PCT Interview With Staff RN's

cdsavannah59, CNA · Feb 27, 2014

Sorry Stephalump and funtimes but I disagree with your ideas of who directs you on patient care. I consider every RN on my floor my boss if I am assisting with their patients. I am the only tech on the shift on a 25 bed floor and we all work together to make our unit run smoothly, and if I am assisting one of their assigned patients, then the RN has every right to direct me on the patient care needed for her patient . Maybe it doesn't make her my boss but it makes her in charge of the situation. , if you don't have the time to help the RN then tell her so, but like it or not she is in charge of your actions if your assisting her patients.

funtimes · Feb 27, 2014

Sorry Stephalump and funtimes but I disagree with your ideas of who directs you on patient care. I consider every RN on my floor my boss if I am assisting with their patients. I am the only tech on the shift on a 25 bed floor and we all work together to make our unit run smoothly, and if I am assisting one of their assigned patients, then the RN has every right to direct me on the patient care needed for her patient . Maybe it doesn't make her my boss but it makes her in charge of the situation. , if you don't have the time to help the RN then tell her so, but like it or not she is in charge of your actions if your assisting her patients.

The RNs you work with may be in charge of the patients they are assigned to, and can veto you regarding the care of that patient, but that still doesn't make them in charge of you. They have no say over what you do with a patient they are not assigned to. Now if they have a problem with how you manage your time they can go to the charge or a unit manager, but then again so can anyone else. A tech could go to a charge nurse and say this one RNs wasting too much of my time and other nurses and patients are suffering, not that I've ever done that.

On some units, its probably worse to get on the bad side of an experienced, well liked and trusted tech than it is a relatively new RN. Its not about some power struggle though. An RN license involves more training and education than whatever requirements techs have, but ultimately everyone has to work as a team. You cant go having LPNs and RTs and phlebotomists and PCTs and PT arguing over who is in charge of the other based on how much education they have, they all have their job to do and their own boss to answer to.

I'll also add this. The notion that every RN automatically knows everything a tech does and a lot more isn't necessarily right. How many times have you had to show a new RN how to use a hoyer lift or give them tips on something else. Heck Ive had to stand there and basically supervise a brand new RN cathing someone or doing trach care because they weren't sure of themselves doing it and wanted someone with more experience to help.

LadyFree28, BSN, LPN, RN · Feb 27, 2014

A nurse IS considered a supervisor over CNAs; it doesn't matter if they don't know certain skills if they are "new"; also, everyone doesn't necessarily have the same equipment everywhere :no: ; the fact remains, when you are working with a nurse, and one decides to play the "power struggle"or rather, the "knowledge" struggle, one can be terminated for insubordination; I have witnessed this happen to a very valued CNA when she exhibited repeatedly undermining a nurse she felt wasn't "knowledgable", even call her "stupid; well, she was out the door while the nurse stayed, despite her "knowledge".

cdsavannah59, CNA · Feb 28, 2014

Great response FreeLady28. The most important thing we were taught when training to become a PCT/CNA was that we report to the RN. To me report to means In Charge- chain of command. Don't matter if your working with one RN or six of them.

kenya1005 · Feb 28, 2014

The rn is not my "boss" however they do have a lot of say in what tasks I perform and in which order. My nurses love me and its because I've learned how to baby them (sorry it's true lol) I know that one nurse wants her baths done early early, one nurse wants her blood sugars done with vitals whether the patient has ordered food or not, one nurse wants her patients up in the chair right away. I do all of things regardless, but I prioritize my tasks depending on who the nurse is. Having a good relationship with the nurses is crucial. If you don't, good luck ever getting hired on as an rn when you finish nursing school if that's your goal. Only the team players make it long term where I work.

funtimes · Feb 28, 2014

A nurse IS considered a supervisor over CNAs; it doesn't matter if they don't know certain skills if they are "new"; also, everyone doesn't necessarily have the same equipment everywhere ; the fact remains, when you are working with a nurse, and one decides to play the "power struggle"or rather, the "knowledge" struggle, one can be terminated for insubordination; I have witnessed this happen to a very valued CNA when she exhibited repeatedly undermining a nurse she felt wasn't "knowledgable", even call her "stupid; well, she was out the door while the nurse stayed, despite her "knowledge".

I think working in a nursing home is different from working in a hospital in this regard. In a Nursing home a CNA will usually have ONE RN who has all your residents, which means that RN should understandably have a lot more say in how you manage your time and do your work. In a hospital I see it as more collaborative, because you are working with multiple RNs at the same time. In some cases you may start out your shift with one group of RNs, and halfway through another group comes on. You may also have RNs who are floating there from another unit or float pool. Its a lot more chaotic and confusing for the techs, who have to try to make order from the chaos.

As for CNAs/techs intentionally undermining new RNs. This shouldn't be tolerated between any employees, whether its RNs doing it to RNs, RNs doing it to new techs, or techs/CNAs doing it to new techs/CNAs(which happens a LOT, especially in nursing homes). Personally I think these employees are the absolute worse kind and can be like a cancer, with their attitude spreading until a place becomes almost intolerable for any new employee.

LadyFree28, BSN, LPN, RN · Feb 28, 2014

It doesn't matter the setting...at my acute care job it was explicitly stated that RNs are considered supervisors and leaders: we have within the scope of practice in our license to supervise others; we have the option to write people up if they insubordinate; most of the time, nurses will go through the chain of command to ensure proper policy.

It is what it is...I've worked in various settings, and the example I gave was not in a hospital not nursing home; again, in nursing, as licensed nurse supervises and is a leader and delegates unlicensed personnel; it is in out nurse practice act as well as in our job description. Having a RN have decision making is NOT the end all or "not required"; because of the nature of our role, it is required, regardless if one lacks knowledge in "tasky" skills; there are far more reaching knowledge that takes more skills than tasks; leading is one of them.

funtimes · Mar 1, 2014

It doesn't matter the setting...at my acute care job it was explicitly stated that RNs are considered supervisors and leaders: we have within the scope of practice in our license to supervise others; we have the option to write people up if they insubordinate; most of the time, nurses will go through the chain of command to ensure proper policy.
It is what it is...I've worked in various settings, and the example I gave was not in a hospital not nursing home; again, in nursing, as licensed nurse supervises and is a leader and delegates unlicensed personnel; it is in out nurse practice act as well as in our job description. Having a RN have decision making is NOT the end all or "not required"; because of the nature of our role, it is required, regardless if one lacks knowledge in "tasky" skills; there are far more reaching knowledge that takes more skills than tasks; leading is one of them.

Let me give you a typical scenario. I have 17 patients divided between 5 RNs. My shift started at 1500 and everyone on that unit is at least q4 vitals which must be completed between 1530 and 1630 per hospital policy(ideally they are all done by 1600), it is the techs responsibility to check vitals for the patients for which they are assigned. I have 2 post surgical patients, one who is due for their final q15 vitals and the other their second q30. In addition I have 2 patients that need to be bladder scanned and possibly cathed at 1600, 2 Q1 glucose checks, one due at 1530 and the other at 1600. I have 4 q2 turns due in that time span, 3 of which are probably incontinent and need to be cleaned up and possibly have their bedding changed. In addition a meal tray arrives for a patient who needs to have their BGL checked prior to eating. In the midst of this an admit just came up with the RN failing to notify me prior, but the RN now wants the patient weighed, vitals obtained, an IV pole and a walker for the patient, who moves slower than molasses and wants me to take them to the BR right this second. Meanwhile 3 call lights are going off and a patient is being discharged and needs their IV DC'd, their belongings packed and a wheelchair found.

Guess what, none of the RNs I work with are going to volunteer to manage my time for me, or even have any idea all the "tasky" things I have to complete. All they know about is their individual patients. That's why its expected that the tech knows how to and is able to manage their time where I've worked. This inevitably means you are going to annoy some of the RNs you work with. You have to weigh the consequences of that with the consequences of your shift turning into a disorganized train wreck. I will usually error on the side of annoying a couple nurses, which is why I've never made any serious mistakes that got me fired, the hospital sued, an RN disciplined, or most importantly a patient killed.

Kandy83 · Mar 1, 2014

"Unlicensed assistive personnel (UAP) is an umbrella term to describe a job class of paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs) and provide bedside care — including basic nursing procedures — all under the supervision of a Registered Nurse, Licensed Practical Nurse or other health care professional."

LadyFree28, BSN, LPN, RN · Mar 1, 2014

Let me give you a typical scenario. I have 17 patients divided between 5 RNs. My shift started at 1500 and everyone on that unit is at least q4 vitals which must be completed between 1530 and 1630 per hospital policy(ideally they are all done by 1600), it is the techs responsibility to check vitals for the patients for which they are assigned. I have 2 post surgical patients, one who is due for their final q15 vitals and the other their second q30. In addition I have 2 patients that need to be bladder scanned and possibly cathed at 1600, 2 Q1 glucose checks, one due at 1530 and the other at 1600. I have 4 q2 turns due in that time span, 3 of which are probably incontinent and need to be cleaned up and possibly have their bedding changed. In addition a meal tray arrives for a patient who needs to have their BGL checked prior to eating. In the midst of this an admit just came up with the RN failing to notify me prior, but the RN now wants the patient weighed, vitals obtained, an IV pole and a walker for the patient, who moves slower than molasses and wants me to take them to the BR right this second. Meanwhile 3 call lights are going off and a patient is being discharged and needs their IV DC'd, their belongings packed and a wheelchair found.
Guess what, none of the RNs I work with are going to volunteer to manage my time for me, or even have any idea all the "tasky" things I have to complete. All they know about is their individual patients. That's why its expected that the tech knows how to and is able to manage their time where I've worked. This inevitably means you are going to annoy some of the RNs you work with. You have to weigh the consequences of that with the consequences of your shift turning into a disorganized train wreck. I will usually error on the side of annoying a couple nurses, which is why I've never made any serious mistakes that got me fired, the hospital sued, an RN disciplined, or most importantly a patient killed.

You are responding to someone so has been a Tech, a LPN an now an RN....most of the time I worked together with a nurse, slow or not...I RESPECTED the role that if they delegated something to me, I did it; regardless of how they practiced; I had to do it, and it got done, even if I was in the middle of what I needed to do, the expectation is in my role to do what is needed.

Now, I worked with a few nurses where I felt I could do their job better-and I did, by becoming a licensed nurse. :)

pookyp, LPN · Mar 1, 2014

When I was a CNA the lpn or RN was my boss. They had the power to send me home and tell the DON later.(I worked nights) I always thought it was a given that a tech works under the nurse/nurses on said shift.

kenya1005 · Mar 2, 2014

Ladyfree rns cannot write up techs in my hospital. Even the charge nurse can't... only the manager can. With that being said, if an rn goes to the manager with a VALID complaint, the manager will write the tech up lol.