New nurse overutilizing ED tech

Emergent, RN · Mar 23, 2019

She's probably just one of 'those' nurses. They reside in all specialties. They treat CNAs like menial helpers.

JKL33 · Mar 23, 2019

2 hours ago, thepitbull said:
What do I say to this nurse so she gets that this is not med surg or psych, that we do not ask someone else to do what we can easily do ourselves?

- The people with the concern are the ones who should address it maturely, using proper channels - including taking the first step of talking with the person about it. Perhaps they have done that and perhaps you are indeed their appropriate next step (charge, shift supervisor, etc.). If not, they should be encouraged to use appropriate channels for addressing their concern.

- Don't make any blanket statements about how things are done elsewhere in the hospital. If there is a problem, this nurse may very well be a one-off. It would be most likely incorrect to assume that because she is from a different floor, all nurses on those other floors operate the way she does. Verbalizing things in that way makes one appear to be less than objective.

- If this problem is within your realm, it seems like a first step would be to hear how things are going for this nurse overall. It would be unfortunate to assume the worst about someone who was simply slightly overwhelmed, which would not be unusual for a newer ED nurse regardless of previous general nursing experience - and is one of those things that could be a factor in what appears to be inappropriate delegation.

thoughtful21, BSN, RN · Mar 25, 2019

I genuinely want to learn more about this. This situation seems strange to me. I have a different background - possibly more similar to med surg/psych, like the nurse in your example. I work at a critical access hospital, and we don't normally even use techs in our small ED.

Do your techs completely do their own thing all shift, and not take any direction from nurses? Have they been there quite a while, and have a lot of experience?

What are their responsibilities?

It would really help me to learn more about this. If the original poster doesn't respond, are there any other ER nurses that could weigh in? Thank you ahead of time!

I wonder if your new nurse somewhat confused by this, like I am, and needs someone to take her under their wing, and explain how things work. What other dynamics affect the situation? I also wonder, like JKL33, if maybe she is swamped with her new responsibilities and feels like she needs the extra help?

NurseBlaq · Mar 26, 2019

Just taking up space so I can see the replies.....

thepitbull · Mar 26, 2019

Our ED is fairly busy. We have a steady stream of ambulances coming in, as well as a high number of psychiatric patients that the police bring in and that come through the door. As far as techs, this means they are going room to room doing EKGs, drawing blood, running POC testing, taking patients to xray, CT, MRI, taking patients to the floor, changing out psych patients into ER scrubs....lots of things that they know to do automatically. Of course they are available to assist nurses with whatever we ask for, but like I said, for the most part, they are self-directed. Yes, they get discharge vitals for us. But when you as the nurse are walking into the room with discharge instructions in your hand (again, this is just one example), it's not hard to grab vitals, especially when the tech you ask to do this has 3 people that need to go to xray, blood to draw and call lights going off.

The techs come to me for advice as far as what to do about this. Maybe I'm asking for a phrase or something to tell the techs to say to this nurse that is kind, respectful and not confrontational. This nurse is very nice and I'm not looking to cause trouble.

Forest2 · Mar 26, 2019

If she is from another unit that could be the reason. Often PCT's are under direction of the nurse, so she may assume as much. If you know that she is not being assumptive but taking advantage of the PCT's, just kindly give her a run down of how things work there. Every unit is different with a different set up and culture. Not that you are judging her or anything, you just happened to notice that she delegates what the other nurses do themselves. Being part of a team, yadda yadda yadda, not the system in place. You know. In addition, I would give the PCT's a pep talk, I understand that they feel subservient, but they don't need to. I can't do my job without them and tell them so. It is OK for them to be assertive, you can do that without being disrespectful or insubordinate. Act it out with them and let them practice saying, " My attention is required now in 3", etc. That's my 2 cents worth.

thoughtful21, BSN, RN · Mar 26, 2019

5 hours ago, thepitbull said:
Our ED is fairly busy. We have a steady stream of ambulances coming in, as well as a high number of psychiatric patients that the police bring in and that come through the door. As far as techs, this means they are going room to room doing EKGs, drawing blood, running POC testing, taking patients to xray, CT, MRI, taking patients to the floor, changing out psych patients into ER scrubs....lots of things that they know to do automatically. Of course they are available to assist nurses with whatever we ask for, but like I said, for the most part, they are self-directed. Yes, they get discharge vitals for us. But when you as the nurse are walking into the room with discharge instructions in your hand (again, this is just one example), it's not hard to grab vitals, especially when the tech you ask to do this has 3 people that need to go to xray, blood to draw and call lights going off.
The techs come to me for advice as far as what to do about this. Maybe I'm asking for a phrase or something to tell the techs to say to this nurse that is kind, respectful and not confrontational. This nurse is very nice and I'm not looking to cause trouble.

That makes good sense! ? Now I can see the big picture. Thank you! Also, @Forest2 's advice sounds great. I hope the situation works out well for everybody (you, the new nurse and the techs)!

WishfulThinkingRN · Mar 26, 2019

Not sure if she's used to relying on PCTs to do vitals all the time? How comfortable is she with multi-tasking? She may or may not understand how busy the PCTs are. If this many of them are coming to you with the same problem/issue then it needs to be addressed by someone in the chain of command. A good PCT is worth their weight in gold and should be treasured as such. Maybe talk to her and find out what she feels is appropriate to delegate? Some correction may need to be done with her. PCTs in ICUs and EDs have, not necessarily more responsibility, but are trained to do more and she may not understand that. If she does and is doing it anyway, then that's a whole other issue that definitely needs to be addressed.

JKL33 · Mar 26, 2019

I will add this...(sorry its a little long but hear me out):

It is a little confusing (and conflicted, IMO) the way that techs work in various places.

They are trained by the employer for the set of duties the employer authorizes them to perform, then puts them to work doing those things. And yes, they do a fantastic job. They are invaluable.

But then there's the part where all of this is supposedly "delegated" (because that is an RN's scope of practice). The patient's RN still maintains responsibility for delegating care to be performed by UAPs (unlicensed assistive personnel). In some places it does get out of control from time to time, with techs declining to do an urgent delegated task because they already have their lists of usual tasks underway - yet they are not legally tasked with prioritizing elements of patient care overall.

The independent work is great, and UAPs absolutely have their plate just as full as any of us as far as their job duties go - but that doesn't mean its suddenly no longer our place to delegate. I understand that isn't the charge being made in this thread, but it's a theme that I will say I've kind of noticed among techs and nurses alike: Why is an RN asking them to do something? They already know what needs to be done and they do it independently.

I'm going off-topic, though. The issue here is that she is asking them to do a simple task she could do while in the room.

The techs need to address this (in a kind and upbeat manner) at each incident where it happens. Not some big talk that makes this nurse who is described as being "very nice" feel humiliated or "talked to." When she says, "Can you grab vitals while I'm giving the discharge instructions?" They should just kindly say, "Would it be alright if I let you to do them while you're in here - I have another STAT EKG to obtain in Rm ____."

Truth told, the only reason I wrote out all this other stuff above about delegation is because I suspect her "delegation" offends their sense of independence a little bit beyond just the question of whether or not any individual request of hers is appropriate. And that (offense at the mere idea of having someone delegate something to them) is....ehhh....not really okay.

I guess what I'm saying is that they shouldn't have the idea that they have their separate tasks so she doesn't ever need to ask them to do anything. And what makes me think that there is an element of offense that she delegated something is because they are repeatedly talking to you, OP, rather than already having (quite easily) handled this with the nurse in question.

I get that it's a little uncomfortable, but not if they don't make a big deal about it or let it simmer and fester before finally saying something. To her.

Again, I don't think you need any phrase to say to this coworker, although it is nice of you to want to help smooth this out. I think if the tech has some legitimate (more urgent) task they need to get to...they should mention that in a friendly manner and work it out with the nurse.

I hope this makes sense...a little ramble-y, I know. ?

Workitinurfava, BSN, RN · Mar 26, 2019

Tell the techs to speak to her and if they can't make any headway on their own, they should have a nurse assist them in this process.

Seeing Myself Out · Mar 27, 2019

Sounds like a nurse manager issue. If you have a nurse manager who support ED Techs the problem can probably get snipped in the bud while the new nurse is still getting acclimatized.