RN vs Ancillary Staff

Blee O'Myacin, BSN, RN · Jun 29, 2006

but if a patient is desatting, we put on the 02 and then call the doc. I would have done the same as you.

Not to be nitpicky, but I consider RT and PT my peers as far as the pecking order. Ancillary is just that - CNA's, unit clerks, environmental. I could be incorrect, but that is just how its broken down where I am.

We had to sit through a two hour seminar on how to speak nicely to your "internal customers" and "external customers"... sounds like some people where you are need this...LOL

Just kill 'em with kindness....

Blee

This is a real big pet peeve of mine. This happened to me last week and I wondered if anyone else has been in this situation...
I had a patient who was admitted with diagnosis of GI bleed, low H and H, pending transfusion and GI procedure. The o2 sats were borderline low so I started the patient on 2 liters via NC. I was discussing this patient in the nurses station with my charge nurse when an RT overheard and threatened to "report me". My CN and I both thought he was joking but he said "you need an MD order to start a patient on oxygen!"
Despite our clarification that we did nothing outside of the scope of our practice, he remained adamant. It was a fruitless arguement. NEXT!!!!
PT returned a patient from the gym demanding that a patient be medicated for pain with MS prior to therapy. Patient is sitting in the hall in a wheelchair overhearing this conversation. Patients nurse explains that the patient has a documented allergy to MS and had been premedicated 30 minutes prior. Again a "I'm telling Mom!" threat verbally made to nurse. UGH. NEXT!!!!
It seems to be happening more frequently and I was wondering if there isn't a lack of knowledge on the part of ancillary staff regarding the RN's duties and authority. Just curious...

prmenrs, RN · Jun 29, 2006

I, too, would view [Registered] PTs and [Registered]RTs as fellow professionals, not as ancillary personnel.

It is, however, inappropriate to discuss stuff like in front of the pt. As for the RT, I'd have told him to go ahead and report me--the pt wasn't sating. Did he plan to wait for the code??? Of course, then I wouldn't have professional, either.

banditrn · Jun 29, 2006

Where I worked, it was a nursing judgement. Of course, if this was a new thing with a patient, I might call the doc to tell him that the patient was having a problem.

Can you imagine a doc's response if you called him to tell him the patients sats were dropping - is it OK if I put O2 on them?

I do know that if you leave the O2 on, you will need to write an order at some time because that's the only way it will be paid for.

UM Review RN, ASN, RN · Jun 29, 2006

You're wondering if there's a lack of knowledge about the RN's duties on the part of other departments? I'd have to say from these two examples that their lack of respect for the nurses is pretty blatant.

You and the other nurses need to stop this disrespect of the nurse's function dead in its tracks. You, the RN, are the manager of care for the patient. Let them have at it when they threaten you. Don't be afraid to stand your ground. YOU are the licensed professional who is responsible for this patient's care, not them.

We don't need an MD order to keep a patient's sats above 92%. So the RT who threatened to "report" me would've been blowing smoke. Our RTs also are very prompt and very helpful, so we would've collaborated on an appropriate response to help the patient. Even a CO2 retainer wouldn't be hurt by some O2 @ 2L, so I really don't see what his problem was. Did you ask him why not? And if he didn't volunteer any logical answer, I would've had to simply ignore him--or report him, depending on how obnoxious he was being. While I certainly respect RTs, RTs simply do NOT have all the information about a patient, and ultimately, I am responsible to that patient.

I would've gotten a tad testy with the PT person. I don't really care how much education they get, they're not qualified to dispense medications.

The PT simply doesn't have the medical knowledge base that you do. This exchange really should be reported because not only was the PT completely out of bounds to tell you what medication to give the patient (practicing medicine without a license now, are we?), he/she behaved in an unprofessional manner when this whole scenario was discussed in front of the patient.

Furthermore, if I was the patient who had an allergy to something, you'd better bet that there'd be bad things happening for the entire hospital if you caved and gave it to me anyway.

Next time, just smile sweetly and say, "Honey, if you want him to have the morphine so badly, why don't you just order it and give it--and appear in court over it later" and walk away.

Jo Dirt · Jun 29, 2006

I believe that oxygen is considered a medication, but where I worked in LTC there were standing orders to apply O2 per nasal cannula to promote comfort.

Empress · Jun 29, 2006

You and the other nurses need to stop this disrespect of the nurse's function dead in its tracks. You, the RN, are the manager of care for the patient. Let them have at it when they threaten you. Don't be afraid to stand your ground. YOU are the licensed professional who is responsible for this patient's care, not them.

RTs and PTs are LICENSED PROFESSIONALS as well, and are held responsible for their patient's care in focused areas. The 2 people mentioned in this thread did act unprofessional, I am not denying that, but in a way they were trying to advocate for their patient, which in this case was half-cocked.

You want respect for nursing? Then give it back tenfold. Respect your new and old nurses. Respect the physicians. Respect all the different areas of healthcare including PTs, RTs, and EMTs. Stop tearing them down with "them versus us" thinking, and please don't judge a whole group by random stories. Judge a person by their individual actions, not a profession by one member.

vamedic4, EMT-P · Jun 29, 2006

Yeah...what she said!!!!!

PANurseRN1 · Jun 29, 2006

The PT simply doesn't have the medical knowledge base that you do. This exchange really should be reported because not only was the PT completely out of bounds to tell you what medication to give the patient (practicing medicine without a license now, are we?), he/she behaved in an unprofessional manner when this whole scenario was discussed in front of the patient.

Wow, is that statement ever untrue. PTs have a minimum of master's degree, and the move now is for doctoral degrees. So let's try to have a wee tad of knowledge about our colleagues' educational levels.

I agree that referring to PT and RT as "ancillary staff" is very disrespectful. They are no less important than nursing.

That said, disagreements about pt. care should be discussed privately and in a respectful manner.

UM Review RN, ASN, RN · Jun 30, 2006

RTs and PTs are LICENSED PROFESSIONALS as well, and are held responsible for their patient's care in focused areas. The 2 people mentioned in this thread did act unprofessional, I am not denying that, but in a way they were trying to advocate for their patient, which in this case was half-cocked.
You want respect for nursing? Then give it back tenfold. Respect your new and old nurses. Respect the physicians. Respect all the different areas of healthcare including PTs, RTs, and EMTs. Stop tearing them down with "them versus us" thinking, and please don't judge a whole group by random stories. Judge a person by their individual actions, not a profession by one member.

Empress, I never said they were not licensed professionals. I did say that they both overstepped their bounds. The nurse is the licensed professional who is the manager of care for the patient and the one legally responsible for the patients in both of the scenarios cited by the OP.

I'm explaining this to you because I see from your profile that you are a nursing student.

This thread was not about the nurse having problems respecting the opinions or considering the suggestions of the RT or the PT.

This thread was about coworkers who disrespect the nurse's role--perhaps because of ignorance of what the nurse's role is--and who try to bully the nurse into doing something that they themselves are neither qualified nor have the authority to do.

If they truly had that authority, they would've been able to veto the nurse's action and take that patient off the O2 or prescribe and dose that allergic patient up with Morphine.

Yikes. I shudder at the thought.

Would the RT know that a patient with a GIB has less Hgb, and therefore less O2 in the blood, therefore is a candidate for cardiac arrhythmias without supplementary O2?

No. Why? Not in his scope of practice.

And I'm not even gonna get into the PT, who was so far out of bounds, the OP should've reported HIM. :trout:

No, to put it a different way, the OP wanted to know if these scenarios could have been prevented if her coworkers fully understood the nurse's role and responsibilities.

I'd have to agree that some education is in order for your coworkers, OP.

But far more important than learning what nurses do, they need lessons in courtesy and respect.

PANurseRN1 · Jun 30, 2006

I'm so sorry you work with such inept colleagues, Angie. The RTs I work with would have definitely known that. I don't consider a PT's request that a pt. be medicated prior to therapy, either. The way it was presented was inappropriate, though.

RT+RN · Aug 8, 2006

I have to put my thoughts in on this one as I was appalled by the comment by Angie O' plasty.

In regards to this ignorant comment:

**"Would the RT know that a patient with a GIB has less Hgb, and therefore less O2 in the blood, therefore is a candidate for cardiac arrhythmias without supplementary O2?

No. Why? Not in his scope of practice."**

WRONG, WRONG, WRONG!!! I take offense to this comment as I still practice Respiratory Care.

The RT would and should know that the patient with the GIB will have less Hgb, and honey common sense tells any Health Care Provider that it directly correlates with the SAO2, SaO2, and SPO2(go ahead and look those up so you can respond). As far as the cardiac arrhythmias, what do you think the RT does with that copy of the ekg they did. They know that O2 consumption and availability will affect the heart.

So... YES it IS in the RT's scope of practice! They should have reviewed that patients chart ask the director of any respiratory dept. they wil tell you the same.

As far as taking a little longer to respond, some nurses still dont get it! The RT does not have a ratio, in very few hospitals are the designated to just ICU, CCU, Med/Surg, Tele, and so on. They have patients on different floors on opposite sides of the hospital and ER calls. Now add a couple vents on top of that and a nurse calling for a spot check of the SPO2, EKG's, or even just to put a patient on a damn NC when its sitting there still unopened at the patients bedside, and they have to respond to every code in the entire hospital.

Organized Chaos!

Remember the next time you page an RT because the vent is alarming and they're a few minutes late, they have 20 patients and that code they just finished doing compressions and bagging for 30 minutes, yet they still come as soon as that MD calls the code and despite the fact that they're forearms are shaking and weak, while you're ordering lunch and getting ready to write them up(doesnt that sound familiar?), they dont/wont throw in your face that its not a respiratory issue that the vent is alarming it was just time for his ativan!!!:angryfire :wakeneo: