Tech vs. RN

[ER Soldire]

This has been eating away at me for a long time, in our ED we also have techs (who are all Paramedics) It gets really, really annoying when some techs act and talk like they know it all, or feel that what they are doing is in fact more important than other things. For example, in a code they would be more concerned about starting a 5th iv than actually moving away to let meds be pushed, or drips started. Also it seems in my experience that a lot of them just don't get acuity of a patient or importance of certain interventions.... You are going to walk a pt back to a room who is having active cp or complaining of SOB and not hook them to a monitor? Or even better not tell the RN a pt is in the room? Even after that rant I still want to say that there are good techs, I guess it's just those few who are lazy and not so with it ruin it for those who are really on their game.

[txERgrl79]

I was never "required" to know the meaning or the "why's" of what I was asked to do; HOWEVER, when time permitted (whether while doing said task) I asked all the "why's" and the RN's I worked with where ALWAYS willing to teach. But I'm a "why" person, I WANT to how, why, outcomes, everything. Just because I love to learn. I ask questions to learn, NEVER meaning that in questioning the RN/Doc...and they always knew that. I personally think that whether RN/Tech/EMS, we should all know the "why" of whatever we are doing...who wants a py asking "why am u doing _____?" And have to say "oh because _____ said to?" Yes that's true but having a little knowledge helps IMO.

[txERgrl79]

Dude, you totally missed the point of that post. Most techs don't get paid to know that information. And actually, all of the techs I work with have a pretty good idea about important lab values. Quit generalizing. All of our techs know the first thing to check in a rapid response is blood sugar.

Have you ever heard of the saying if you have a problem with everyone, maybe you should look at the common denominator in the equation?

And nurses like you ma'am, are the BEST to work with and helped in my decision to go back to school. As an USAF medic, our training is a lot like that of an LVN, so while I do have some knowledge, there is so much more to learn. As a tech, working with nurses who help inform their techs and also realize that (some) techs do posses some useful knowledge, makes the job so much better...again IMO

[Pudnluv, ASN, RN]

I started in the ED after working on a very busy telemetry floor for 11 years. I had all my RN skills down, but didn't know the first thing about ED nursing and was the first to admit it. I learned so much from one the techs working there. He was definitely one of my go to people for many things. He taught me so much about the ED and emergency medicine and was instrumental in my becoming the ED nurse I am today. At the time, all our ED techs were paramedics or LPNs, since then, the requirements have changed and we have ED techs that were formerly CNAs or HCTs from the floors. There has been a real difference in the quality of work since the change. I still will take my old ED techs/paramedics in an emergency situation over many of the nurses I work with any day of the week.

[Esme12, ASN, BSN, RN]

I think there are lazy nurses and lazy techs. I think there are lazy co-workers no matter what profession you are in. I have been both Rn and medic. I was a RN first. Being a paramedic is a completely different animal than being a nurse.

I have worked with some fine medics who could start an IV and save the patients behind upside down in a blizzard stone cold drunk (just a figure of speech) I would trust my children's lives to them any time any day.

You need to have a well run department to utilize personnel properly. It is unfair to treat the medic as a tech for their skills exceed that job description. I have worked with and managed departments with all skill levels of personnel and developed and enforce policies that allowed everyone to work to their potential. If your TECHS are not performing to standard then it is either an individuals deficiencies or the departments failure to properly utilize it skilled personnel.

The medics I worked with would answer codes in the hospital and intubate patients. The did all difficult IV sticks for it is common that their skills are pretty fine.

Medics a accustom to functioning in different environments and may be uncomfortable in the "restricted" environment of the ED. I had a program for the nurses who worked in the department I was in charge of......the had to spend a few shifts with the medics. Almost every single nurse had a new found respect for the medics when they had to haul their backsides up several flights of stairs in Cabrini Green, Chicago.....to resuscitate Grandpa who is a recluse buried under a 100lbs if trash while FIDO licks your face. It took them a while to be accepted and comfortable in that environment just as the medic has adjustments to the ED environment.

Medics are protocol driven individuals but there is a whole lot of skill involved when intubating in a ravine covered in shattered glass during a blizzard to get that patient extracted and to the ED alive.

Respect others as you wish to be respected........ reap what you sow.....

[gcupid]

The techs in the ER are fabulous and they are good with looking at our patient list in the computer to see what needs to be done. If I have a difficult IV start, they are my go-to people. I have delegated things to them without a problem. I do agree with the OP, though, sometimes they do other things that they think are more important. I had just gotten a patient who was discharged earlier that day, but was in respiratory distress and had developed increased secretions. Patient needed to be suctioned. They had advanced Alzheimer's, too. One of the techs beat me to the room and established an IV and got all of my labs, which is great, but then another one comes in and asks why I haven't gotten any vitals yet. I was in the middle of suctioning all of those secretions from the patient and told them they gotta remember those ABCs. A set of vitals can wait a few minutes.

I think this would upset me. Why is the tech asking you why you haven't gotten vitals? It appears as if they are acting as the nurse and delegating to you as if you were the assistant. The nurse is held to a higher standard in regards to taking care of patients. We are required to document vital signs. I'd try not to utilize them at all unless it is to help reposition a patient.

Here is a protocol. Don't ask any nurse why they haven't done anything. Only ask is there something extra you would like me to do.

[akulahawkRN, ADN, RN, EMT-P]

I think this would upset me. Why is the tech asking you why you haven't gotten vitals? It appears as if they are acting as the nurse and delegating to you as if you were the assistant. The nurse is held to a higher standard in regards to taking care of patients. We are required to document vital signs. I'd try not to utilize them at all unless it is to help reposition a patient.

Here is a protocol. Don't ask any nurse why they haven't done anything. Only ask is there something extra you would like me to do.

If you're referring to a Tech that's nothing more than a glorified CNA, I can agree with that statement. However, if your techs are Paramedics and they're allowed to perform to their level and you treat them like that, I guarantee that your Paramedic Techs would do as little as possible for you, and won't help you out unless they have to. If you stopped at a prehospital scene, you would be thrown off so fast your head would spin.

While I wouldn't be OK with a lesser license/Cert/UAP attempting to delegate things to me, I wouldn't consistently disrespect those under me.

Here's a hint: cultivate a good, positive working relationship with your subordinates and they'll bend over backward to help you out and make you look good.

As stated above:

Respect others as you wish to be respected........ reap what you sow.....

[SweetMelissaRN]

I think this would upset me. Why is the tech asking you why you haven't gotten vitals? It appears as if they are acting as the nurse and delegating to you as if you were the assistant. The nurse is held to a higher standard in regards to taking care of patients. We are required to document vital signs. I'd try not to utilize them at all unless it is to help reposition a patient.

Here is a protocol. Don't ask any nurse why they haven't done anything. Only ask is there something extra you would like me to do.

Whoa, they aren't slaves!! "Anything else I can do for you master?" That's awful. My techs are my colleagues, not subordinates. They don't answer to me. They are there to help and do a DARN GOOD JOB!

[emmy27]

Here's a hint: cultivate a good, positive working relationship with your subordinates and they'll bend over backward to help you out and make you look good.

This! A million times.

It's one thing to recognize that at any given moment you have different legal rights and responsibilities, but another to assume that that completely defines your relative worth or abilities. Some of the best techs I've worked with are also paramedics or were in school to be nurses, NPs, PAs, or even docs, and the critical thinking skills that made them good at those eventual jobs didn't get handed out the day they got their diplomas.

Yes, the buck stops here with regard to my patient's nursing care. But if a tech questions what I've done or not done, especially if they have experience in the field, that seems like a good time to either educate them (once the patient is stabilized) on why it was handled that way, or double-check my own priorities.

Can you imagine the uproar if someone suggested a nurse should never question what a doctor had done, but only ask if anything else was needed? Being good at delegation does not equal being a domineering jerk to your coworkers.

[SweetMelissaRN]

This! A million times.

It's one thing to recognize that at any given moment you have different legal rights and responsibilities, but another to assume that that completely defines your relative worth or abilities. Some of the best techs I've worked with are also paramedics or were in school to be nurses, NPs, PAs, or even docs, and the critical thinking skills that made them good at those eventual jobs didn't get handed out the day they got their diplomas.

Yes, the buck stops here with regard to my patient's nursing care. But if a tech questions what I've done or not done, especially if they have experience in the field, that seems like a good time to either educate them (once the patient is stabilized) on why it was handled that way, or double-check my own priorities.

Can you imagine the uproar if someone suggested a nurse should never question what a doctor had done, but only ask if anything else was needed? Being good at delegation does not equal being a domineering jerk to your coworkers.

Amen, Emmy!

[springchick1, ADN, RN]

Maybe it has to do with the attitude of the nurse they are working with. Maybe the nurse thinks they are better than the tech because they are an RN. Just a thought.

[gcupid]

If you're referring to a Tech that's nothing more than a glorified CNA, I can agree with that statement. However, if your techs are Paramedics and they're allowed to perform to their level and you treat them like that, I guarantee that your Paramedic Techs would do as little as possible for you, and won't help you out unless they have to. If you stopped at a prehospital scene, you would be thrown off so fast your head would spin.

While I wouldn't be OK with a lesser license/Cert/UAP attempting to delegate things to me, I wouldn't consistently disrespect those under me.

Here's a hint: cultivate a good, positive working relationship with your subordinates and they'll bend over backward to help you out and make you look good.

As stated above:

HINT NOT NEEDED....

There was nothing stated about consistently disrespecting any subordinate. I treat subordinates, colleagues as well as supervisors the same. And it does not matter whether the tech is a CNA or paramedic. It all boils down to following chain of command and/or who is ultimately responsible for a patient should anything negative occur in whatever setting it may be. Teamwork is important and to effectively prevent tension there must be some sort of job description that clarify roles so there is no confusion.

And I stand by the statement that instead of asking why something wasn't done, (unless for educational purposes of course) the tech whether paramedic or CNA should just pitch in and get them or ask the nurse would you like me to get the vitals...... (This has Nothing to do with slavery but nice teamwork)

If nursing was male dominated, this would not even be up for discussion.

[gcupid]

Whoa, they aren't slaves!! "Anything else I can do for you master?" That's awful. My techs are my colleagues, not subordinates. They don't answer to me. They are there to help and do a DARN GOOD JOB!

I would also assume that they are not there to intimidate and frustrate the nurse under a high stress, saturated workload environment. They help [not delegate, not run, not supervise, not antagonize, not exert superiority complex, not (feel in the blank)] and do a DARN GOOD JOB!

I'm sure no nurse wants to be called master. I believe nurses want to be respected for the education and experience that we bring to the table. And add in a side order of AUTONOMY, so that every joe, dick, Tom, Harry and Jessica won't think they are qualified to boss us around.