Dont want my license to cover a certain PCT

[singleprego]

I will be going to my FA this Wed and telling her that I am not willing to have a particular PCT working under my license. I am not sure how it is going to go, but I am going to stand my ground. This tech has some mental issues, like passive aggressive and others. She knows how to be a tech, but she thinks she is the nurse and argues with my decisions. I listen to her opinion but my decision is final. The final straw for me, and this has happened in the past with her, is that on the vitals line she charts something like "bp low, saline given, RN notified". SHE DOESNT NOTIFY ME- EVER!! I have a problem with her charting that I was notified. It makes me liable for a situation I am unfamiliar with! She also goes behind me and changes my settings after I specifically gave directions. Other pcts say she changes their stuff too!

HAS ANYONE REFUSED TO HAVE A TECH WORK UNDER YOUR LICENSE?

[Management sucks and frankly, this is the most stressful job I have ever had. My clinic is SO busy. Of my 14 hr day I can sit when i potty or take a break. I am always on high alert for an emergency, play waitress often, handle situations techs can handle and do my and their jobs. It confuses me how a tech cannot run two pts off at the same time- but I can. (we have phoenix machines that stop the rinse back automatically).... Repeat every 4 hrs. ]

[Onekidneynurse]

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

As a traveler I used to have a list of the states. Where it might be is a mystery. But come April, I believe, they will have to be certified in every state. Thanks to CMS. FMC is tutoring their PCT's heavily.

[DeLana_RN, BSN, RN]

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.

The scenario Lacie describes is really the only one where you would be held liable for the PCT's failure to follow P&P - i.e., you did not do something that you signed for, or allowed the PCT to do something they are not legally able to do (I'm in the same state as Lacie and also disapprove of the common practice of letting PCTs give heparin; once, an RN I used to respect told me that in a clinic she used to work at the nurses "trusted" a certain PCT to give all tx meds to the pts - oral and IV, even EPO! Later I found out that the same PCT was functionally illiterate and the clinic had covered up for that as well

Anyway, my understanding is that if you don't allow your PCTs do do things that are illegal or that they have not been properly trained to do (or proved themselves competent to do) - then your license would not be in jeopardy if they do it anyway (unless you know about it ignore it). For instance, if the PCTs give NS for hypotension, know that they should notify you but fail to do so, then they should be disciplined or fired - but you cannot be held responsible for something that you were not told about (hmm... does the nurse have to be in ten places at once, assuming you have 10 pts on the machine?!) If that's the case, there really shouldn't be dialysis techs who are legally able to do some things in my state that are truly frightening (e.g, access central lines/perm caths!)

HTH,

DeLana

[corky1272RN]

Have you thought of writing her up? especially for the falsification of legal documents? With that being said, if upper management doesn't support you then you should decide if it is worth the job. There were a few PCTs that I had to watch "extra" just so no pts died (not really an exageration). I totally understand your predicament.