Teamwork...Why do we do this to ourselves?

[Beachbum671]

If I may vent for a moment.....the other day, as I was perusing through the usual social media sites, I cringed as I came across a post written by a Patient Care Technician (PCT) who works in a clinic I used to manage. She stated how good it felt to know her patient trusts her more than any of the RNs on the floor. Below this post were numerous other comments from other technicians applauding this and detailing other discussions they've had with patients about this same thing. "RNs are really only there for the license and to pass meds" (double cringe).

As an RN of almost 15 years now, this is certainly not the first time I've heard of this. I've heard it and experienced it many times before. Regardless, I have a great respect for LPNs and unlicensed professionals such as CMAs, CNAs, EMTs, and PCT. They are some of the most skilled, competent, and fast-on-their-feet individuals I've known. They were especially invaluable to my learning as a brand new nurse on the floor. In many specialties, an RN will spend a great deal of their orientation with them due to their technical knowledge and skill.

While the contention that exists sometimes between licensed and unlicensed personnel is an issue as old as time, my frustration is not with the viewpoints on the unequal division of labor, or who is more skilled/knowledgeable, or even who works harder. My issue is when we encourage these thoughts, discussions, and ideas with our patients and other team members---oh yes... and now on social media?? With the number of medical errors reported across the country and the negative media attention health care organizations and healthcare professionals receive for "incompetent care," we just can't afford this attitude and behavior. It undermines teamwork which ultimately undermines the quality and safety of the care we give our patients. More importantly (whether we realize it or not) it undermines the trust of our patients have in us as a department, unit, clinic, organization, and industry. Can we not lift each other up and support each other...especially in front of our patients?

[mirandaaa]

I don't understand the competition between healthcare staff altogether. Between docs, nurses, and unlicensed professionals. It just doesn't make sense. Everyone is there with the same goal in mind: heal people, make people better.

Everyone has an important role and they're all different.

I will also say, speaking in such a way on social media is definitely grounds for some disciplinary action though. It makes the facility look bad to anyone outside looking in.

[Purple_roses]

Wouldn't a PCP want to reassure the patient that he/she is in the best hands? Insinuating that an RN can't be trusted as much does nothing for the patient's emotional state.

[ktwlpn, LPN]

Have not been to a clinic or physician's office yet in which all the staff did not masquerad as RN's

[nursel56]

The thing that is more concerning to me than the insecurity-based need to put others down or trash-talk on social media is that the statement implies that there was a discussion between the PCT and the patient about who the patient "trusts more".

It is an unusual thing to say when talking about a clinic, where most conversations regarding assessment are one of the few things most states prohibit unlicensed personnel from engaging in.

Whether an inpatient floor or a clinic it is absolutely wrong for anyone working in healthcare to undermine another member of the team.

[icuRNmaggie, BSN, RN]

I would not hesitate to send screenshots of that post and the replies to the top administrator, preferably a nurse, at my former place of employment.

I would express that I found the derogatory remarks about the Nursing profession very offensive and that this lack of judgement reflects poorly on the clinic as a whole.

[jadelpn, LPN, EMT-B]

And as a gentle reminder--LPN's are also licensed nurses. We do not "work under the license" of an RN. And some have encountered the same kinds of issues as you are describing, OP.

I have another thought process. Due to insufficient staffing, or staffing patterns that don't "work" for a licensed nurse, many nurses are delegating skills to PCT/EMT/CNA's that they perhaps should not be, or that they don't have the time (nor energy) for. This certainly gives an UAP a sense of "doing the nurse's job". And for some, that (incorrectly I might add) gives them a sense that they are the "nurse".

We have CNA's who have specialized and are certified to the point of giving medications, ambulating and otherwise assessing function as far as movement, assessing skin, monitoring output, doing fingersticks.....lots of things that a primary nurse would usually do themselves, as to intervene themselves with the results of same. That certainly gives a sense of what drives UAP's to believe their job is much more than it has classically been.

With all that being said, there is no one better than a CNA to inform the nurse on something "not being right" with the overall patient. Because of the sheer amounts of time a CNA will spend with the patient (or resident) they are key to catching something before it becomes an acute and/or overwhelming issue.

A good CNA/PCT/EMT is worth their weight in gold. It is administration and cost cutting measures that heap a whole lot of responsibility on increasing the function of UAP, and interestingly, at the responsibility of the licensed nurse.

[Beachbum671]

"Have not been to a clinic or physician's office yet in which all the staff did not masquerad as RN's"

I had a conversation with my great-grandmother about a similar issue. She is worked as a midwife during WWII. She remarked that it is so difficult to distinguish nurses these days. In her day, you always knew a nurse by her uniform and cap ��

[lindarn]

And that, I might add, is done on purpose, so patients think that they are being cared for by licensed, educated, professional staff, when in reality, they are being cared for by HS dropouts.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

[SierraBravo]

What really bothers me is when people don't fully understand the scope of their role, or when they think that their role is more than it is. I have known PCT's that have "in their own mind" believed that they were more important or had a wider scope of practice than a RN. This poses a problem on multiple levels.

Here's the fact of the matter (and I know I'll get grief over this statement)... In a hospital, PCT's are not necessary but nurses are necessary. Why, you might ask? Well, a nurse can do EVERY aspect of a PCT's job, however, a PCT can NOT do every aspect of a nurses job. Therefore, PCT's are supplementary but not necessarily required.

In terms of jadelpn's post regarding CNA's giving medications, I'd be interested to know what state that is which allows CNA's to pass meds. For the life of me, I can't even begin to wrap my head around the concept of a CNA giving medications without having a solid foundation in anatomy, physiology, pharmacology, and pathophysiology.

[toomuchbaloney]

We did this to ourselves?

[maxthecat]

Before we come down too hard on the CNA/techs (and I agree that the comment is out of line), we would do well to police our own peers. I find it just as frustrating when nurses act like they are the real saviors of patients and midlevels and physicians are just there to write orders.