I think I crossed the line

Published

Specializes in Telemetry.

So I've been at my new job a month as a new grad. I'm doing really well according to my preceptor. I really like it, I'm fitting in well with everyone, and already taking a full pt load doing admits and discharges fairly independently. My preceptor thinks I'll be ready to go in another month, and I think so too. (Orientation is anywhere from 8 to 10 weeks long) So overall its been a really good experience.

So the last day I worked I had the day from hell. Just one of those days- things kept coming up that put me behind, and every time I'd think I was about to catch up, something else would happen. I had a pt's family chew me out for something that really was their own doing because the other family member who brought the pt in apparently gave us the wrong history (pt was from out of town) and so we were going on what we were told which was according to the other family member, completely inaccurate. (And its 2 days later after the admit)

Anyway, I was just at the end of my rope, and because I'm new I'm working really hard at trying to be aware of things and know whats going on with my patients- its not as second nature to me as it is for the more experienced nurses. My preceptor and I get along great, she is very laid back. I've taken issue with some things the techs have been doing, and just keeping my mouth shut. They do things very independently, and have been performing things that are technically nursing interventions, which drives me nuts because I end up finding out later, after the fact, when I feel like I need to know these things as they are happening. ie... flushed an IV because the pump was alarming, instead of coming to get me, checking BS, it being low, going ahead with OJ or whatever, with out even letting me know it was low. (like 50s)

It was towards the end of the day and I was finally catching up on my charting, and we had just gotten a wound culture back that was positive for MRSA, we had suspected, and were going to move the pt to a private room and put him on isolation once we got a few things done and prepared. No one had talked to him yet, and I was getting ready to go let him know, and preceptor finds out the tech already moved him and told him about his results and didn't bother to tell anyone. I have 2 problems with this: 1. not telling anyone till so much later, 2.Telling a pt their test results and doing any kind of explaining about things like that. We are supposed to do the teaching for a reason. Who knows whether or not she has all the info he would need or answers for his questions? Sure enough I go into his room and ask him if he understands whats happening, and he says no, he is confused. I kind of went off about it to my preceptor and prefaced it with saying, "I'm sure this is because I'm new and not used to it, but I'm getting really annoyed with the techs doing things that are out of their scope, and not finding out about it until later"... etc etc. I'm sure my tone of voice was annoyed and short. She kind of just let me vent and said that they are very independent, and have been there a long time. I could tell that I was out of line in my comments by her reaction. I apologized, told her I knew I was being new and dumb, and was just having a bad day and was aggravated in general. She seemed fine after that, but now I feel l totally put my foot in my mouth.

Maybe I was overreacting, and maybe its because I'm new, or maybe I was just having a bad day and was just on a short fuse after 12 hours from hell. I think techs are great, and are invaluable, but I feel like its just not ok for a tech to be flushing IVs, or getting BS in the 50s and going ahead and giving OJ with out even telling me and I find out about it when they chart it an hour or two later. I don't think its ok for the techs to be doing patient teaching. I appreciate her trying to help, but I guess until I know her, I need to do these things myself so I can feel confident that I know what is happening with my patients, and that they are getting accurate information and interventions. I don't know. Am I out of line? Maybe I just should have kept my mouth shut.

Up Vote Up Vote ×
Specializes in Fall prevention.

I do not feel that you were out of line. You are responsibe for your are responsible for all aspects of you pt care. You might try talking to the tech and just explain that you are new and that you need to know eveything that is going on with you pts.

Up Vote Up Vote ×
Specializes in ED, ICU, PSYCH, PP, CEN.

You are absolutely right. These techs are going way over the line. You have to know when a pts blood sugar is low and you have to decide how to "resugar" the pt.

This is the only way you can keep track of a potentiallly serious problem and document accordingly. What happens if this is the 3rd time today that this has happened and you don't even know about it for hours. There could be a serious medical issue accurring that you need to address.

Also not cool that they moved your pt and didn't tell you. You need to know where your patients are at all times. At worst they should have moved the pt and immediately come and got you and told you.

It sounds like the nurses on your unit are letting the techs do way too much of their work. You might come to like this, but it would bother the heck out of me.

Techs are an invaluable part of the team, but it sounds like these techs are not including you in the team.

Whenever they do something that you think needs to be done differently just quietly and kindly let them know that you need to be in the loop sooner.

For example when I have a chest pain in the ER the tech does the EKG right away and takes it to the doctor to see. I want to see it first and I am usually nearby. So as I see them heading off to the doc I catch them and just say "Let me always see this first okay" They slowly learn that is what I need and then do it.

Remember, we teach the patients and their families, but we also teach each other daily, maybe without realizing it.

Good luck on your unit and I hope it continues to go well for you. I wouldn't worry too much about the other day. Everyone will most likely chalk it up to new person syndrome. All of us have had new job meltdowns. Being a nurse is hard, but well worth it.

Up Vote Up Vote ×

i think the most apparent problem is, you don't know the capabilities of your nsg assts.

there are certain aides that i have no problem doing these tasks.

but what i do expect, is ongoing communication.

i need to know the what, who, why..

afterall, follow up is often as important as the event itself.

and, i'm anal like that.

i want to know everything.:)

when it comes to your own pt assignment, there is nothing wrong with letting the aides know your expectations.

so if you want them to keep you updated, it's equally as important for you to be updating them as well.

if you want to do the pt teaching, then tell them.

as for bs's and flushing, i don't see anything wrong with them doing that.

not all of them, but for sure, some.

best of everything.

leslie

Up Vote Up Vote ×
Specializes in ICU/Critical Care.

Techs shouldn't be teaching or performing anything that is within the nurse's scope of practice.

Up Vote Up Vote ×
Specializes in pediatric critical care.

i don't think your out of line at all. techs have no business informing patients about test results or flushing ivs, and my pt had a bs in the 50s and i wasn't informed, i'd be livid! they have overstepped their bounds. problem is, they may have been allowed to do this for a long time by nursing, and maybe they truly think they are just helping out their nurse. speak with the nurse educator on your unit and find out exactly what the techs are/are not allowed to do. then it's up to you what you do with that information. me personally, i would talk with the techs, and outline my expectations. you will probably meet with resistance, especially since you're "the new guy." you will most likely be the nurse they may hate to work with for some time. stick to your guns, and protect your license, you worked too hard to get it. regardless of what they've been allowed to do in the past, they should be well aware of what they can/can't do. good luck, and congrats on flying through orientation so well! this is a speedbump, and we all have them once and awhile. keep your chin up!

Up Vote Up Vote ×

You are NOT out of line--it sounds like the nurses there (or at least your preceptor) takes advantage of their techs to do some of their tasks for them. But it is YOUR patient and YOUR license. What kind of educational background do the techs have? How do they determine how low a blood sugar gets before telling you, or what if they misinformed a patient in his teaching and told him things that caused him to panic? Potentially, this patient could tell the doctor the "incorrect info" that was told to him by his "nurse"! If the techs are acting as nurses, how can the patient tell who really is the nurse? Not to mention the fact that techs don't have a license to lose!! Your preceptor is only going to be your preceptor for a short while. Once you are "free" I fully recommend letting your techs know exactly what is expected/allowed when working with your patients (delegating!!) and always remember not to let a tech do a nursing intervention even when you are swamped and could use the assistance. It can be convenient, until someone possibly dies. It scares me to think of them flushing a line whenever the pump beeps--those beeps are sometimes warnings that something is WRONG! I agree you will have to keep your mouth shut until you are officially on your own, but not one second after that. It is a tough situation. I fully send my support to you!:up:

Up Vote Up Vote ×
Specializes in Cardiac.
Techs shouldn't be teaching or performing anything that is within the nurse's scope of practice.

And they shouldn't be flushing my IVs either. Can you imagine if it were pumping because it sensed an occulsion from an infiltration? Or what if it's something that I don't wish to have mainlined with a flush, like insulin, levo, potassium, etc, etc???

And absolutely no teaching!

Up Vote Up Vote ×
Specializes in LTC.

Talk to someone who knows what the tech's official scope of practice is. As a CNA I'd never flush an IV (though I've done it as a nursing student), because I know it's out of my scope of practice at the hospital I work at. However, if I have a patient who has a blood sugar of 50, I will follow the hospital protocol taped in the accucheck case that states give OJ and crackers as long as the patient isn't NPO. When I tell the nurse all depends on who I bump into first, the nurse or the carton of OJ.

I'd much rather give OJ by protocol than spend 10 minutes huntting down the patients nurse to report the blood sugar.

Up Vote Up Vote ×
Specializes in behavioral health.

I can't see a tech flushing a line, maybe getting a BS. Also, bottom line is that of communication. Even it was in their scope, and I highly doubt that it is, they displayed poor communication skills. They may have knowledge on how to perform "nursing skills", but that doesn't make it legal. The "team" needs to work together and that always includes communication. I feel bad for you because you are the new person. You are the new person, and this obviously has been going on. They will perceive you as the bad guy, but you need to protect yourself. Congratulations on your new job!

Up Vote Up Vote ×
Specializes in CVICU, Burns, Trauma, BMT, Infection control.

The techs are over the line. No matter how able they are I wouldn't want them to access an IV line. I don't know their technique and also as the nurse I am responsible for what happens to the pt regarding the IV. If the pt gets a blood borne infection traced to the IV line the nurses are going to be seen as responsible for that. I have seen very shabby technique by others. As for the blood sugar if you have a protocol and they are familiar with this pt and give him plain OJ,no sugar added(I've seen people load up the sugar too).And then they tell you asap because if the pt crashes and gets brain damage/worse from hypoglycemia it's your license on the line among other things.

I would just bide my time and keep a close watch on them,maybe they are very knowledgeable and helpful but having them access the IV and be so laissez faire about the low BS would make me nervous.

I almost lost a pt who was post bronch and hypoglycemic and whose IV crapped out when we needed to give D50.The techs didn't tell me that they got a BS of 62 2 hours previously when he was NPO. Luckily another nurse got a line in and we got him back though,barely.They may be able to do the skills but don't know the rationale behind them.

Up Vote Up Vote ×

First off, try and find an outline of their job description. I'm willing to bet it doesn't include flushing IVs, independently treating low BS, or initial health teaching.

The NAs think they have the knowledge, skill, and education to be doing things beyond their training. They don't understand the potential danger and harm they could inflict. They're not likely to to be receptive to hearing about it either, especially from a newbie. Other nurses have allowed this to become a problem.

It's your license and the only way to protect it is to put your foot down. Be prepared for attitude and backlash from both nurses and NAs if you put your foot down.

Up Vote Up Vote ×
+ Join the Discussion