Dont want my license to cover a certain PCT

Butterfliesnroses · Nov 1, 2009

I know as an aide in a nursing home, I do chart charge nurse notified...but I do notify the charge nurse if I chart it. Mainly it's something to cover MY butt. Such as a resident vomits, I'm going to chart resident vomited x2. Charge nurse notified...that is basically so if they could get a med or whatever, they can't read my charting and assume that I didn't tell the nurse, if the nurse didn't give meds. But I can see how YOU would be frustrated if you weren't notified...Sometimes I wish I didn't have to work under certain nurses, but I can't refuse them. It may be different though for you if your license is in jeporady if she screws up.

Lacie, BSN, RN · Nov 1, 2009

One of the very reasons I recently left working dialysis for good. Too many gray areas at the cost of my license. Most PCT's dont get this as they dont have a license to lose, we do. When I would question certain things like pcts pushing heparin (cant do in my state) or not notifying me when giving saline or pt hypotensive I was told "This is the way we've always done it". I found they tend to back the techs most of the time usually because they have been doing it for so long. Many FA's forget what it's like to be on the floor. And many FA's arent RN's either. In fact I'm reviewing a case now for an attorney where a PCT messed up and the RN is going to be the one to probably take the fall. What happens when people prechart checks to save time rather than actually do the work. Her initials are on the chart that she double checked the pcts work. I have no doubt it wasnt done due to "trust". Shame.

Long Term Care Columnist / Guide · Nov 1, 2009

For the record: PCTs, CNAs etc. do not work under a nurse's license, they practice under their own certifications and are responsible to their state's Board of Nursing, just as we are.:)

That said, I don't blame the OP for not wanting to work with the tech in question. The nurse IS responsible for overseeing the tech's work as well as the care of the patient, and when the tech doesn't do his/her job, any bad outcome is apt to fall on the nurse's shoulders. If management is not responsive to requests to remove the tech or at least for the OP not to work with her, then I'd be looking for another job, pronto.

tewdles, RN · Nov 1, 2009

PCTs may not practice under a nurse's license, however, if the nurse is charged with supervising that tech then the actions of that tech do reflect upon the nurse should there be some legal question. Given that this PCT apparently falsifies records by charting that the RN is informed when she is IN FACT NOT INFORMED is a serious legal issue which cannot be ignored by either the RN or the management. IMHO if management is not willing to support the RN with performance improvement strategies with this PCT then the RN should seek other employment.

Woodenpug, BSN · Nov 1, 2009

A long time ago, I worked with someone, who was, IMHO, not safe to care for my patients. I refused and was granted the same pt. load, without any assistance. I was fine with this, it was safer than the alternative. I still found employment elsewhere. That person eventually was fired. I know your frustrations, because management would not hear anything I had to say.

The moral of the story is: You will probably lose out, but someone has to be the first.

BabyLady, BSN, RN · Nov 2, 2009

Tech's don't work under your license.

Tech's work under the hospital.

You, as a nurse, are responsible for verifying anything the tech does...that isn't the same thing.

NurseKitten, MSN, RN · Nov 2, 2009

Many of the posters here don't have a clue as to the situation you're posting about. I do - I lived it for 13 years.

Stand your ground. By referring to "FA's", I'm going to assume you work for either Fresenius or DaVita. Document, document, document, who you spoke with, don't be afraid to take it to the regional director and higher if need be.

In an outpatient dialysis clinic, those techs DO work under your license, in most states. If she's charting you were notified, then your butt is hanging in the breeze.

The PCT's who have been doing this for years may THINK they know more than the licensed nurses, and some do, but if they want the money they're so resentful of us making, then they need to take their butts back to school and QUIT WHINING ABOUT IT!

It is the licensed nurse's decision, and if the facility administration won't stand behind you, then run as fast as you can.

How's your relationship with the medical director? When I was having an issue with a PCT in my last clinic before I quit, the medical director got wind of some of her shenanigans ('cause I went by his office on my day off and we had a chat) and she was gone within a week. But he and I had that kind of a good working relationship, and he wasn't afraid to stand up to clinic management.

That might be a way for you to go.

Good luck. Been there, done that, the t-shirt has holes in it from being worn so much.

Trauma Columnist · Nov 2, 2009

Dialysis is a little different. I'm gathering we are talking chronic hemodialysis. The techs are specialized unlicensed assistive personnel and though they don't work UNDER the RN license, the RN is eventually responsible. My take on this and advice (only if you want to play hardball that is) is:

1. Write down times, dates, instances.

2. Discuss your concerns with the facility administrator (FA) which is hopefully a nurse.

3. Put your concerns in writing - stress how this person's lack of professionalism and expertise negatively impact patient care and how you are concerned about the liability aspect.

Now...that said, I would also consider moving to another clinic if you want to stay in dialysis or moving on.

I wish you the best!

Lacie, BSN, RN · Nov 2, 2009

For the record: PCTs, CNAs etc. do not work under a nurse's license, they practice under their own certifications and are responsible to their state's Board of Nursing, just as we are.:)
That said, I don't blame the OP for not wanting to work with the tech in question. The nurse IS responsible for overseeing the tech's work as well as the care of the patient, and when the tech doesn't do his/her job, any bad outcome is apt to fall on the nurse's shoulders. If management is not responsive to requests to remove the tech or at least for the OP not to work with her, then I'd be looking for another job, pronto.

Depends on your state. Florida PCT's are not required to be certified and many dont even have a GED or high school diploma. I have never worked with a PCT who was certified. That being said I am glad CMS guidlelines is finally making this a requirement. The facility I recently left all the pct's took the test in July and not one of them passed. They are hoping to retake in December. It will be interesting to see the staffing situation if the fail rate is same as the proceeding testing. The facility has done nothing to help the pcts to prepare for the exam except take thier money. I have seen RN's suspended over techs actions for not ensuring they followed through to ensure the tech did thier job or for allowing them to overstep thier bounds in area of practice. It may not go to BON but it can cost you your job depending on the facility.

Onekidneynurse · Nov 5, 2009

Tech's don't work under your license.
Tech's work under the hospital.
You, as a nurse, are responsible for verifying anything the tech does...that isn't the same thing.

I believe the OP works in an outpatient chronic unit, not a hospital. In some states, NM, AZ tech's have to be certified now. They can lose their certification. And they need to be reminded of that fact. I believe many of them would not want to lose their jobs.

Trauma Columnist · Nov 5, 2009

In IL also - the dialysis techs have to be certified.