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.
Specializes in Medsurg/ICU, Mental Health, Home Health.
what's a tech? we have pca's.
whether they're tecchs/pcts, pcas/cnas, nurse techs...they're uaps (unlicensed assistive personnel). that means that they do not have a license and work under a nurse, who delegates tasks to them that do not require a license.
Specializes in 5th Semester - Graduation Dec '09!.
I work as an tech while I am in school (3rd semester) I feel uncomfortable even silencing the pump while I get the nurse. IV flushes? Are you kidding? Not Kosher!
Do you think you'd have any luck addressing the techs directly?
I've had a lot of luck with the..."Don't hate me please. I'm new, and still kind of a control freak. In a few years, we'll all laugh at the newbies together. But for now...I would really, really appreciate it if you would let me know a patient's status before you do any interventions."
People are usually pretty receptive to the "It's ALLLLLL me, NOT you" approach. In the meantime, hopefully you all develop a new habit of better communication while working together, and over time....YOU don't really have to change at all, or let go of the things you feel are important.
Another tack would be to ask your preceptor if you can shadow parts of their day as a part of your orientation, and ask some direct questions about their scope of practice. Tell the techs directly...."I was just curious how these things work for our team. I'm pretty protective of my license still!" (Insert big cheesy grin here) It could very well be that these are practices they have been ASKED to do by overwhelmed or inefficient nurses.
I don't think you're out of line at all. We have a problems with our tech - not so much doing things out of scope as refusing to do what is in their scope while telling others what to do. My theory is that if they want to provide nursing care or direct others in patient care they should go to school, get a license, and get a different job.
PCT's and NA's are a very sore subject where I work, so if i sound a little snippy it's cause I am.
I would do an incident report telling the patient that he had a MRSA infected wound.
Someone that is unlicensed should not be discussing test results with the patient b/c they are not qualified to teach, explain, educate.
In some states, that may even be a legal issue.
The techs giving the patients with low blood sugar OJ is technically a treatment, and flushing of IV's is technically medication, and in my state, you can't do this unless you are an RN or an IV certified LPN.
I would probably speak to the nurse manager on what the "rules" are b/c it appears you are having these same things happening again and again.
First, I think, you have to be familiar with the scope of practice of techs. I don't think flushing ivs is in the scope of our techs. Accuchecks are. If a patient tells the aide they think their bs is low I see nothing wrong with the tech getting a blood sugar. I don't even see anything wrong with them giving oj depending on the patients diet which the tech would know. They should immediately let you know so you can assess whether some other actions should be taken but techs usually are better trained than an aide and that is the reason we have them. Good techs are valuable. Just as in parenthood, you have to choose your battles wisely. As far as moving the patient to isolation, the tech did not really educate or the patient would have had some clue as to why they were moved. It may have been an irritant that it was done before you told them to do it but however it was done the patient would have been moved. Seems like some of this problem is due to your inexperience which is understandable since you are in orientation. With time you will learn which battles you really need to fight.
At my small hospital in East Texas PCA's are not allowed to take blood sugars. I am a tech( here it means I have finished one nursing skills class) we can but I verbally report the number to the nurse asap, even if I have to find him/her.
Specializes in surg/ortho/trauma- float-travel nurse-ic.
Hi. You absolutely were not out of line. If one of your patients had an adverse result secondary to a tech "crossing the line" it's your license. And I can bet you'll be standing alone when that happens. You are the licensed professional responsible. By the way, I hope you have your own malpractice insurance. If ever a suit the hospital will protect the doc first. Seen it.
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.
Ah, beachbum! Bless your heart! Just reading your post makes me SO glad I'm retired and away from all that!
Yes, the techs need to communicate with you! You are rightly annoyed! Altho you'll come to depend on the good ones.:) You need to find out, as someone said, who has what kind of skill. Let them know how much you appreciate them, but that they need to keep you informed.
Penelope_Pitstop, BSN, RN
2,369 Posts
whether they're tecchs/pcts, pcas/cnas, nurse techs...they're uaps (unlicensed assistive personnel). that means that they do not have a license and work under a nurse, who delegates tasks to them that do not require a license.
jess