Patient safety issue with medical tech

kalevra, BSN, RN · Nov 3, 2011

Your an officer in the military. If you let this one person slip with trying to place blame on you about their incompetence you will set a precedence for it to happen again. You should confront them, preferably while they are attention. I understand responsibility falls on you when people screw up. It is the nature of the position. However you must in turn correct their screw up. I recommend having them say Sir The Color of the Tube Will be (insert color)! 10 times in front of another person to verify proper tube color. I am sure there are a few NCOs that can help you out on "inventive" ways to motivate techs not to screw up tube colors.

Best of luck.

luckynurse_1234 · Nov 3, 2011

Thanks, I like your idea! The crux of the problem is most of us were civillians a year or two ago and I used to regarding the techs as peers and I think the techs sometimes take advantage even though they know military structure better than we do. The techs on the other shifts complain the nurses make them do everything and ours brag about our good relations however the NCO has hinted our shift is too lax with them. I suppose taking someone to task for something only get easier with practice and so I should just bite the bullet and start doing it.

GimiRN · Nov 3, 2011

I am a military RN and our military medical technicians are basically LPNs. It was the end of a busy shift and I had an admission get canceled. The tech who was assigned to it and myself suddenly had some unexpected free time. I was going to help another nurse with her new admission and I asked the tech who had been assigned to my admission to get a blood draw for me on another patient since the tech for said patient was really busy. She said "sure." I handed her the lab slip and told her I needed a cbc. She took the lab slip and a student she was training with her. On our unit, two people are supposed to verify right patient, right lab, right tube color, etc so she used the student as her second verify. I got busy then the lab called and said the wrong tube was used for the cbc so the lab needed to be re-drawn (a cbc is a purple top and they used a green top). I had to explain to the patient she had to be stuck yet again. I was busy/really ****** so I didn't talk to the tech but my charge nurse found out and took it upon himself to question her. I overheard her say my name in the explanation but I couldn't make out anything else. The charge came out and told me even though it sounded like the tech didn't correct the student drawing the blood on the tube color, I should have told her in no uncertain terms it was to be a purple top and made sure she really understood it was to be a purple top. This tells me she probably blamed it all on me saying I wasn't specific enough, it wasn't even her patient etc. The charge nurse also said I should have been at the bedside when it was drawn to ensure it was done correctly. The whole reason I had her do I it was I was busy, and doesn't that defeat the purpose of delegation? Btw, the lab slip says the tube color and everyone knows a cbc is a purple top by the end of their first week and this tech has been on our unit over a year. Now, I have to treat every tech like an idiot and tell them the tube color for lab draw three time and have them verbalize they understand (according to charge nurse if I am not micro-managing it myself). All because of one person's laziness. Sorry a bit of venting but lab errors are a big patient safety issue. And I realize I should have talked to the tech but I didn't trust myself to remain calm and professional. Thanks for reading!

I've been out of the military a while. I got out right as they were converting the 91C (LPN) MOS to 91W. I worked as a medic in the emergency department, then later as an LPN in the SICU. Never did I have anyone supervise me as I drew blood. In fact, working for the military allowed medics and LPNs the opportunity to do so much more, than they would ever be able to do in the civilian sector. And once a skill was learned and properly demonstrated, we were expected to do it from that point on.

It definitely sounds like that tech threw you under the bus. And I'm surprised that things have changed that much, where the charge would place the blame solely on you, instead of ensuring the tech was retrained or something similar. After all, this is a very basic skill that she needs, if she is working in healthcare.

Sure, she had a student with her. But she should be competent enough on how to instruct her to correctly draw blood. A CBC is a very common lab and one of the first you learn about (in my experience anyway). If I were you, I would still address it with the tech now that you have calmed down. And I would let her know that in the future, if she is ever uncertain about something she is asked to do, she needs to speak up.

Rob72, ASN, RN · Nov 3, 2011

I'm not current or ex service, but I do know the system- know your chain of command. If the tech is "qualified" to instruct students, then the responsibility is theirs. Period. Obviously, the "real world" is a bit different from service structure.

As the senior officer, directly above them, yes, you would get some chewing on for the error, but it is your responsibility to pass the pleasure along. That's where the concept of "poo rolls downhill" originates. :smokin:

There are a few ways to deal with the situation, from using scope of practice to isolate and/or punitively assign the tech, to having a "firm" conversation, to writing it up.

maelstrom143 · Nov 4, 2011

As the senior officer you delegated correctly. What you asked her to do was within her scope of practice and therefore it fell under her license. Her assigning blame to you should not have flown and your supervisor should have had the presence of mind to realize this without having it explained in baby steps. If an LPN under my supervision makes an error after I delegated a task within her scope of practice, it is her error. If she failed to ask for help for something she did not comprehend, it is still her error for failing to ask for clarification or assistance. End of story. I would definitely talk to the LPN and get this clarified and address the issue with your supervisor. It is not ok not to take responsibility when one knows one has screwed up as your LPN did.

kalevra, BSN, RN · Nov 4, 2011

How long have you been an officer in the military? What branch?