Delegation Situation

[StephRN08]

First of all, here is a little background information...

The hospital I work at is part of a large health sytem and is undergoing major changes. Many specialty areas, such as cardiology and neurology, are moving to other hospitals within the system. Our oncology program is set to move to another hospital sometime next summer. Many of my co-workers in the outpatient department have left which has resulted in one secretary, one PCA, and no transporter.

The current and only PCA fomerly worked steady night shift and has a bit of an attitude problem, but she does have a decent work ethic. Our patients are scheduled for certain times throughout the day for infusions and outpatient procedures and enter our department through a short registration process. During this time, we have the patient sign treatment, insurance, and billing consents and obtain vital signs. The procedural patients are prepared and then sent off to their procedure. Traditionally, we had a dedicated transporter that did this. After he left, our former PCA's would do the transporting.

We typically have 5 to 6 patients at any given time--some receiving infusions such as chemotherapy or blood products and others having outpatient invasive procedures. Our manager decided that our sole PCA would do the registration process while the RN's transport patients all over God's creation in the hospital. However, this presents a problem when you have to constantly report off to another nurse and when multiple patients are being sent off to other departments. For example, last week I was off the floor for nearly 45 minutes transporting 3 different patients to radiology, GI lab, and pre-op holding. Each time I had to report off to someone different because other RN's had to transport.

I am perfectly fine with transporting patients, in fact I used to work as a nurse tech on a busy cardiac unit so that was a norm. However, I feel that as an RN in this type of setting and with some of the patients we have, it is unsafe practice for us to be constantly running off the floor. If the patient has chemotherapy or blood prodcuts infusing, then we most certainly have to go with them. Several other co-workers have also complained about the same thing. It is bad enough that we have to play secretary on most days too.

It is also important to know that our current PCA likes to complain--A LOT!!! We think this is why she is doing registration, and registration only, instead of transporting.

Personally, I feel that transporting (in this situation) is a PCA duty. In our fully-staffed past, if we had a PCA call-off we would register our own patients as they came in or when not busy. We can also obtain their medication and health history during this process which helps out the other RN's if they patient wasn't our own. This would be my proposed solution to this problem.

Does anyone have thoughts on this issue? Is there anyone in administration that has any suggestions on how I could approach our manager and try to resolve this issue?

[Davey Do]

StephRN08:

Please forgive my ignorance: PCA? That's the accepted abbreviation in our institution for Patient Contolled Analgesic. Perhaps Patient Care Advocate? Licensed or not?

Regardlessly, this is a valid concern. For a nurse to be distracted from their professional duties and do the work of a gopher sets that nurse up for a fall. A professional cannot be expected to make prudent decisions when their energies are spread over a vast area. One can only be expected to provide competent care when able to focus on a specific area.

Has any attempt, in writing, regarding this area of concern, been generated and sent to the delegating official? Internal notification through an objectively documented process, is always a good beginning. Allowing Administrative Officials to reply, in writing should be expected.

Documenting the problem-solving process decreases misunderstanding of factors in the situation. And, documentation creates a paper trail for any outside entity to evaluate the process and made a sound judgement on the appropriate course to take.

The best to your in your endeavor to provide focused, competent care in your nursing process, StephRN08.

Dave

[cali2007]

I completely agree with stephRn08. This is putting patients safety at risk. Definately put your concerns in writing to the delegating official as stephRn08 suggests. I wish you all the best.carol, RN07

[wondern, ASN]

Sounds like the place you work spreads their staff as thin as possible regardless of anyone's safety, your patients or yours, for that matter. Scary!:smackingf:sstrs:

If that is indeed the case I doubt your administrator cares enough to hire more help. The tech with the attitude maybe actually be related to him/her, or just good ole buddies.

[OttawaRPN]

Wow, it sounds like the PCA runs the show here. Why, I have no idea. But what a waste of your skills and professionalism, they certainly don't need a well-trained nurse carting patients all over the place. Waste of resource and money. I would approach management with your concerns exactly as you described in your OP, and ask them why they're paying a nurse's salary for a porter's job? Emphasize the cost factor, usually money talks.

[OttawaRPN]

Please forgive my ignorance: PCA? That's the accepted abbreviation in our institution for Patient Contolled Analgesic. Perhaps Patient Care Advocate? Licensed or not?

PCA = patient care assistant. We don't use that term much either. Orderly or HCA (health care aid) or PSW (personal support worker) interchangeably. Unlicensed.