pct debate

tiger · Mar 13, 2003

sorry for a kind of a double post--i didn't think the first one took.

Tweety, BSN, RN · Mar 13, 2003

Originally posted by Brownms46
I found some links here, and felt they might be helpful:

This is from the Dept of Health in Washington state, as pertains to N. A., and delegation:

http://www.leg.wa.gov/wac/index.cfm?fuseaction=Section&Section=246-841-405
http://www.leg.wa.gov/wac/index.cfm?fuseaction=section&section=246-840-910

http://www.leg.wa.gov/wac/index.cfm?fuseaction=Section&Section=246-840-930

http://www.leg.wa.gov/wac/index.cfm?fuseaction=section&section=246-840-900

The following is from Mass:

http://www.state.ma.us/reg/boards/rn/cmr/24403.htm#3.05

From what I'm reading, if you delegate a task to an unlicensed person, you are held responsible for what that person did.

I'm in kind of a hurry. So I only skimmed the links you provided. What was asked was if the unlicensed person causes harm.

Say I have an assignment. I've assessed my patients and I decide patient A needs a bed bath as part of his "plan of care". I delagate the bath to a PCT and leave the room. The PCT during the bath drops the patient out of bed and the patient breaks a hip.

Since I delagated the bath to the PCT am I liable/responsible for the broken hip.

From what I've read, no. I've assessed the patient using that blasted nursing process, I've appropriately delagated a task with the unlicensed person's job description. Why would I be responsible for the harm.

Doesn't mean that I'm not still responsible for the patient's care, plan of care, nursing process, etc.

In Florida all patients are under an "RN level of care", but if an RN assigned the patient to an LPN and that LPN makes a med error am I responsible?

hogan4736, BSN, RN · Mar 13, 2003

3rdshifter...

nice post...

NO ONE is above questioning...

always question anything that seems questionable...

check out this thread:

https://allnurses.com/forums/showthread.php?s=&postid=379234#post379234

CATHYW · Mar 13, 2003

Originally posted by nurse-lou
I work in a 387 bed facility in PA. We use PCA's. They do ADL type stuff and some are trained to be Unit Secretaries. They do NOT pass meds or start IV's. I don't know that I'd want them to do that stuff. [/quote
In my hospital, things are very much the same. I Know that there are some very competent folks who do the job, but there is NO way that I would want them to start IV's or pass meds. That is ridiculous, and dangerous beyond thought!

angelbear · Mar 13, 2003

sbic56 You said what I was thinking.

Vsummer1 · Mar 13, 2003

Originally posted by tiger
val--i think you are taking this a little far. in your first post-you may not have said it, but insinuated, that anyone less than an rn is like a monkey. trained to tasks only. and now you are grilling lpnga. it is like you are trying to get some satisfaction or recognition. it is kinda sad. imho.

Hmm.. recognition for what? I am just a lowly student. I was just merely repeating what my instructor would ask before I so much as attempted to give a common drug, such as ibuprofen, to a patient. Because, quite frankly, I have only been "trained" in every type of procedure you all state you have been, and I have only "performed" every one of them on patients several times. But I don't yet hold the license so I must be able to answer all these questions at the drop of a hat in order to perform a procedure, or give a drug. I merely thought that you too would be able to answer the questions that I must answer in order to do these things... oopss i forgot, I am only posting this for satisfaction and recognition of my status as a lowly, struggling student.

Brownms46 · Mar 13, 2003

First this was a discussion about unlicensed or PCT/CNAs.

Second here is an statement taken from the Florida Nurse Practice Act:

Now in my view if you made the decision to delegate a task to a PCT, and that PCT performed that task wrong, you're responsible for your decision to delegate that task to that PCT.

Also in one of the links I provided it said this:

Can the task be performed improperly without life-threatening consequences? No -> Do not delegate

Are the results of the task reasonably predictable? No -> Do not delegate

Now in order for the task to be reasonably predictable, you would have to know that there was no way for the resident to fall and break a hip...if you decided to leave the room.

Is appropriate supervision available? No -> Do not delegate

Can the task be performed improperly without life-threatening consequences? No -> Do not delegate

The above is from the Washington BON

The following is from Mass BON:

Generally, appropriate activities for consideration in delegation decision-making include those:

which frequently recur in the daily care of a patient or group of patients

which recognize that UAP do not have a knowledge base upon which to make nursing judgments;

which do not require complex or multi-dimensional application of the nursing process by a licensed nurse;

for which the results are predictable and the potential risk is minimal; and

which utilize a standard and unchanging procedure.

http://www.state.ma.us/reg/boards/rn/advrul/ruldelg.htm

The following is taken from MA. BON

Responsibilities and Functions - Registered Nurse

A registered nurse shall bear full and ultimate responsibility for the quality of nursing care she/he provides to individuals and groups. Included in such responsibility is health maintenance, teaching, counseling, collaborative planning and restoration of optimal functioning and comfort or for the dignified death of those they serve. A registered nurse, within the parameters of his/her generic and continuing education and experience, may delegate nursing activities to the registered nurses and/or health care personnel, provided, that the delegating registered nurse shall bear full and ultimate responsibility for:

(1) making an appropriate assignment;

(2) properly and adequately teaching, directing and supervising the delegatee; and

(3) the outcomes of that delegation.

the delegating licensed practical nurse shall bear full responsibility for:

(1) making an appropriate assignment,

(2) adequately teaching, directing and supervising the delegatee(s), and

(3) the outcome of that delegation:

Now I was attempting to answer the question posted. From what I read, it seemed to say that the licensed nurse is held accountable for the decision she/he makes. In other words, if you don't feel comfortable delegating a task to an unlicensed person..don't.

caroladybelle, BSN, RN · Mar 13, 2003

Thank You Brownie!!!!!!!

askater11 · Mar 13, 2003

I've worked at three facilities.

The first one...went from transition from CNA's to PCT's. At first the PCT's drawing blood wasn't bad....they got a long orientation to drawing blood. At that time I was an CNA so I know how the orientation was. (very good) Then they started getting an hour our two verbal orientation then drew blood a few patients and were out on their own.

The second place I worked the PCT's did the lab draws, ekg's and blood glucose fingersticks.

The biggest problem I've found was with lab draws. I had many patients complain about certain PCT's and their lab techniques. Patients even complained to our supervisor .... but there was no changes.

Regarding EKG's....that makes me not as nervous but nervous. With 12 leads... I got orientated to 12 leads...I couldn't believe the discrepancies between where the PCT's said to put the leads. I had the same person orientating me to EKG's for 50 total EKG'S all seemed fine....but then out on the field I couldn't believe the discrepancy fellow PCT's were saying the lead should have been.

One more concern....with these poor PCT's stretched to do so much...there wasn't much time for hygeine care or basic care...that was very neglected. Perhaps better staffing would've helped that. I did also find that no matter how I explained a stat EKG....meant STAT and why it meant STAT it was never getting done. (that's why I orientated to EKG's...if they wouldn't get to it...I would) I first spoke to the PCT...then to management about STAT EKG's...nothing changed...

Now I started at a new hospital. CNA's do basic care and that's it. They can collect U/A or stool cultures but that is it. The patients are actually getting turned q 2 hours. The direct care is not being neglected at all.

I love our PCT's/CNA's...and going from a CNA to a PCT...I did see the problems. Personally I would turn the patients every 2 hours...but after all the added task the time just wasn't there.

lpnga · Mar 13, 2003

vsummer......not going to continue playing your games...so find someone else to be mad at...I am also a student for my pre reqs..

thanks for all the replys I was just wondering if other people have heard of pct's and what alll they did because in a different post everyone thought I was crazy....

No I don't know everthing about nursing...vsummer so i can't answer every med you ask but I can do alot of them.......

I am just happy that other people have heard of pcts and the task they perform...in the LTC i work in if we do...let a pt fall and break a hip....it's our fault.......not the RN or LPN we don't have enough nurses in out facility to take care of every pt

askater11 · Mar 13, 2003

vsummer what do you do in nursing? Are you an instructor?

DeniseLDRN · Mar 13, 2003

I was reading this thread and thought I would give my 2 cents....

My grandmother was in end stage renal disease and was to go for a Colonoscopy the following day. The doctor wanted her to drink the "go lightly" to cleanse her out. My grandmother drank some of the "go lightly", but then refused to drink the rest. At 3am that night 2 PCT's came into my grandmothers semiprivate room, and tried to force a NG down. Scarred the living crap out of my poor dying grandmother, and her roomate. The PCT's also left huge bruises on my grandmother arms and hands where they tried to hold her down, to get the NG in. MY mother and I were furious about the incident, my grandmother died a month later. My mother was going to do something about it, but was overwhelmed by grandma's death. I was very upset to find out that a PCT could place an NG, obviously more education is needed!

Deniseldrn