Concerned about a nurse operating an x-ray machine without training.

Editorial Team / Admin · Jan 9

I understand your concerns, and also wonder if the nurse received proper instruction and cautions. Also, I do not know (have not been able to locate on the website) if WA State requires all persons operating X-ray equipment to possess a license/formal training. This is left up to the individual states to assign and monitor.

My advice would be to lodge a complaint with the WA State Department of Health. They can then look into the matter. Do some research yourself, if you intend to speak with the nurse directly, so you can give specifics. Thank you for caring enough to question this, out of concerns for the nurse's health.

Mike.Nichols · Jan 9

Thank you very much for the advice. I contacted the Department of Health just now and explained the situation, they aren't answering their phones and I got a message about a full voice mail box when I called them so I sent an email.

DOH has a fairly long turn around so I may also at least ask if the nurse in question is aware of the dangers of ionizing radiation exposure. It's a small clinic and they don't do that many xrays but the more I think about this the more things stand out to me as suggesting that maybe she isn't aware of the risk. I remembered that the movable radiation source was at least five feet behind me, pretty far away. With the operator door open and light propagating in an expanding arc and her standing in that open door I think she's getting hit with direct radiation too.

lifelearningrn, BSN, RN · Jan 9

I would definitely appreciate being made aware of the dangers of radiation exposure if I was unsafely using a machine. We don't know what we don't know. I *think* in Texas only licenced techs and radiologists can use the equipment. I've never known a nurse to do it, but could be wrong.

You could be saving her life, literally. Also, if she were to become pregnant, the danger to the fetus is something to consider as well. (Or at least I would have been concerned during those years).

Mike.Nichols · Jan 9

Thank you very much for the reply and additional information, I hadn't even considered pregnancy risks.

I reached the department of health over the phone, they're having a physicist call me back to make sure my understanding that this is unsafe is really correct (person I got through to just answers phones but agreed that it sounded unsafe.) The plan is to explain the dangers to her ASAP, verify that the booth she has is actually lead lined so she would be safe if she closed the door, if not and if her employer doesn't take corrective action basically immediately, to have DOH do a spot inspection and stop this from happening.

Tenebrae, BSN, RN · Jan 11

In New Zealand a person has to be a qualified radiographer.

There is no way in hell a nurse would waltz into an Xray suite and start messing around.

This sounds as dodgy as heck

DavidFR, BSN, MSN, RN · Jan 11

Likewise in France the person has to be a qualified person who's followed a 3 year training and is registered as what we call a Manipulateur Radiologique.

Similarly when I worked in the UK this could only be done by a qualified, trained, registered Radiographer.

I have also never heard of a nurse doing this and you are 100% correct to raise concerns. Sounds like this may possibly be a dodgy clinic doing this on the cheap???

Mike.Nichols · Jan 12

Thank you both for the replies and additional information about normal standards. I was able to speak to both the PA at the clinic, his supervisor and an xray inspector for the state department of health here in Washington.

First the bad part: There is no training requirement for a nurse to operate an xray machine in the state of Washington according to the DOH xray inspector I talked to. DoH wants there to be one and they have been trying to impose one for years but a group he described as a "nurse's lobby" has successfully fought all efforts to impose any training requirements on nurses.

Everyone else in Washington has a training requirement to use xray equipment, just not nurses. Which is a patient and nurse safety issue in my opinion. The inspector went on to state that he normally asks nurses to simulate taking an xray and then fines the facility when they mess up (which happens constantly according to him) in the hopes that doing so will motivate the facility to train people who operate their xray machines, he also said it really hasn't helped. The facilities just pay the fine and don't provide training. I haven't fact checked any of this, it's just what the inspector told me over the phone. I can't see why a nurse's lobby would oppose a basic training course for xray operation, but maybe there's a financial incentive I don't understand.

The slightly better part: According to everyone but the nurse who told me she wasn't trained, they are all trained. While I do trust the PA, he's my PCP and has never lied to me yet, I also tend to believe the nurse who told me she wasn't trained because that seems like an odd thing to lie about. There may be a miscommunication and he thinks she was trained but something got dropped at the admin level and she wasn't. Everyone running an xray machine at that facility is supposed to complete a six week training course plus annual follow up according to the PA's supervisor. However, that six week course doesn't include what rems or sieverts are, or "any of that stuff." According to the supervisor. It's how to use the machine and where to stand. So, better than nothing, but if it doesn't include how to recognize, for example, skin reddening due to radiation overexposure, or how to monitor radiation exposure over time and when it is important to do that, well, it's really not a safety course.

I can't see why she'd lie about never completing that course. Yes, I am a bigger guy and sometimes women find me intimidating, but lying about not getting training seems like a very strange thing to do, since it only raises more reasonable questions and continues the conversation. Normally when people feel uncomfortable around me I get brief answers, not multiple parts of their life history and how they came to be running an xray machine without being taught about the risks involved.

The PA told me there's a leaded plexy divider nurses stand behind to take the xray. I briefly stood in the room with the nurse while she showed me the xrays on her system and I didn't see one. I'm not perfect, maybe I missed it, but it really looked like she was just taking the xray from the computer just inside the door and in the arc of the beam. When I'm next there I'll look at the xray room again. A lot of those dividers are panels on legs and they move, if this one does perhaps someone decided it was inconvenient to have there and the nurse who took my xrays didn't know she needed to put it back. I hope I just missed it.

The nurse in question was off today and I think they circled the wagons on talking about this, but I did ask another nurse who operated the xray machine if she had safety training. Which is a yes/no question. She paused and said that she was trained how to operate the equipment. Which isn't the question I asked or the response someone who was comfortable with their level of safety training would normally give. If someone asks me if I am trained in hazmat safety procedures for, as an example, dry confined space entry, my answer is "yes." Not, "I know how to open a manhole."

Unfortunately, Washington probably isn't a very safe place to operate xray machines if you are an untrained nurse because training, if any, and it's quality, is entirely up to the employer. On the bright side I do have a level of confidence that the PA who works out of there will now be concerned enough to look into and fix any problems that exist. From what I've seen he has a conscience and good ethics, if he knows there's a problem I think he'll do something about it, the broader organization not so much, but I think he will. All the state will do is a spot inspection, and a fine which the place will pay and then business will continue as usual. They may hate me for bringing it up, but, if I am correct, hopefully they'll fix it, even if they don't admit fault. There doesn't seem to be much else that I can do in this state until the law is fixed.

Thank you all again for all the advice and input, I'm sorry I don't have a better resolution to this issue to report.

GoodSamaritanWithKits, EMT-B, EMT-I · Jan 12

This sounds like a common theme in Washinfton state right now. The ability to cover critical areas in healthcare are being filled by the untrained and are often being put at risk themselves and putting others at risk while doing it.

I recently recieved multiple xrays in Eastern Washington from a Brand new college student who hadn't even been admitted any sort of program in the radiology field after finishing any sort of associates degree. She still did not have enough prerequisites to apply tonany advanced program. Not even the very first radiology class involving taking xrays, exposure limits, registration, or classroom time including the basic machine introduction, usage. She had heard of RADS, though no knowledge of the meanings of measuring units like "Gy, rem, or Sv." And no knowledge of emmitted radiation measurements. No knowledge of really any of the most basic textbook radiation types, why they are important, how they mess with the body.,Nothing. She was not even technically an unpaid intern with direct supervision. While imaging me, she took took multiple very difficult to get angles of bones which are very hard to see epecially in a large habitus. She had been doing this for 6 months! She had a gentle touch, excellent bedside manner and I only knew she was not a tech because I looked at her badge. She was so very professional. I know in the state of Oregon a Doctor can order a treatment or intervention from anyone even if it exceeds their scope of practice. But I believe the physician has to be in the room to ensure the intervention test or treatment is done correctly since the liability falls on their license. I don't know about Washington state laws or any of them involving something similar. However the young woman did possess an active CNA license and was under direct orders from a hospital employed MEDICAL DOCTOR. Though he was not in same room and I don't know if he was even on the property.

She had been given a crash course in taking images and was thrown into a position under the paygrade of CNA. She was safe in her practices. But juat because she was doesn't mean other people that might be finding themselves working in an imaging lab definitely need the training. There are extremely important reasons for.it. and like the author od this post. I come from a background involving the importsnce.of radiation and measures to prevent exposures to life, propery industry, manufacturing, storage and transportation. HAZMAT/Fire/EMS/-

Eastern Washington is far worse staffing the most basic of medical care positions. Local patients are mostly unaware of being treated by people unqualified to provide certain levels of care and people all over the rest of the state have zero idea. Especially outside of the state. Covid pandemic caused a huge loss of workers, but I believe the workers and doctors fear for their jobsband fear more for their patients ending up with access to even less care than they are getting now so nobody Is speaking out or admitting the true dire reality of the situation. If everyone noticed they wouls demand better care. And then almost everyone would become victims to complete care collapse.

GoodSamaritanWithKits, EMT-B, EMT-I · Jan 12

I'm curious, did this xray session by a nurse with no training also happen in.... lets say Eastern Washington state? Like my almost identival.expwrience except she was a CNA and had been doing xrays alone for 6 months and was great at it and taking proper precautions as far as I could tell?

Excuse my auto correct and typos

CrunchRN, ADN, RN · Jan 12

I am curious.....was it a nurse or a medical assistant?

DallasRN · Jan 17

Was she wearing one of those badges that detect the amount of radiation received? Years back in the trauma unit, because we did so many in-unit x-rays, we wore those and they had to be turned in every 30 days or some fixed time frame. Also, do you know for a fact she did not have training? Frankly, if I was concerned, I would have asked to speak to clinic director to voice concerns rather than wait indefinitely on a State Board. Finally, what type of hazmat training have you had? Asking because different professions/positions require different types of training. Example: Most local fire departments have hazmat teams that are called in for specific occurrences rather than the regular firefighters.