How would you handle this?

[MedFlightDreams]

I'm a traveler and am a little out of my element dealing with a situation like this since it's not my own home ER where I'm comfortable. There is a tech in my ER who has been there for 20 years. He is a bit too comfortable in his role and it's getting on my nerves, but he's the type who you have to watch your back with so I have been hesitant to deal with this period...however, the other night he ordered a urine for my patient under my name without asking, then sent it and after getting the result told the patient they may have a UTI. He also advised the doctor of the results in front of the patient before going to me. I have also caught this tech looking up results on other patients who aren't mine under my login and now I have been logging out every time I turn around. He was even doing it when I was right there. I have also seen other things like him advising a nurse on where a patient's STEMI was when medication was dependent on it, but I wasn't involved and wasn't interested in getting involved. This tech wants to do everything BUT tech things, and I respect the longevity but I have no relationship and it's my ass and license. Do I pull the tech aside or do I go to the manager? Either way I'm setting myself up for a long assignment of backstabbing and being under a microscope, but I HAVE to say something because I'm not a pushover and I won't be treated as one by someone working under my license.

[Anna Flaxis, BSN, RN]

I could be wrong, but the tech isn't working under your license. He is working under the Medical Director's license, just like you are.

How is he getting access to your logon? If you're leaving yourself logged in, then you're asking for it. Make sure to log out of every work station every single time.

If he has been there for 20 years and this is how he rolls, and you are just a traveler, you really don't have much to gain by rocking the boat. You really just have to watch your back. I would just be really friendly toward him and try to get to know him and establish a rapport, while watching my back at the same time.

[RN_rescue_ninja]

Everyone is working under their own license. No one works "under" someone else's license. Now, you could get into trouble with your license if something bad happened to the pt because you are the one supposed to be delegating tasks and what not, technically...I am a new nurse, but I'd think this is something to take up with the director. Say something to the tech along the lines of...you know...you can really get into trouble by putting in orders. I'd hate to see you get in trouble over that. See where that gets you to start.

[morte, LPN, LVN]

I am thinking the guy would take that as a threat. perhaps the direct tack would work better? "don't order things under my name" I appreciate that you were trying to save time, but I need to do those things myself, unless I have directly asked you to do so.

Everyone is working under their own license. No one works "under" someone else's license. Now, you could get into trouble with your license if something bad happened to the pt because you are the one supposed to be delegating tasks and what not, technically...I am a new nurse, but I'd think this is something to take up with the director. Say something to the tech along the lines of...you know...you can really get into trouble by putting in orders. I'd hate to see you get in trouble over that. See where that gets you to start.

[MedFlightDreams]

As far as working under licenses, a nursing assistant/ER tech is considered a UAP, and you are responsible for what you delegate to them.

[Kalipso]

The simple answer here is to make sure you log off your computer. If you were staying long term then I would say bring it up. But I will also be the first to tell you that I have met a couple of techs like this that actually know more about what to do in and ER than the nurse does, so don't burn your bridge with him. The bigger problem is you don't know him so you don't trust him. I think saying something about "I need to do these things myself unless I directly ask you to do so." Sounds snobby and like you don't care what his input is...which is bad because obviously this guy is a trusted member of their team if he feels comfortable doing such a thing. I would just say something along the lines of "Hey, you do a great job and I can see that people here really value your input because you have been here so long, but I'm a traveling nurse. As a traveling nurse I don't get to know the staff as intimately as the regular staff does, thus I often don't feel comfortable letting others use my computer when I'm logged in to it. It creates a potential legal issue for me because I don't know the regular staff well and I would not be able to stand by my carting 100% if others were using my log in to place orders or chart." I know it is long winded, but I think it takes all the possible finger pointing and problems and places the blame on you instead of trying to tell the tech what his place should be. I agree with you that it would be irritating to me also if someone I barely knew was using my log in without my permission. If after you have this conversation he doesn't stop then I would go to the manager but stick with the story above. 'He's a great team member and I can see that he is valued here, but as I don't get to know people as intimately because I'm not a regular I am really uncomfortable that he doesn't log me out when he needs to use a computer I was on. And I certainly don't feel comfortable with him placing orders under my log in. While I understand that I need to be better about logging of my computer, I still need this issue addressed with him.'

[Anna Flaxis, BSN, RN]

As far as working under licenses, a nursing assistant/ER tech is considered a UAP, and you are responsible for what you delegate to them.

Being responsible for supervision and delegation isn't the same as the person working "under your license". They have their own certification or license that they are working under. In the ER, standing orders/protocols are typically written by the medical director for that ER. If the tech is following protocols that are within his scope, I'm not sure how he is practicing under your license. Also, the physician can delegate tasks to the tech without even your involvement. The physician can direct the tech to place a splint or irrigate a wound, for instance, without your involvement. The bigger issue here isn't how this tech is practicing- clearly he's been around for a long time and it's been allowed and one traveler coming through who isn't comfortable with it isn't going to change it, and if you take a stand you're just going to make your assignment there really uncomfortable.

I think it is an issue to have someone using your logon. That is not okay- the tech should be using his own logon, and using yours to place orders or view things that he might not normally have access to view is not okay. You can either confront him, go to your manager, or make it a practice to never turn your back or walk away from a workstation that you are logged onto.

Personally, I would opt for the latter, and try to find a way to get to know this tech a little better and make him my ally instead of making an enemy of him. He sounds like someone that could be really helpful to have on your side when the poop is hitting the fan.

[imanedrn]

I just started traveling, and this is one of the reasons I love it: I don't have to stay around for the BS. The above suggestions about tactfully talking to this tech are great (and I wish I could take them to heart, as I tend to be less tactful and rock the boat more often than I'd like). If that fails, always escalate (by email initially), if for no other reason than you have documentation to back your case.

[NurseOnAMotorcycle, ASN, RN]

I'm not a traveler but had the same problem with a tech when I first started in the E.R. Just let them know that you really like how they are proactive but don't want them to order stuff under your login. I agree that you are right to log out when you step away. They sure as hell shouldn't be doing that anyway!

Leave it alone... it will only go badly for you.

You've been around the block a time or two... surely you know this.

For certain, CYA... and don't leave yourself logged in.

That said, if you directly catch him indisputably entering anything in the EMR under your login, confront him right then and there, tactfully and respectfully, but don't let that slide.

Still, he's the old dog and you're the young pup (at least in that department) and you're not likely to come out of any 'fight' without a number of scars.

[icuRNmaggie, BSN, RN]

I would privately say that in every hospital that I have been to it is grounds for termination to use someone else's log in.

It makes me very uncomfortable. etc. I would really appreciate if you use your own log in in the future okay thanks.

If he accidentally orders an EEG instead of an EKG that is going to be traced back to you not him.

Frankly I think he has no boundaries and he is up to no good especially if he is looking up other pts. under your log in.

Techs may have more limited access to the EMR and CPOE so he may be using you to circumvent policy.

Change your password immediately.

[icuRNmaggie, BSN, RN]

OR - I might tell the tech I need more practice with the system, so I'll enter my own orders for now, but thanks for offering to help me out.

You became a traveler to avoid drama, this is how I would probably handle it.

Don't make a big fuss, just quietly establish some boundaries.