Fired for following orders

Mr. Murse · Mar 12, 2015

i understand the logic as to why this task is beyond the scope of practice, however, my former employer never once provided me a copy of a job description. We routinely are expected to perform tasks for which we never formerly were evaluated on our level of preparedness (foley insertion, dressing changes, etc). Based on the fact that the patient was A and O and able to follow instructions well, I was confident that the procedure would go smoothly, which it did. Nonetheless, I checked with the supervisor. What more could I have done? I checked with someone in authority. And, I remind you, in our state, legally, the RN who delegates is to be held accountable, not the unlicensed person. To answer other questions, this was reported to management by a nurse who was working on a different part of the floor. Never had a problem with him, he is just one of those people that loves to tattle. He has gotten many people in trouble. Sadly, he is a good nurse, he just likes to create drama for others. Neither the supervisor, nor the RN I was working for, had an issue with my work. They were as surprised as I was that it was being taken up by management.

Wow.......PCTs in Ohio do dressing changes and insert foleys? you may want to check on the foley thing too......if they had an issue with an NG insertion, I don't know why they would be okay with you putting in a foley. I'm even surprised about them allowing you guys to do dressing changes, even though they're not as invasive, it's still an RN task.

Is this kind of stuff expected of PCTs statewide or just your facility?

xsnurse · Mar 12, 2015

I work in Florida and PCT insert foley on all floors. Not NG tubes though. One PCT told me in her last job she could do more like draw blood and I forget what else.

LynM75 · Mar 12, 2015

In MA where I worked as a PCT, we had classes on phlebotomy and ekg's but we never touched IV's or NGT. Again it was in policy and procedure manual.

Mr. Murse · Mar 12, 2015

I work in Florida and PCT insert foley on all floors. Not NG tubes though. One PCT told me in her last job she could do more like draw blood and I forget what else.

That's interesting. Our PCTs can remove foleys but that's about it. They can't even take out IVs any more, although they used to be allowed.

I've had so many problematic foley insertions, I'm kind of surprised it's allowed. Not to question the competence of PCTs, it's just a lot of potential health and legal issues that I would think employers would want our licensure to be backing up.

dudette10, MSN, RN · Mar 12, 2015

It all comes down to knowing what you are and are not allowed to do in your facility and, in some cases, on a particular unit in a facility. In my old facility, RNs dropped NGs routinely, removed PICCs routinely, etc. At my current facility (which is in the same health system), I would get written up for dropping an NG, although the NG policy does not state that an RN CAN'T do it. On one particular floor in my facility, the nurses remove PICCs routinely, but it isn't allowed on any other floor. (When I float there, I refuse to do it, and I ask one of the unit staff nurses to do it. Thankfully, they are cool with it.)

The inconsistencies with what an RN is allowed or not allowed to do is, in my opinion, problematic. I'm quite sure my facility is not the only one that deals with such inconsistencies. However, the lesson is to know what is generally acceptable, even if by policy the task is allowed.

I was almost written up for not doing something in a specified time frame. I understood the timeframe one way because I actually read the policy, but all the nurses (including management) had become accustomed to a different timeframe all together. I defended myself with policy in hand, and I didn't get written up. If I had just done what was generally acceptable rather than actually reviewing the policy, all that stress and brouhaha over the event would never have happened.

us2uk4u · Mar 12, 2015

I have learned that if I'm not 100% sure that it is within my scope of practice I don't do the task. If 10 people say I can do it but I'm still not sure, I don't do it. Not sure what state you are from but in my state a nursing student may insert an NG tube in the PRESENCE of an RN.

Nursynursenurse, ADN, RN · Mar 13, 2015

Not sure what state you are from but in my state a nursing student may insert an NG tube in the PRESENCE of an RN.

That applies only to the nursing student during clinical hours. It doesnt matter if the nursing student is also a tech at the same hospital. When you are on the clock as a tech, you practice within that scope. The nursing school's insurance wont cover you if something goes wrong with your tech job and vise versa.

Home Health Columnist / Guide · Mar 13, 2015

In the good ole days, one of our introductory classes on Professional Nursing we were provided a copy of BON regulations and major aspects reviewed in class.

I highly recommend to first year nursing students to visit their states Boards of Nursing website and review LPN and RN "rules and regulations". BON link found bottom every allnurses page in black toolbar.

Link to: Ohio Board of Nursing

Chapter 4723-4 Standards of Practice Relative to Registered Nurse or Licensed Practical Nurse

Especially see Ohio's Chapter 4723-13 Delegation of Nursing Tasks

4723-13-05 Criteria and standards for a licensed nurse delegating to an unlicensed person.
(A) A registered nurse may delegate a nursing task to an unlicensed person if all the conditions for delegation set forth in this chapter are met.
(B) A licensed practical nurse may delegate to an unlicensed person only at the direction of the registered nurse and if all the conditions for delegation set forth in this chapter are met.
© Except as otherwise authorized by law or this chapter, a licensed nurse may delegate to an unlicensed person the administration of only the following medications:
(1) Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier; and
(2) Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas.
(D) Prior to delegating a nursing task to an unlicensed person, the delegating nurse shall determine each of the following:
(1) That the nursing task is within the scope of practice of the delegating nurse as set forth in section 4723.01 of the Revised Code.
(2) That the nursing task is within the knowledge, skill, and ability of the nurse delegating the nursing task;
(3) That the nursing task is within the training, ability, and skill of the unlicensed person who will be performing the delegated nursing task;
(4) That appropriate resources and support are available for the performance of the task and management of the outcome; and
(5) That adequate and appropriate supervision by a licensed nurse of the performance of the nursing task is available in accordance with rule 4732-13-07 of the Administrative Code.
(6) That:
(a)
The nursing task requires no judgment based on nursing knowledge and expertise on the part of the unlicensed person performing the task;

(b) The results of the nursing task are reasonably predictable;
© The nursing task can be safely performed according to exact, unchanging directions, with no need to alter the standard procedures for performing the task;
(d)
The performance of the nursing task does not require that complex observations or critical decisions be made with respect to the nursing task;

(e) The nursing task does not require repeated performance of nursing assessments; and
(f)
The consequences of performing the nursing task improperly are minimal and not life-threatening.
(E) Prior to delegating a nursing task, the delegating nurse shall:
(1) Identify:
(a) The individual on whom the nursing task may be performed; and
(b) A specific time frame during which the delegated nursing task may be performed.
(2) Complete an evaluation of the conditions that relate to the delegation of the nursing task to be performed, including:
(a) An evaluation of the individual who needs nursing care;
(b) The types of nursing care the individual requires;
© The complexity and frequency of the nursing care needed;
(d) The stability of the individual who needs nursing care; and
(e) A review of the evaluations performed by other licensed health care professionals.
(F) The delegating nurse shall be accountable for the decision to delegate nursing tasks to an unlicensed person.
(G) If a licensed nurse determines that an unlicensed person is not correctly performing a delegated nursing task, the licensed nurse shall immediately intervene.

Both the nursing supervisor and RN were wrong in directing you to perform this task.

ALL employees should be given copy of their job description. Our health system has the employees sign off that they received and reviewed their job description as part of hiring process and included with job offer.

All three parties involved: Supervisor, RN and yourself should have been counseled over this situation. Firing--depends on your job performance, patient outcome and event report. Be aware one can ALWAYS write a rebuttal to any disciplinary event addressed to HR to be kept in your personnel file ---- so that future HR staff could review event, especially if reference requested.

Let this be a lesson to AN members: Nursing students working as PCT should only perform tasks within PCT role unless they are hired as NURSE EXTERN. Sorry your employeer came down hard on you. May this firing lead you to be a stronger nurse and hopefully protective of nursing students you work with in the future.

Wishing you better days ahead and smooth sailing in the remainder of your nursing program.

funtimes · Mar 13, 2015

Techs should not be passing ANY kinds of meds, IV or otherwise. Period.

Suppositories and enemas might be considered meds, and techs do those all the time. Oxygen is a med, heck, a saline flush might be considered a med. Athough I get your point.

I think the problem here is that techs are not certified or licensed, so their scope is vague, they have no respect and no clout, and are totally at the mercy of RNs who look after their own first, hence this tech got fired and the RNs are in the clear.

Personally I don't think anyone should be allowed to work as a tech unless they are at the very least a CNA. Nursing students should not be employed as techs unless they are a CNA(and for that matter I think CNA should be a prerequisite to RN school, which it is for SOME schools).

This is exhibit A in why nursing students often are problematic as "techs". They are too damn eager to please, too worried about making a good impression so they can get hired as an RN, and eager to gain experience, ANY experience, and are willing to work for peanuts to gain it, knowing the job is just temporary. Instead of patient care being the focus, a head start on ladder climbing and networking is. It totally screws over the other techs and ensures patients have a steady supply of people with no experience taking care of them instead of techs who know what their doing.

LPNs were run out of hospitals because they weren't eager to please students, and this is what the result is.

shmedium · Mar 13, 2015

Saying "I only did it because my boss (the RN) told me to" is not a valid "excuse".
You KNEW that you had no business performing this procedure, the fact that everyone thought it would go well and it did is meaningless.
Would you run a red light because your friend riding shotgun told you to? Just because someone told you to do it, doesn't mean you should

Based on the way this hospital is, no, I did not know I had no business doing this.

Angeljho, MSN, NP · Mar 17, 2015

I was recently fired from my job as a PCT. A nurse asked me if I could perform a particular task. I told her I wasn't sure, I called the supervisor and asked if I am permitted to do this. She asked if I had been taught it in nursing school. I indicated that I was. She said that the nurse can, then, delegate that task to me. I did it and was fired about a month after. This occurred in the state of Ohio, where the law is clear that the RN is responsible for accurate delegation and is to be who is held accountable for improper delegation. The task was inserting an NG tube. The procedure went smoothly and no harm was done. I have never been written up before, never even been late. The RN I was working for and the supervisor both said to do it. I rely on their knowledge to know how to do my job. I feel like I am a patsy.

The RN should have been fired too. You both were accountable.