Has Anyone Worked A Strike?

[Geeg]

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

[caroladybelle, BSN, RN]

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.

[NRSKarenRN, BSN, RN]

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/legacy/npa/art.htm#r4-19-402

[hogan4736, BSN, RN]

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

[hogan4736, BSN, RN]

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.

[-jt]

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.

[hogan4736, BSN, RN]

Originally posted by -jt

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.

[-jt]

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.

[hogan4736, BSN, RN]

"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"

Thanks jt, that's a tangible answer. What I was getting was anything but that kind of an answer...

I'm not in any way anti strike, just trying to stimulate discussion, and thinking outside the box. As my personal experience has been that some nurses aren't concerned about a plan for the patients, just their own bottom line...

sean

[-jt]

actually, I think the instructors did keep their students as their #1 priority when they educated them on the issues of the striking nurses and the reasons for the strike. These are issues that students have to know about & understand how things like short staffing and forced ot affect them & their pts & how detrimental they can be. These students will have less reality shock when they get to work. They will not be complacent doormats and accepting of the unacceptable. I think the instructors were right to pull the students out of that hospital & arrange other facilities for clinicals. These students happened to agree, but even if they didnt because they didnt want to be inconvenienced driving a little further to another facility, the instructors should still have pulled them out of clinicals at the striking facility on principle - whether the students liked it or not - because the issues were more important than personal inconvenience.

[caroladybelle, BSN, RN]

Thank you JT

[caroladybelle, BSN, RN]

Originally posted by -jt

thats not true. There are carefully outlined solutions but nowadays too many hospitals are refusing to follow them. How is that the fault of the striking nurses?

All of this blaming the striking nurses for unsafe pt conditions is misdirected. Its the hospital that chooses to put the pts into that situation. Most of the pts should not even be there. Nurses dont just walk out. They give the hospital 10 days notice to discharge pts who can be discharged & arrange their home care for them, transfer pts who need hospital care to other nearby facilities that are not on strike (and the striking nurses then work at those facilities per diem during the strike to take care of them), cancel elective surgeries, cease admitting new pts, downsize the in-house pt population, mobilize RN managers, RN clinical cocordinators, RN educators, and other non-staff RNs who work at their facility & put them to work at the bedside of the few pts who are supposed to remain. The only service that is supposed to be open is the ED & emergency OR. Striking nurses go back in to handle critical emergencies or surgeries & then come back out when its under control. And they form a pt safety committee to keep track of whats going on inside & to make sure the few remaining pts ARE receiving proper care. Thats how its supposed to be & the fact that this all cuts down on hospital business & revenue is the trump card & why its effective in bringing the hospital back to the table, avoiding a strike altogether, or ending it quickly if it occurs.

Loss of revenue is the only thing that administration pays attention to. Moving pts to other facilities & shutting down services causes them a loss of revenue. Paying for scabs with taxpayer funds does not. So hospitals sometimes wont do all of these pt safety solutions during a strike, will keep every pt there, & ignore the strike. Putting their business before the pt, they will call in scabs to work 12-20 hr shifts 6 days a week so they can keep all the pts there & keep business going as usual. There are solutions for who takes care of the pts during a strike but calling in out-of-state scabs who work excessive, unsafe hours is not one of them.

Nurses who decide to strike do so for safer working conditions & retention/recruitment initiatives which ARE for the pt because if the hospital doesnt pay enough & has unsafe conditions, nurses wont work there & that does affect the pts everyday.

If the hospital chooses to provoke a strike & then refuses to apply the solutions, choosing instead to keep the beds filled during a strike, putting profits before pt safety, it is not the striking nurses who are endangering the pts.

There should be concern for pts in hospitals that ignore the 10 day notice & refuse to apply the solutions for who cares for their pts during a nurses strike, but the pressure & blame for that should be put squarely on the shoulders of the hospital. They are responsible for their own actions - and inaction - and should be held accountable. If any pts (who shouldnt even still be there) suffer because of this, that is for the hospital to answer to, not the striking nurses.

This was posted on 2/27 - an intelligent post and it didn't take a week to obtain (something stated earlier on this page).

[hogan4736, BSN, RN]

seems as if I have made an enemy in ms belle...

oh well, can't win 'em all

it's tough to debate with someone who dislikes me...