Since I am new and have no idea regarding Dialysis, I have many questions.
So here are a few regarding PCT's and me as the soon to be LVN that will be liable. I am very nervous about my license being at stake and I am not sure what is normal and what is not.
In your Facility what do your PCT's do?
Are they accessing everything but Catheters?
Are they drawing up the Heparin, Lidocaine and Saline then labeling it? If so how are we supposed to know that what they drew up is really what they say it is?
The PCT's in ours set up the packs, meening they draw up the Heparin and label it. Then they put it in the packs for the Catheter pt's. so the packs are ready even before they pt. gets there. It makes things flow nicely, yes, but I am just wondering how we are guaranteed that this is what the label actually says it is. They also draw up lidocaine if pt's need it. My concern is, the lidocaine sits next to the Heparin and in the 4 days I worked this week. I found the lidocaine in the Heparin box twice. I also say several predrawn Heparins that weren't the amount the needed to be, say like the pt was supposed to have 8000 Units, the tech would pull back to where they thought 8ML's were and that was it, but when I would look at it, it would actually be under or over by as much as 1ML. So being the nice, sweet person that I am, I wouldn't say anything, but fix what they did wrong.
Since I dont' start theory part of the orientation till next week, but have been drilled to death in school about exact amounts, I am thinking that if the Dr. ordered. 8000 units, shouldn't it be exact rather then almost?
And my other thought is, when it is me that is responsible for the heparin on the catheters, shouldn't something be said about, unless you are giving it, don't draw it up?
Oh, one other thing, Say the RN in Charge does an access, because it is a tricky one, shouldn't that Nurse be responsible for documenting the Bruit and accessment rather then the PCT. I was told yesterday by the PCT, "here, go ahead and check that the Bruit was good, and his resp's were OK." I said, "I didn't feel the Bruit, I watched the Nurses technigue, I didn't touch that pt." She said back to me, "That is OK, we always do this section of the sheets." I gave the pen to her and said, here show me what you mark. And left it at that.
It makes me nervous about these kind of practices, I don't want to step on toes, but feel this is my license I need to protect. Am I being overprotective?
I would just like to add one more thing....I noticed in some of the posts on this thread that people said "in our state, it is allowed under law that PCT's can draw up heparin, lidocaine, etc." Just because the law says PCT's can do it, doesn't mean they SHOULD do it. How irresponsible would that look if you are in court and you say "Um, I was just giving what my PCT drew up" Come on people....you earned the right to draw up and give your own meds. Just think about it....
AngelNurse25
not to be rude, but you don't work in a chronic unit do ya? I do not give any meds that other people have drawn up-- but our techs do draw up heparin and lido and legally give and sign for it. I would not have a problem in a court of law or in front of my state's nursing board, thats why I stated that one should read policy. nurses are not the only people who can give meds(emts, medical assistants, cmas,....), as a registered nurse they pay me for my nursing assessment, no one else may assess a pt, only a registered nurse. there are many "skills" that an unlicensed staff can perform, including administering the above meds in a chronic hemo clinic. What a sad day for all nurses if we do not remember our primary job---to assess our pts, develop a plan of care, and utilize our critical thinking skills---I do not put my license on the line when a tech gives 0.4mls of lidocaine SQ. Nor do I compromise my license when a tech puts a pt on and sets the hep bolus/infusion/stop time. I would have a legal /ethical problem if I failed to assess my pt. Back to the question, I still say read the policy, read the policy, read the policy!
Hi there guys. I'm an advanced practice RN who has been in dialysis since July - not long at all. I don't actually do the dialysis, I'm employed by the MD practice and I do the medical management of the pts. However, the giving of heparin by the pts concerns me. In the hospital where I came from (level one trauma center), heparin was considered a "high risk" med and in order to give it IVP, we had to have a witness when we drew it up in order to double-check.
Its concerning to me to watch some of these things.
not to be rude, but you don't work in a chronic unit do ya? I do not give any meds that other people have drawn up-- but our techs do draw up heparin and lido and legally give and sign for it. I would not have a problem in a court of law or in front of my state's nursing board, thats why I stated that one should read policy. nurses are not the only people who can give meds(emts, medical assistants, cmas,....), as a registered nurse they pay me for my nursing assessment, no one else may assess a pt, only a registered nurse. there are many "skills" that an unlicensed staff can perform, including administering the above meds in a chronic hemo clinic. What a sad day for all nurses if we do not remember our primary job---to assess our pts, develop a plan of care, and utilize our critical thinking skills---I do not put my license on the line when a tech gives 0.4mls of lidocaine SQ. Nor do I compromise my license when a tech puts a pt on and sets the hep bolus/infusion/stop time. I would have a legal /ethical problem if I failed to assess my pt. Back to the question, I still say read the policy, read the policy, read the policy!
I work on a Renal/Diabetes unit where most of the patients are on hemodialysis...
i work on a renal/diabetes unit where most of the patients are on hemodialysis...
hemo pts are as diverse as they come, just as nursing is. many of my pts have cardiac issues, drug addictions,the histories encompass a broad range of health issues--i do not presume to be a cardiac nurse because one of my pts has a cardiac history, nor do i have specialized knowledge regarding chemo because a pt is currently receiving chemo-therapy. i do not work in these highly specialized areas, so i don't know the many different laws that govern them. you do not work in a hemo clinic. i didn't mean for you to get defensive dear angelnurse, just making a point of how we all need to follow policy, and if we think in any way, that policy is putting us at risk of losing our license, then we need to address this issue. taking care of a pt who gets dialysis vastly differs from initiating a dialysis treatment. tdn
Tired Dialysis Nurse is right. PCT's administering Heparin, Lidocaine, Saline bolus, setting UF goals ect. is the INDUSTRY standard. An unlicensened PCT in a chronic or acute dialysis unit has a broader scope of practice then a LPN in a hospital. It is not only the standard of practice for the industry it is within the scope of practice that is the law. I don't have to like it but I do have to abide by it. Personally I was horrified when the different dialysis companies in this state successfully petitioned the state board of nursing to allow PCT's to access and cap off central lines. An LPN working in the hospital can't access even a dialysis catheter but the PCT in the inpatient dialysis unit can. As I said I don't have to like it but I do have to follow company policy and state regulations. If the company and state both say it is permissible I have to abide by that decision or look for work elsewhere. I decided when I started in dialysis that basically those on the state board who make these decisions don't have a clue as to what is involved in dialysis.
Working with dialysis pts is alot like being the passenger of a car. You may know alot about the driving of a car but until you are actually behind the wheel you don't know how to drive.
I see your point, but if the BON allows that UAPs in chronic dialysis units draw and give hep and/or lido*, among other things (such as accessing central lines and even - in some states - doing assessments, and I'm not just talking about VS - then your license would be protected (just as it would be if an LPN you work with in the hospital does something he/she is allowed to do). You can always maximize safety by watching them draw the meds (i.e., making sure they use the correct heparin concentration and certainly not lido ) and then double-checking the dose. Also, in clinics the heparin is usually put in an "on pack" containing the supplies needed to start each pt's tx; this would be placed on the pt's clipboard/tx sheet; the nurse could then double-check that each pt has the correct med(s) in his pack.
Personally, I don't agree with the policy; but if it's the law, then it's the law... However, it isn't in my state. The only med PCTs are allowed to give is NS boluses; nothing else. I know it would certainly have made my life as a clinic RN much easier if my PCTs could have given their own heparin (therefore not constantly requiring me to interrupt my own pt care to do this for them); I also know - having been told by a trusted PCT, who wanted to follow P&P (and the law!) but had to give heparin when she was assigned to these other nurses since they refused to do it for her - that I was the only RN there who adhered to the law... I guess that's why some of the other staff (nurses/PCTs) called me slow (it will certainly slow you down!) Alas, I refused to compromise my principles. At the same time, this is one of the reasons why I won't go back to chronics.
It is truly a different world outside the hospital - one that some RNs may not feel comfortable with. Therefore it's good to find out before going into such a setting (I had no idea!)
DeLana :)
P.S. I do like dialysis, though, and the patients. But I'm going back to the hospital soon - to an inpatient/acute unit - which I think is the best of both worlds. And the best part: there are only nurses!!! This eliminates another problem with UAPs doing nursing tasks: they may think they are nurses (I've heard them tell the patients that!) and can get quite an attitude
*I wonder who/what has "encouraged" the state BONs to do so...
Still not sure I agree with PCT's drawing up and giving meds, but since I don't work as a nurse in a hemo clinic, guess I don't know what I'm talking about. Thanks for the info DeLana.
Our techs were allowed to draw up the meds and also give the heparin and we as LPN's were asked to sign the documentation sheets that we had given the heparin. We were not made to do this, but if you didn't like me, you were "not a team player". These techs were presented to the patients as "nurses". The techs were allowed to put patients on the machines and do assessments and decide when to bolus NA+. Go figure.
I filed a grievance with the BON who then sent cease and desist letters to the company I worked for. A big investigation that involved the state attorney general began. In the end, I was asked to leave by the company. The BON did NOT support me and said I would be better off not working there. The techs were allowed to continue working and I figured out that the BON has no power over unlicensed people.
It is one of those situations that you either love dialysis and put up with the working culture and risk your license or you move on. Unless your state has regulation over the techs, there is nothing you can do if your employer allows them to do certain things.
Our techs were allowed to draw up the meds and also give the heparin and we as LPN's were asked to sign the documentation sheets that we had given the heparin. We were not made to do this, but if you didn't like me, you were "not a team player". These techs were presented to the patients as "nurses". The techs were allowed to put patients on the machines and do assessments and decide when to bolus NA+. Go figure.
I filed a grievance with the BON who then sent cease and desist letters to the company I worked for. A big investigation that involved the state attorney general began. In the end, I was asked to leave by the company. The BON did NOT support me and said I would be better off not working there. The techs were allowed to continue working and I figured out that the BON has no power over unlicensed people.
It is one of those situations that you either love dialysis and put up with the working culture and risk your license or you move on. Unless your state has regulation over the techs, there is nothing you can do if your employer allows them to do certain things.
Wow, that's shocking. Obviously, you worked in a state where UAPs are not allowed to give meds and the company let them - or even expected them to - do it anyway; outrageous! In my clinic, it was not officially condoned, but believe me, it happened, and nobody can convince me that the FA was clueless. The official line, of course, was "Don't do it."
I know that the same outcome would have occurred if I had done what you did and turned them in to the BON or even Medicare; the whistleblower always gets the shaft. :angryfire
Why is this kind of thing allowed to happen? Well, we know that UAPs cost the companies less than nurses. Also, it's understood that outpatient dialysis is a thankless job... the work is hard, often dirty, often dangerous (heavy blood exposure and what not) - it's difficult to recruit and retain, and if letting UAPs do things they have no business doing makes UAPs who want to play nurse and lazy nurses happy* - then they will look the other way.
It's the dirty secret no one wants to talk about - but I ask those of you who work in states where UAPs are not allowed to give heparin who wish to speak up: can you tell us that this is not going on in your clinic? I guess it would give me hope
DeLana
* In no other setting have I seen nurses and UAPs doze at the desk while their coworkers who play by the rules drown
At our facility the PCTs do not draw up meds or give them, unless its saline. After completing a Cath training class we do all all caths and cath care. We call when we need a med push. We do all assessments and notify a nurse if something is out of normal range. We work 1 staff to 4 patients. The pods across from each other have an LPN and PCT working together with 8 patients. We also have a RN who does not take any patients and will rarly draw up meds for LPNs. PCTs do make packs. Sometimes I feel the nursing staff would not care if we pushed the meds but I would not put my job or a nurses job in harm. We wouk together well....No complaints here.
One can always dream tho..........
- then your license would be protected (just as it would be if an LPN you work with in the hospital does something he/she is allowed to do). You can always maximize safety by watching them draw the meds (i.e., making sure they use the correct heparin concentration and certainly not lido 
Obviously, you worked in a state where UAPs are not allowed to give meds and the company let them - or even expected them to - do it anyway; outrageous! In my clinic, it was not officially condoned, but believe me, it happened, and nobody can convince me that the FA was clueless. The official line, of course, was "Don't do it." 
tired dialysis nurse
19 Posts
not to be rude, but you don't work in a chronic unit do ya? I do not give any meds that other people have drawn up-- but our techs do draw up heparin and lido and legally give and sign for it. I would not have a problem in a court of law or in front of my state's nursing board, thats why I stated that one should read policy. nurses are not the only people who can give meds(emts, medical assistants, cmas,....), as a registered nurse they pay me for my nursing assessment, no one else may assess a pt, only a registered nurse. there are many "skills" that an unlicensed staff can perform, including administering the above meds in a chronic hemo clinic. What a sad day for all nurses if we do not remember our primary job---to assess our pts, develop a plan of care, and utilize our critical thinking skills---I do not put my license on the line when a tech gives 0.4mls of lidocaine SQ. Nor do I compromise my license when a tech puts a pt on and sets the hep bolus/infusion/stop time. I would have a legal /ethical problem if I failed to assess my pt. Back to the question, I still say read the policy, read the policy, read the policy!