Has Anyone Worked A Strike?

Nurses General Nursing

Published

Just wondering what it is like. Anybody have anything to say about the specific companies?

paramedics have been starting IVs for years...are PCT 3s a threat?

Sean, RN

Specializes in Oncology/Haemetology/HIV.

Appropriately performed nursing research, etc. has demonstrated clear dangers of understaffing of RNs to good pt outcomes. Therefore, unless management can convince the public (death d/t understaffing is a preferable outcome) otherwise by citing adequately performed research, then most of the public would agree that appropriate licensed staffing ratios are "right". And that there have been numerous studies done on increases in errors related to number of hours worked (I believe the hours that were noted as optimal was no more than 10 1/2).

As far as PCT 3 being a threat, well I reiterate (as in the PCT thread) that quality facilities owe it to patients to have adequate numbers of licensed personnel to perform invasive procedures. And if they choose not to, then nurses have a choice to make - stay or leave - I personally would vote with my feet.

But, hey, if you want to risk your license...well that's your decision.

And soldiers start IVs in the battlefield - it doesn't mean that every retired soldier should be starting the IVs that I give chemo through.

I would disagree that my license covers them...They are certified, and thus fall under their own certification, and fall alone in that respect of liability (though the HOSPITAL might be partially liable, but NOT the RN)...

I'm not sure what your "soldier" blast means...My only point is that medics/firefighters start them (75% of blood given in traumas are given through IVs that a prehospital medic started, then changed w/in 24 hours), and it seems possible that an appropriately trained person could help us...Let's be real, IV starts aren't much "taught" in school, just on the job training...So how many IV starts should a newly licensed person have to perform (in practice, just not on me right?) before other RNs don't become outraged?

I would kill to have someone else (other than the RN, because he/she is likely swamped) start my IV. while I am preparing chemo.

sean

Specializes in Oncology/Haemetology/HIV.

PCT' s are not always CNAs - sometimes only have in hospital training.

When you go to court - you will find out that certification means little - what matters is that you "delegated" this procedure to an unlicensed individual. The questions usually include "Did you adequately assess this individual's skills prior to delegating this procedure?"

Certification is not a license, and frequently the RN is held responsible for the CNA's acts.

so a medic's certification is useless?

if I as a medic attempt an intubation, and am unsuccessful, who then would you have be responsible?

the prehospital coordinator (usually an RN), or the MD who is the prehospital medical director...

in Arizona, a PCT, MA, CNA, etc., ALL (skills) fall under the MD's license...as these people arent ASSESSING patients...

No RN liability...as a matter of fact, in my experience, the hospitals have been quite clear on this fact...

I suppose it may be different in your respective states, but please do us a favor and check...

Specializes in Oncology/Haemetology/HIV.

No slam was directed at soldiers, but a point being made that what happens outside of the hospital setting is significantly different than what happens inside the hospital setting. And that a skill may be learned by an unlicensed person, might not necessarily be appropriate for them to practice in a quality hospital setting.

As this thread is about strikes at facilities/hospitals, I presume that these skills are being practiced within said facilities.

And as there is generally no MDs on most hospital units and they are not responsible for hiring, training or assessing the skills of staff in most hospitals (that is a nursing job) - it would be rather difficult for them to be thusly responsible in the general hospital setting. This also does not reflect what I have personally witnessed in hearings before the Nursing board.

However, I only have licenses in 5 states - and have only attended court proceedings in two of them - and have only been an RN for 10 years - so I am giving you the benefit of my oh so meager experience. And , oh yes, I am well aware of my responsibility in holding those licenses.

And, yes, in my nursing school, IV skills were taught quite thoroughly, and practiced, in Florida - I do not know about yours. But just as you can train anyone to do about anything does not mean that they should be doing that skill.

I repeat that quality hospitals should staff adequate licensed personnel to perform invasive procedures - and if such staffing is inadequate - staff have a duty to take action to correct the situation and not accept substandard care. While I do not strike (as a Southern girl it does not appeal to me), I do vote with my feet and my hands - refusing to work at those facilities that staff poorly and accept a lower standard of care. And I do not cross picket lines.

PS . If you want an unlicensed caregiver to start an IV and give you chemo...well, that's your choice. But when you show up in my hospital with an extravasation, or liver/cardiac damage, or life-threatening mucositis and dehydration, or neurologic damage because the proper teaching, followup and assessments were not done, well we'll take care of you right nicely.

Carolina in the South

Originally posted by RNonsense

We don't use outside agencies here...it's our own union people (who have set out acceptable essential service levels months prior to a strike along with management) who take the turns on the pickets..then inside as staff nurses.

Hogan, your original question of "Whocare for the pts when the nurses strike?"

Was answered by RNonsense above.

Hogan,

Have you read this study about how RN staffing levels directly affect pt outcomes and rates of death?

http://www.hsph.harvard.edu/press/releases/press05292002.html

ms belle, i NEVER said unlicensed personnel would GIVE th chemo, only start the IV...

and have you not heard of a PA practicing "under" an MD's license w/o the MD being there (rural communities)

I never questioned your experience, only offering a different (seemingly in AZ) point of view...

we have many MAs/CNAs practicing under an MD's license, and the MD isn't in the office...

sean

Originally posted by Hellllllo Nurse

Hogan, your original question of "Whocare for the pts when the nurses strike?"

Was answered by RNonsense above.

Hellllo,

That's the first intelligent response to the posed question...it took about a week too:p

though that's the ONLY question I really ever initially asked, and then everyone wants to pile on w/ "intelligent" self-fulfilling logic like "we're right because admin is wrong, and...uhhh...we're right!"

Originally posted by caroladybelle

PCT' s are not always CNAs - sometimes only have in hospital training.

When you go to court - you will find out that certification means little - what matters is that you "delegated" this procedure to an unlicensed individual. The questions usually include "Did you adequately assess this individual's skills prior to delegating this procedure?"

Certification is not a license, and frequently the RN is held responsible for the CNA's acts.

caroladybelle,

FYI, a response from 3rdshiftguy on a current PCT thread:

"If you improperly insert a line and cause damage to a patient, who takes the liabilty for the actions of the PCT (CNA 1,2,3, whatever) "

If I deligate an IV start to a PCT, and that PCT causes damage to the patient. I'm NOT liable for the damage that PCT caused...IF that PCT has the proper certifications and is acting within hospital guidelines.

Same as if I cause damage to a patient for whatever reason my manager is not responsible for my harming a patient, as long as my assignments and ordered duties were within my scope of practice.

Does that make sense? If you deligate a task, as long as that person is qualified to perform that task (and usually hospitals keep those on record, i.e. the PCTs have three documented IV starts undersupervision before they can start one on their own), then you are not liable for any harm they cause.

__________________

This illustrates my point...if some entity certifies a PCT3 to start an IV,the hospital hires said PCT, he starts IV and the patient gets phlebitis, THE RN BEARS NO RESPONSIBILITY! It's a common misconception that you have, and shared by many RNs.

If you ask housekeeping to empty a specific trashcan, and he/she gets stuck w/ a needle, are you now responsible, as you delegated the task?

Seriously though,in your defense, it seems to differ from state to state:)

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