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RN's in my ED are having a problem with a tech, need advice

So, I am currently working in a small ED. Prior to this ED, I have worked in a Level 1 Trauma and a SICU prior to that. I love being an ED nurse. I like the slower pace this facility has to offer. However, there are a few issues that I am having a hard time with. We have a tech that is PRN that works about 24hr/wk. She has her EMT-B, which is great for her cuz she does this full time. She really enjoys it. However. Her work ethic as a tech is horrible in the ED. Here are a few examples. She will document a patients heart rhythm or chart a critical lab value, or put in verbal MD orders, take out IV's, flush IV's- all of which are not with in her scope of practice at this facility. After being told multiple times, she still continues to do so. That is not just it. The techs in this ED work hard helping the patients and helping the nurses keep the patients safe. They can do EKG's, vitals, assist pt to the rest room and transport to the floor. She is the exception to this. She really thinks she is above the RN's level of knowledge. Multiple RN's have to ask her multiple times for help. Like, "Hey, HER NAME, can you get an EKG,Vitals or run pt in room 3 up for me while I give report to the accepting hospital." Her response is, "Why can't you do it?" As she is on her phone. Recently I asked her to get an orthostatic on a pt. She started w the pt sitting instead of laying. I seen it and corrected her and said no, they have to be laying flat, then sitting and then standing. She told me in front of the pt, "You do it then." All the nurses have encountered this with her. She won't even acknowledge you if you ask her for your help, it is like it's an inconvenience she is there. And she is rude to the patients.

She also thinks and says RN's know nothing and could never make it in an ambulance because we rely on doctors. She says, she doesn't need any doctors order to do anything as a Basic. Also, Flight RN's only do paperwork and it is the medics who run the codes. (Flight Nurses are very,very knowledgeable and so are Flight medics. Hello, they take ECMO and IABP pt's)

Little does she know, most of the ED RN's are ECRN because we are medical control for the surrounding hospitals and in order to have your ECRN, one must take the protocol test for BLS, ILS, and ALS. The Protocol books for the surrounding regions are by the call radio for EMS. So, really, her scope in the pre-hospital world is very limited. It is all protocol. But she doesn't see the point. That is out in the field, and her ED tech job is in the hospital.

Now, you are probably thinking, tell your boss. In fact we have, many times. No corrective action has ever been taken. IF she spoke to her, nothing has changed from it. It is hard to work with someone like her. It is not safe or effective care the patients are getting. They are having to wait longer for the nurses who are busy doing her job and then trying to do everything else. She refuses to keep up on protocol vitals. The other techs and nurses show up to work to care for patients.

Our boss knows about it and since she is a new boss, she has not done anything to change it. Should I go to the next chain of command?

What are your thoughts? How would you feel? What would you do in your ED?

Thank you!!!

Go up the chain of command. Include your direct supervisor in the conversation.

Have you considered using the incident reporting system to document instances of unsafe, delayed, or omitted care as a direct result of this person's behavior?

NurseOnAMotorcycle, ASN, RN

Specializes in Med-Surg, Emergency, CEN. Has 10 years experience.

Also I would tell her "never touch my patients". And I would know that this means I'm all alone to take care of my patients and plan accordingly. In this case, I think it would be completely worth the extra work.

EDNURSE4LIFE

Specializes in Emergency, CVICU, PICU, NICU, MICU, SICU. Has 17 years experience.

When I was a staff nurse we had similar issues with a tech. I will tell you what we did and the outcome.

Little background......

We had a tech that was ACLS certified...they could not preform CPR for the life of them

They thought that the MAP was the heart rate

They felt it was appropriate to give patients their personal information

Would unhook pts from the monitor without checking with the nurses

Complete nursing assessments and leave the RN for the pt a note about her findings

Plus many many more

Here is what we did.....

We kept detailed logs of the issues (dates, pt initials, and the issue)

What we advised the tech about the issue

The response from the feedback given to the tech

The issue that you have is that when it is busy it is hard to keep an eye on the "bad apple" so we had to find a few techs that are awesome and felt that this person was also a "threat" and asked them to help "keep and eye" on them

Three of us (2 RN's and a Tech) plus a charge nurse that was on board with this tech being a safety threat scheduled a meeting with the manager and showed her the information that we had collected and basically this tech was written up and was required to be retrained for 12 weeks. The tech was assigned to a tech and 2 nurses for the night and the nurses basically had to supervise them for a few weeks and the simple duties like stocking linen was OK for her to do but anything that was pt related she needed an escort.

She lasted about 6 months after the write up and changed floors. After the second orientation and working closely with just a few nurses they seemed to improve.

Sorry that this was so long..... Hope it helps

MedicFireRN

Specializes in Emergency Department, ICU. Has 7 years experience.

Yeah I would escalate that up the chain of command until you get an appropriate response. What about risk management? That's a huge safety risk.

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

You have a boss problem.

It sounds like you have a problem with the tech...

Just follow up with your chain of command.

Also be open-minded I know techs don't have all of the education RN's do but she's seen a lot too...

In fact she's probably learned from watching you...

If her work ethic is as chintzy as you say - allow the big dogs to deal with it.

This is scary. I would never stand for that.

Thanks.

She has a problem with everyone. Some nurses she is really nasty to, me not so much. I have just learned to not ask her for help. I just let her sit and play on her phone.

Bobjohnny

Specializes in ER.

Something I point out to my staff is, please don't just talk to me about it. Send me an email, then I have written documentation. Without that written documentation, I can't do jack squat. Make sure that you do it, it makes our job a million times easier.

"Boss,

Just as a follow-up to our discussion earlier...."

What else is she doing that your not seeing?

I would bring it up on chain of command. Talk to her document it. Bring it to charge or if your charge write her up. I know you have alot of work to already do. But she is working under your licenses. Hell I would do like stated above Ill take care of my own patients or better yet an incident report will be written every day I worked with her. They cant just ignore incident reports. Theres a reason for them.

Patient safety is ultimately number one. Also your licenses.

You have a boss problem.

At this point the tech is just a symptom of your real problem. A boss who is lazy, incompetent, or just doesn't give a crap.

Pheebz777, BSN, RN

Specializes in ICU, CVICU, E.R.. Has 18 years experience.

Someone like that is a liability to your unit. She does not see the legalities of her actions. If any legal issues were to happen in your E.D. every staff involved will be examined and cross examined and every staff's scope of practice will be brought up. Even if her intentions were good and nothing happened directly related to her involvement, any prosecuting lawyer will use that as evidence of questionable practices within the E.D. They'll do anything to discredit your E.D. when the time comes. Believe me, I've been to 2 depositions and they will grill you down to the last detail.

Besides going up the chain of command and doing the appropriate documentations needed, for the time being I would try to belittle her ego.

I've dealt with people with attitude problems in the past. If she tells me to take the ortho's I would tell her out right, "Ok, I'll show you how to do it, watch and learn!" That way you'll know how to do it next time." That would really blow a hole in her ego. lol

If she tells me, "Why can't you do it?", I'd narrow down her choices for her, "Ok, it's either you give a full detailed report to the floor, make sure you know all the labs, the meds given, the MDs on consult, update the patient vitals and I'll do the EKGS." "what will it be?"

Instead of "ordering" her to do specific things (I guess that's how she sees it when you ask her for help), give her choices that she herself chooses to complete.

Edited by Pheebz777