Pct refused delegation

Nurses General Nursing

Published

A couple weeks back I was caring for a very high maintenance patient with a new colostomy. I had taken care of the patient three nights in a row. On the third night when the patient was more stable physically I asked our PCT to empty the patient's colostomy before the end of her shift at 11PM. She refused. She stated that it was not within her scope of practice. I let her know that other PCTs empty them and she rebutted that if it came off she couldn't put it back on. Because ultimately I am responsible, I emptied the costostomy. At our monthly night nurse unit meeting I asked if it was outside the scope if practice for PCT's. I was told it wasn't and it was taken down in our meeting minutes so it could be clarified later. The notes are then turned into our manager. I don't think any names were used, but I'm sure if the senerio was mentioned infront of the PCT she would recognize the situation as the one shared between us.

Friday my manager called me on the phone and asked me about the situation. She said, "Deana (name changed) says you won't change patients or empty colostomies because it makes you vomit." Admittedly poop is my weakness. Some people are grossed out by sputum or vomit. I went to school who was grossed out by eye drops. Poop is hard for me. Ocassionly, I do dry heave. I try to do everything I can to be discreet about it, I even carry a small bottle of body spray in my pocket for super Code Brown situations however it does happen that I dry heave. I have never, however, vomited because of it and I most certainly don't clean up my patients to avoid it! Many times this PCT has helped me clean patients in the 3 years I've been at this position.

I'm really bothered by this. I would like to confront the PCT in the presence of our manager just do the record can be set straight. I don't know if it will just start all this to snowball. Should I just leave it alone. Or should I schedule a meeting.

I'm concern about here accusation and feel I must do something.

I think this is a common thing. I worked as a CNA on the floor that I work on currently as an RN... now from one CNA inparticular there is animosity as I have transitioned into my new role. It can often been seen that she hides her unwillingness behind her "inability" or passing off that now that I am an RN I don't do patient care (which is completely untrue, because patient care is my favorite aspect of nursing). And my reputations has been backed up by all of the other CNAs on the department. Although it is not right, often it is easier to do things yourself than argue with your aides. However, at least in my states, this is a delegatable task. If the PCT is unsure of how to complete the task she needs to seek the needed education to do her job. Good luck and sometimes making teamwork actually work is the biggest challenge.

Specializes in Acute Spine, Neuro, Thoracic's, LTC.

Funny, I just had this exact situation happen to me last week. I am new on a busy Med/Surg unit and was in a ward room hanging an IV med for one pet and having some pump difficulties. While I was in the room dealing with the IV and the pt(who had just been admitted right before the start of my shift) 2 of the other pt's in the room both rang their call bells to go to the bathroom. The Care aide came strolling in and spoke with one pt. and when she found out that she had a colostomy that needed emptying as well said " Your nurse in in here she will do that", "Care aides aren't allowed to do that" and started to walk away. The pt. yelled after "but I have to go pee too" the care aide pretended she didn't hear and started to walk out. I told her do you mind helping that pt. to her bedside commode and the care aide groaned but helped her. Meanwhile my pt. with the IV is getting nauseated so I am trying to help him. Care aide puts the first pt on the commode and starts to walk out again while the pt. in the bed directly beside her says " could you please help me to the washroom too" Care aide ignores her! The pt. repeats herself practically yelling and the care aide pretends she doesn't hear. I am at the bed beside them and tell her. Can you just help ___ pt to the washroom too. She just needs help with her IV pole. So she groans and does it.

The previous day that I worked the other care aide I was working with emptied the colostomy no questions asked. I didn't even have to delegate it to her she just emptied it and reported the output to me. I am new to this province so wasn't sure if things were different here... but where I lived previously in BC care aides emptied these all the time with no problem.

Specializes in Acute Spine, Neuro, Thoracic's, LTC.

Seriously though, it just makes me so mad. When you have care aides like this I would just as soon not have them there at all. This lady does absolutely nothing and I mean it. I have worked with some amazing care aides at my previous job and always appreciated them immensely however at this place they all seem to have this contempt for the nurses and don't want to lift a finger. The same lady and her co-worker were on again the next night and I had a very confused pt trying to climb out of bed that was placed in the hallway (he can't stand) and I had just arrived on shift. I had been given an admission the min I walked in and had 2 other pts on heparin drip and having PTT's done. Meanwhile this pt. will not stop climbing out of bed and the care aides are just moseying around wiping down counters and looking at me. Won't even offer to help. I asked this lady if she could watch him for a few mins so I could go do my assessments and she sort of groans and stand by him . But when I look out his legs are flung over the side rails and she isn't doing a thing just sitting there playing a game on the computer next to him.

Seriously I'd rather they weren't there at all. Its more work just trying to delegate and manage these people that just to do it myself.

I always chart whatever happened out of the ordinary in the patient chart (without pointing fingers) but "RN emptied colostomy,....." then in my own private files at home to document what the issues were with difficult staff, and then I usualy leave a note for the head nurse, specific to the issues, so that when the difficult person comes in with all the he/said she said crap, there isn't much wiggle room, I charted I did it, and I told the head nurse you wouldn't do it. end of story. Gotta get them before they get you.

A weak spot is a weak spot, be careful who you share them with.

A weakness can always be used against you and skewed to fit the situation.No one is all strong and without a weakness,we just have to be careful who we share them with.

Specializes in Emergency.

Sounds to me like a manager is dodging a problem employee who needs to be have counseling on failure to preform duties as assigned. It doesnt matter that the why the nurse is delegating the task, just that 1) its in the scope, 2) there was a blatant refusal to do the task and 3) a continued disregard and respect for a superior.

lilaclover in Canada- your description sounds exactly like many of my shifts over the past years Glad to see there is not much different in the PCT/CNA/Care aide's poor work ethics across the borders- lol. It must be a 'international hand book'. Don't you love it how they think they are so clever and no one will ever catch on to them because they are the only ones who know this work evasion techniques.- They are soooo BUSTED!!!:lol2::D:lol2:

Their tricks and techniques to practice their scope of poor work ethics could be a whole new web site

Specializes in Critical Care.

PCT was being lazy and using the I don't know how excuse to get out of it! Then when confronted that she was wrong during the staff meeting, she decided to cover her but by turning it on you and blaming you that you didn't want to do this.

You should let your manager know that she refused a direct request from you, was basically insubordinate. She managed to get to the manager first to turn the tables around and blame you when she was actually in the wrong! A tactic guilty, lazy, manipulative people are prone to doing!

Speak up for yourself and let the manager know you work as a team but this tech defied you. Unfortunately, this is common in nursing. I've had this happen to me, they listen, then you find out later the work was never done. It is very frustrating! Many times I have to literally take the CNA's by the hand to make sure things get done; otherwise patients won't be cleaned up or turned.

Don't back down! Don't let the CNA have the final word! Make it clear she is there to help and you have the right to delegate and if she refuses she is being insubordinate!

Manate111- it sound like you are getting endocrinated into the world of dirty unit politics- Where the aise changes the story to make you look likethe bad guy- shame on you for making that aide do her job for her hourly wage.

I have more than one aide tell me to do it because I was paid more than them, I have had aides and LPN's change their story around for what ever reason suits their hierarical purpose- they just don't feel like they want to do it. I've had an aide tell me tell me at the end of the shift- she left me a foley bag to empty as she left out the door on time, I was left to do all the charts( she couldn't by law) and that foley( which she can by law). Next time I worked with her I emptied all the foleys and asked her Is there anything else you need me to do for you?? She knew I was being a smart a**, was putting her down to the level of not being able to do her job and it was not ment to be nice or helpful. I have also had a patient with their call light on, aide ignoring, my having to ask- can you give this IV lopressor while I answer the call light? her response was"Oh, were not allowed to give that!!" I responded "MY point exactly!!" I needed a stat EKG done last week- the aide sat there and continued to do her homework. I stood there asked again, and continued to stand there as she continued her homework- I asked her- Is the homework almost done because this guy really needs this EKG. Now if these aides had half the knowledge base they give airs about themselves they do- wouldn't they recognize the urgency of these requests. Their poor work ethics give them away. As for the changing of the story-maybe confronting her would be the best thing- but them she may just make your life more miserable and tell a bigger lie, like you were mean and abusive to her, which would get you in more trouble. If you say something to her infront of witnesses like- "in the interest of good customer satisfaction....answer light promptly" she could come back and say you embarassed her infront of a group, Or you could bring it up at you night nurse meeting as a generic situation, give the proposed corrective action - "in the interest of good....... we need to answer lights promptly so we don't increase our patient complaints on OUR shift" How long have the NM and this aide been working together. Does this NM backup and support her/his nurses? It's a tough job and it's not the patient care that's tough.

I am working as a tech in the critical care setting to put myself through RN school, and we are even allowed to put in Foleys. However, on the floor, the regular techs can't do catheters, but they can DEFINITELY empty ostomy bags, and I'm pretty sure they can change the bag if needed. That tech is just lazy. I don't think you should confront her about it at all. I do think, though, that each time you work with her you should ask her to empty ostomy bags, change linens, and clean up EVERY code brown you come across. Confronting her won't keep her from talking bad about you. And, if she's gonna talk smack about you, might as well give her a reason to. :)

maybe she is playing you, but there is also a chance that she has never emptied one.

show her a 1:1 (including changing one) so after, she can't use that as an excuse again.

as soon after you learned she tried to hang you, i would've put it all in writing from start to finish.

keep a private diary for yourself, as well.

leslie

Specializes in ER.

Agree with the assessment that she just tried to get her story to the unit manager first. I would respond in writing. The manager might be looking for both sides of the story. I would do anything to work with no pcts and just do all the care for all of the patients myself for this very reason.

Had a tech tell me she couldn't take vital signs because it was outside of the scope of her practice too. Had another start an iv on a patient, hook up to cardiac monitor and leave diaper for me since she wasn't sure that was in her scope either. (she said maybe I wanted to check skin first. Lingo, right?)

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