar 12, '03
  6. by   hogan4736
    Originally posted by caroladybelle
    PCT' s are not always CNAs - sometimes only have in hospital training.

    When you go to court - you will find out that certification means little - what matters is that you "delegated" this procedure to an unlicensed individual. The questions usually include "Did you adequately assess this individual's skills prior to delegating this procedure?"

    Certification is not a license, and frequently the RN is held responsible for the CNA's acts.
    caroladybelle,
    FYI, a response from 3rdshiftguy on a current PCT thread:

    "If you improperly insert a line and cause damage to a patient, who takes the liabilty for the actions of the PCT (CNA 1,2,3, whatever) "

    If I deligate an IV start to a PCT, and that PCT causes damage to the patient. I'm NOT liable for the damage that PCT caused...IF that PCT has the proper certifications and is acting within hospital guidelines.

    Same as if I cause damage to a patient for whatever reason my manager is not responsible for my harming a patient, as long as my assignments and ordered duties were within my scope of practice.

    Does that make sense? If you deligate a task, as long as that person is qualified to perform that task (and usually hospitals keep those on record, i.e. the PCTs have three documented IV starts undersupervision before they can start one on their own), then you are not liable for any harm they cause.


    __________________

    This illustrates my point...if some entity certifies a PCT3 to start an IV,the hospital hires said PCT, he starts IV and the patient gets phlebitis, THE RN BEARS NO RESPONSIBILITY! It's a common misconception that you have, and shared by many RNs.

    If you ask housekeeping to empty a specific trashcan, and he/she gets stuck w/ a needle, are you now responsible, as you delegated the task?

    Seriously though,in your defense, it seems to differ from state to state
    Last edit by hogan4736 on Mar 13, '03
  7. by   caroladybelle
    Originally posted by hogan4736
    ms belle, i NEVER said unlicensed personnel would GIVE th chemo, only start the IV...

    and have you not heard of a PA practicing "under" an MD's license w/o the MD being there (rural communities)

    I never questioned your experience, only offering a different (seemingly in AZ) point of view...

    we have many MAs/CNAs practicing under an MD's license, and the MD isn't in the office...

    sean
    If unlicensed personnel can give meds - they can be given chemo - chemo is frequently a PO med - inappropriate doses of it in PO form can cause and some cases have caused all of the problems listed - excluding extravesation. In addition, meds such as decadron, prednisone, tylenol, benedryl, tagamet, zantac, are frequently give and titrated as part of the chemotherapy regimen, though they may not appear at first glance to be chemo. Some common meds if not given at exact (to the minute) times can alter the action of the chemo in the body and cause major problems. Some drugs are considered salvage meds (leucovorin, etal) and if vomited after ingestion may need to be given IV immediately.

    The major cause of extravasation is the IV cannula being improperly placed and frequently leads to severe infection, pain, skin grafting and ocassionally amputation of the limb affected. The ONS recommends that the nurse administering the chemo be the one starting IV, due to the risks involved. And if a case goes to court - the ONS guide to administering chemo - is the one invariably cited.

    Again, as I believe we are discussing strikes in hospitals (please see thread title), PAs, MAs, and CNAs working under an MD license in an office does not really come into it. Also, as that does not involve an RN license - the question is moot in this discussion. However, on the subject of clinics, the Oncology/Hematology Clinic of NE GA (servicing much of GA for CA care) - does not permit any unlicensed personnel to start IVs, does not permit chemo to be given when there is no MD personnally present on the premises, and has an all RN staff giving IV chemo. Despite paying office wages and requiring updates on education, they manage to keep a well-educated staff on by treating them well and taking pride in their work.

    If only our hospitals were as diligent.

    In reference to the citing that RNs are not responsible for what is delegated - please see Ms. Brown's links on other thread. They are quite accurate to what I have seen in court and in life.

    As far as "intelligent" response, I feel that you have gotten quite a few intelligent responses. But I suppose that they were not the specific ones that you were looking for. And as many of us were responding to the thread title rather than your question, many of the answers were appropriate. Labeling all of the others as not intelligent was extremely rude and uncalled for and unbecoming to someone in the Nursing profession.
  8. by   NRSKarenRN
    If you delegate a task, as long as that person is qualified to perform that task (and usually hospitals keep those on record, i.e. the PCTs have three documented IV starts under before they can start one on their own), then you are not liable for any harm they cause.
    Two fallacies here:
    1."as long as that person is qualified to perform that task usually hospitals keep those on record"

    Records are lost ALL the time. Persons seek employment at hospital A. They teach an individual task to CNA/PCA /LPN/RN etc. Due to training time constraints, persons technique is not the greatest, barely adequate but they pass the course/inservice as RN thinks they'll improve on the floor and receive a certificate and copy of skills checkoff . They work on a unit but are minimally performing employee. This individual sees that hospital B is hiring at .25c more an hour so they apply to hospital B and are accepted.

    Hospital B sees that they have a new certificate and skills checkoff so no further skills assessment needed. 3 months later fire PCA for poor skills. Hospital C is in such a staffing crisis they are paying 1.00 more/hr than Hospital B did. PCA tells them she left for more money and agree to hire PCA as only had time to check hospital A's record's. All qualifications recent so they put the PCA to work immediately.

    This PCA is now on YOUR floor. You actually have NO assurance that this person is competent until you have personally observed work performance

    In my 30 years in healthcare, I've seen the above scenario repeated too many times to count


    2. " you are not liable for any harm they cause."
    You are directly responsible for any tasks you delegate to someone who is reporting to you=supervision.

    From AZ SBON:
    R4-19-402. Scope of Practice for a Professional Nurse
    B. A professional nurse shall be responsible both for the nursing care directly provided by the nurse and the care provided by others who are under the professional nurse's supervision.
    http://www.nursing.state.az.us/legac....htm#r4-19-402
  9. by   hogan4736
    Last month, I worked w/ a person who stated she was an RN and was sent by the temp agency...

    She had worked for an agency for some time, and had a valid license at the time of hire...Well, she lost her license at some point, and continued to work for the agency. (We found this out after her shift)...

    Who would be responsible for any malpractice by her, if any had occurred...

    "Records are lost all the time" seems to imply that it happens for unlicensed personnel...Why no mention of RN related scewups?

    hmmmmm....

    Sean, RN
  10. by   hogan4736
    ms belle,

    the thread title pertains to nursing strikes...
    my simple (seemingly) question was, "Who cares for the patient if the nurses are striking" Oh, I see how that's not germane to the discussion now :roll
    It's not that they weren't responses "I was looking for," the question wasn't being answered directly. "Admin has time to plan, and divert patients" or "we're right, admin is wrong" aren't answering the question at hand.

    you also stated:"If unlicensed personnel can give meds - they can be given chemo"

    what does that mean?
    are you trying to imply that I stated unlicensed personnel can give meds? I reread my posts, and I never posted that.

    And I'm happy your nursing program "taught" IV insertion. At my university, we just practiced on each other, and the rest was on the job training. I guess I'm not worthy.
    Last edit by hogan4736 on Mar 13, '03
  11. by   -jt
    <Is it selfish of the instructors to jump in (they don't work there technically), as their #1 priority should be the students.>

    No. It wasnt something that was done to the students. It was done with the students. Students & instructors had debate & discussion & decided they both wanted to support the RNs and take clinicals elsewhere.
  12. by   hogan4736
    Originally posted by -jt
    <Is it selfish of the instructors to jump in (they don't work there technically), as their #1 priority should be the students.>

    No. It wasnt something that was done to the students. It was done with the students. Students & instructors had debate & discussion & decided they both wanted to support the RNs and take clinicals elsewhere.
    thanks for the clarity jt

    the scenario makes more sense now.
  13. by   -jt
    <Who cares for the patient if the nurses are striking the question wasn't being answered directly. >

    I thought it was - its already been explained that nurses at other facilities care for the pts because the hospital is given 10 days to move the pts there. The ER is the only full service dept and remains open. In emergencies anywhere in the hospital, striking RNs come off the picket line to assist until the emergency is under control. Pts are stabilized in the ER & transported by paramedics to the next facility if they need continuing care. Between transferring pts out & shutting down elective services, there should be very few pts left to be cared for in the striking hospital, but those that are still there are cared for by RN manangers, RN clinical specialists, etc - all the other RNs who work at the hospital in positions other than staff RN. Many times just the thought of having to go all thru this is enough to bring the hospital to its senses & settle the strike before it happens and then their own staff RNs will continue to care for the pts.

    If the hospital chooses not to follow the 10 day notice and these contingency plans for providing care to the pts, does not transfer pts, and does not cut services just so it can ignore the nurses strike, then its up to the hospital to explain why it is putting pts in this situation and how it plans to provide for them.
    Last edit by -jt on Mar 13, '03

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