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.
A)techs who have been on the floor a long time do have clinical knowledge of what may be going on....however, I would be livid if they flushed a line without telling me, or gave OJ and didn't tell me what the blood sugar was for a hour....that being said, I believe that if I'm nowhere to be found, I would welcome the tech that I trust to give OJ and then come find me right away....I don't want someone bottoming out because the tech can't find me. It is NOT ok for things to be taking a hour or two to be communicated....you need to know right away.
B)In terms of the MRSA issue, I would ask the techs to NOT move any of my patients or teach them about anything until I have had a chance to inform the patient of what is going on. Your patient being confused highlights an important part of why techs shouldn't teach....A more telling aspect would be that if the tech is aware of the new positive MRSA culture, then you need to move that patient up before any other tasks and inform the patient what is going on, so the techs can move them before exposing roommates or staff to any potential infection and ASAP.
It's tough being the newbie....the techs have been used to doing whatever their own way for months if not years, and you will have a uphill battle. but you're not there to make friends, you're there to do a job. such is life.
When I was a tech in the hospital I would not have dreams of doing pt. teaching or flushing an IV. Those are in the nurse's scope of practice not a tech's. However, I might have gave the pt. OJ if I could not find the nurse right away, but I would have told the nurse ASAP. Moving your pt. without being told to do so, is way out of line also.
Personally, I would not wait until I was done with orientation to put a stop to the techs doing these things. I would feel like my lincense would be on the line every time they did these things.
Specializes in Community Health, Med-Surg, Home Health.
I would begin by telling the techs assigned to me what my expectations are and a bit of why. It is important for the nurse to be aware of things before they are done because we are licensed to document and intervene and they aren't. As you get to know them, you'd have a better idea of what talents they possess and you can decide what things they can take initiative to do. You can instruct them to inform you the moment they get a blood sugar out of range, and then, you instruct them on what to do.
It could very well be that they have been working there for so long that they are 'in sync' with the nurses, similar to what happens with nurses that have worked with doctors for so long...they almost know to the letter what each provider is going to do, and that isn't a bad thing. The PCAs I work with in my clinic are well tuned to what my needs are and the same for me-I know what they need when I have to pitch in and help them. They don't make a move before they tell us and get our okay or nay to act. It is the communication issue that you need addressed, since you are new to the scene as well as a new nurse.
I would be very uncomfortable with UAP doing anything beyond the bed baths, feeding, and toileting which those with whom I've worked have traditionally done. I certainly wouldn't let UAP flush a line, period. The OJ, I can see if there are standing orders as long as it was reported to me quickly. Moving without letting me know where my patient went, I'd be angry, too.
The bigger problem, though, isn't that they do these things, it's the resentment that they (and the licensed personnel) will have towards you should you attempt to curtail it.
I don;t know what the answer is, but I'm glad I'm not in your position. It's a lousy one.
As a tech, I would never flush an IV and I always tell the nurse the blood sugar (good or bad). Its very important to be a team and tell each other what is going on. I can see your frustration, but tread lightly. If your too harsh, these techs will suddenly disapear when you want/need them. I think you might consider going over the assignment and letting them know that you want to know what pt so and so's bs is and to call you if an IV is beeping just so you can assess and better your skills (being new and all). This way it lets them know that you want to be informed yet you aren't demanding they do things your way. Good luck and keep us posted.
There is a reason we have a scope of practice. Allowing techs(wish you had been specific about what kind of tech) to practice outside of their scope is illeagal IMO. Don't risk your license that took four years to get just because the other nurses allow the techs to do their job.
Thanks for all the replies... its good to know I wasn't way out of line when I got upset. It was one of those things- I hadn't been saying anything, and then this last thing happened and I kind of blew my cool a bit.
Communication is a huge issue, and really is THE issue here. There is no reason for them to not find me to report BS (or anything else). We wear those Vocera things- all staff, and use them frequently.
I don't know what I'll do. The IV flush thing, my preceptor was mad about that too, but not the blood sugars or the moving and teaching the patient. I figure I'll wait until I'm off orientation and then just make sure I'm communicating with the aides (techs) at the beginning of the shift that I'd like to know the blood sugars and if anything seems low to let me know before intervening. If something comes up like a pt needing to be moved for whatever reason then I'll be sure to communicate quickly not to move them until I talk to them. I think eventually they will learn that I like to do things myself. If I approach it that way, maybe there won't be too many waves.
Another question, do your techs/aides verbally tell you blood sugars? In clinicals that seemed to be what they did, but not one day since I've started has a tech ever told me what a blood sugar was. I've had to look it up in the chart, and most days they aren't charting right away. Just seems to me that they should at least report blood sugars that are out of the normal range.
I would also be pretty uncomfortable with techs doing these things, especially if I was new and did not know the techs. Especially the teaching and the IV flushing. Not so much the OJ but you should have been notified ASAP after the juice was given.
But it sounds to me if the techs have been independently doing all this, then you will be met with resistance from the other nurses and the techs themselves of you bring these concerns up the wrong way. And you will be perceived as uptight and they will probably be passive aggressive towards you. I would be very sure of official policy and word my concerns carefully.
Its unfortunate for the techs and the nurses that this floor has outlined this behavior as acceptable. I was a tech while in school and I really felt like I wasnt qualified or being paid enough to do anything outside my scope, although certain floors would expect me to because I was a nursing student. I agree with a previous post that this is a culture problem for sure.
Its your license.......Protect it. Don't let any assistive person do a task that is not within their scope of practice or that you do not specifically delegate.
What's a tech? We have PCA's. If a blood sugar is low they tell me and ususally are on the way with apple juice and sugar. I am always informed at the time. No one flushes a line but an RN. Very scary but I have learned a lot as a new Rn from my patient care assistants.......I love them.
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leslie :-D
11,191 Posts
a licensed nurse is allowed to delegate certain tasks as long as:
- uap has documented competencies
- nurse assesses pt's nsg care needs prior to delegating
- nurse delegates tasks based on pt condition, uap's capabilities, and ability of nurse to readily supervise or respond.
as long as task doesn't require ongoing nsg assessment or judgment, we are allowed to delegate certain tasks.
but the bottom line is, it is our licenses.
and that is why i wouldn't agree to uap doing certain things unless aforementioned was demonstrated.
leslie