Termination

[FutureERDoc]

So, I am actually an ER technician and was recently terminated for suturing a patient. I was under the supervision of the MD, but still terminated for practising outside of my job scope. I actually wasn't aware of the possibility of me getting fired over it, and simply took it as something new to learn. I have seen all over the internet that many ER technicians are able to do basic sutures, but not able to find out much information beyond that. The job scope set in place at my former hospital was very ambiguous and I am currently trying to get my job back. I miss the nurses and the doctors that I worked with and truly don't think I deserved the termination, especially since I was directly supervised by the ER doc.

Any insight given would be truly appreciated... Am I doomed or are there certain things I should know that would help me get my job back? It may even seem dumb that I am fighting for such a job, but I really enjoyed helping people and I really think that my time in the ER so far has helped me become a better person. I have two bachelor's degrees, and I am going to medical school next year, and I really want my job back, a job that only requires a semester at a junior college. Why? I miss it...

[HouTx, BSN, MSN, EdD]

This is a very interesting discussion and points out some of the licensure & scope of practice differences between states.

Here in Texas, we one of the last remaining states that have 'permissive licensure' where physicians (only) are concerned. Basically, if they are directly supervising and agree to retain liability . . . they can pretty much delegate anything when it comes to their own practices. But of course, there are limitations imposed by hospitals. No hospital is going to allow a non-licensed individual to do this unless it is part of a bona fide educational experience. As it was described, this was not.

ED techs are not "licensed", in my state... I don't even think they have a certification (like a CNA). They can only function as an extender or Unlicensed Assistive Person (UAP). Other than an unanticipated emergency situation (where normal rules are suspended), I cannot imagine anyone delegating professional responsibilities to a UAP. It would be extremely unethical - and bring enormous liability exposure.

[scoochy]

The reason why I think that nurses could help, or at least have advice is simply because of the fact that nurses run hospitals. The doctor did speak up and so did the medical director, both saying that they didn't think that I should be terminated.

In my time in the ER I have witnessed many nurses practice outside their scope, including intubations, sutures; etc. But, they never get fired, merely suspended. And most of the time suspension begins on the the next day and includes days off.

The termination as of now stands, but I have to undergo a peer review evaluation as the next step to possibly getting my job back. This panel will be made up of other technicians and nurses, and human resources says that if they rule in favor of me that I will be reinstated. I am allowed to bring others to speak on my behalf, which I think could be my saving grace.

Any nurse who goes beyond the limitations of the nursing scope of practice is inviting the Nursing Board into his/her life for an extended stay............

[Quidam]

In my time in the ER I have witnessed many nurses practice outside their scope, including intubations, sutures; etc. But, they never get fired, merely suspended. And most of the time suspension begins on the the next day and includes days off. quote]

This bit makes me think that you KNEW that suturing was outside a nurses scope of practice in your facility....and yet you as a tech thought it was ok to do it?

[NurseCard, ADN]

Something rather similar happened at the last hospital where I worked. A nurse allowed her CNA to start an IV on a patient; the CNA was a nursing student, whom I believe was in her last semester of nursing. There were actually two nurses in the room with the CNA helping her. Another nurse, actually the hospital float nurse, happened to walk by the room when this was occurring, and reported the nurses and the CNA.

I know that all of the parties involved are still employed by the hospital so no firing involved, but I know that they did get in some bit of trouble. Bottom line, not a good idea to practice outside your scope of practice, AND not a good idea to allow someone who is not licensed, to practice outside of their scope under your supervision.

[FutureERDoc]

In my time in the ER I have witnessed many nurses practice outside their scope, including intubations, sutures; etc. But, they never get fired, merely suspended. And most of the time suspension begins on the the next day and includes days off. quote]

This bit makes me think that you KNEW that suturing was outside a nurses scope of practice in your facility....and yet you as a tech thought it was ok to do it?

Well in reality, EVERYTHING is out of scope of practice for an EMT/ ER Technician. We are simply not allowed to do anything unless it has been approved or assigned to us by a physician or nurse, which is completely understandable. My main point in bringing up nurses and scope of practice is it is evident that people do in fact go above what they are allowed to do, but are not terminated for it.

Did I think I was allowed to suture? NO, but then again I wasn't allowed to do any procedure unless instructed to do so. My only inquiry was to see if there were ways around this, and me possibly getting my job back.

[lake girl]

Hi,

I am so sorry for your loss. I know you must be greiving the loss of this job. It maybe that you just accept it, in time and move on. Be kind to yourself, forgive yourself. It could happen to anyone, especially when a doctor is leading the way. It seems you were lead into it, and you followed. Live and learn............sometimes things happen for a reason. Someday you will look back and remember this when you are a doctor and will not lead anyone into things out of their scope. It's not fair that this happened to you.

[Quidam]

Well in reality, EVERYTHING is out of scope of practice for an EMT/ ER Technician. We are simply not allowed to do anything unless it has been approved or assigned to us by a physician or nurse, which is completely understandable. My main point in bringing up nurses and scope of practice is it is evident that people do in fact go above what they are allowed to do, but are not terminated for it.

Did I think I was allowed to suture? NO, but then again I wasn't allowed to do any procedure unless instructed to do so. My only inquiry was to see if there were ways around this, and me possibly getting my job back.

I was not trying to be sarcastic. I see how it may have sounded that way. I just curious as to your thought process when you were doing it. I have no ideas for you as far as getting your job back...but I do wish you well.

[~Mi Vida Loca~RN, ASN, RN]

I hope you can find a way to get your job back or another job back. Remember in the end, you work for the hospital and must follow their policy's. You don't work for the doctor, Nurses have to remember the same thing if a Doctor asks them to do something not allowed. Us students face it as well, we will be told by a Co-Nurse to do this or that and we say we can't and they have said "Oh it's ok I won't tell anyone or I will watch you" but if we go ahead and do it, we risk being thrown out of nursing school whether our Co-Nurse said we could or not.

[netglow, ASN, RN]

Vida Loca,

What a cute avatar idea!

[dishes, BSN, RN]

I don't think I would bring up the information that a precedent was set by others who have performed skills outside of their scope of practice during the panel hearing. It will not go over well with the administration and you want the panel members to focus on your positive attributes, not the wider problem.

dishes

[nursel56]

If you don't mind, FutureERDoc, I am wondering how this came to the attention of the PTB in your emergency dept.- chance walk-through by co-worker? pt complaint?

I'm sorry you lost your job. There are doctors who seem to enjoy teaching simple procedures, and they really don't think they are jeopardizing your job. Hope the MD doesn't feel too much like a crumb over the whole thing. I worked with a dermatologist who offered to teach me how to curette and freeze a basal cell carcinoma-- I said, no that's ok. . . (don't worry everybody-no unsuspecting patients had their basal cells treated by the nurse) :)

[Snickerdoodles]

I am wondering how your superiors found out about this incident? As a new grad and hospital employee for several years I have learned that you have to follow the "don't ask, don't tell" policy with these experiences. Sure, most hospital employees in training for another position get the opportunity to practice techniques not in thier current job scope, but you also can't run and tell everyone how cool it was! Not to accuse you of doing so, but I am assuming that you told people since at the time you didn't think it was wrong since the doc was there. Nurses and docs all used to learn by doing and now with everyone being sue happy, these experiences have changed. The nurse who was caring for this patient may have just wanted to cover her own behind and felt this should have been addressed! It is hard to say, but in the future I would either not put myself in this situation, or keep it on the QT. Good luck!