What to do about tech refusing to get VS?

sloydrn · Feb 7, 2005

I agree with the other comments. Don't take this kind of gruff for one more minute. I would document in an objective and factual way in writing and go over the asst manager (who has failed to respond) and give it to your manager and copy it to your Director of Nusing. Sometimes you have to put a fire under people to get them to act. Your managers owe you a duty as their employee and as a professional and fellow nurse (I might add) to assist you in resolving this conflict. You can probably be sure of these things too:

You're not the only person this tech treats disrespectfully.

She could be treating patients this poorly as well, so you are advocating for the patient by pursuing a resolution.

Don't worry about 'getting her fired' etc. It is not your job to decide if she gets fired, punished, etc. That is up to managment.

Maybe she has issues/personal problems/medical or chemical dependency problems, just an unhappy person, etc. Who knows, but none of these are an excuse to behave the way you described.

Management is getting paid to worry about these problems/issues and you deserve a supportive work environment. Dont' accept anything less!

As for the parking lot suggestion....You're on your own on that one!!

Good Luck.

I have a tech at work who I'll call Sarah. She is a really good tech. The problem is that she has an attitude with me. I have reported her at least twice and nothing ever gets done. It goes like this:
I always get my own admission VS, post-op, post cath, and blood VS. I very rarely ask a tech to do anything for me. They know what they are supposed to do and they do it. Yesterday I had a new patient that the physician had sent up from his office, he wasn't even allowed to stop at admitting, dx: viral meningitis. He was 80 years old and I was told that his temp was 103 and that I was to immediately start an IV, order labs, give IV Phenergan, get VS, etc, etc..... At the same time I had another admit come up from the ER. I asked Sarah to get the vital signs on the first patient while I was starting the IV. She brought the dinemapp in the room and said "since you're in here you can get them" I said no Sarah get the VS, she said " do you want me to show you how to operate the equipment, is that the problem?" and she promptly left the room. I was not only furious but embarassed in front of the patients family. I told my assistant nurse manager and she didn't say much.
This is the 3rd such similar incident with this CNT in about 3 months time. I have spoken to her directly also with no results. Any suggestions? What I'm thinking about is asking for a confrontation in the nurse managers office.
I would like to tell her that I think she does a good job but do not appreciate her reluctance to do something that I ask her to do because I only ask when it's really needed. I would like to tell her that she needs a refresher on what her job description entails. Should I mention that I am her superior, well that's not the word I want to use but you know, I'm over her, in charge......?
I want to tell her that if she wants to give the orders that she should go to school and get her nursing license. Thanks for any advice you can offer. We both work tomorrow and I'll let you know how it goes. Thanks.

julesRN12 · Feb 8, 2005

Forgive me for not seeing the frustration...but I feel by the way you described your first patient, I think it should have been YOU to obtain vitals. You are the one with the license that says you are responsible for assessments. Being in an advanced nursing course myself, I too was unaware of what I was liable, responsible and accountable for until recently. For years, I relied on my LPNs and techs for many seemingly trivial tasks, until I realized I was ultimately responsible for the patient. I'm not trying to side with anyone here, but I feel that the tech may have done you a favor by allowing you to be the one in charge of assessing the new admit. Am I missing something? Please advise. Thanks.

actioncat · Feb 8, 2005

Forgive me for not seeing the frustration...but I feel by the way you described your first patient, I think it should have been YOU to obtain vitals. You are the one with the license that says you are responsible for assessments. Being in an advanced nursing course myself, I too was unaware of what I was liable, responsible and accountable for until recently. For years, I relied on my LPNs and techs for many seemingly trivial tasks, until I realized I was ultimately responsible for the patient. I'm not trying to side with anyone here, but I feel that the tech may have done you a favor by allowing you to be the one in charge of assessing the new admit. Am I missing something? Please advise. Thanks.

Yes, exactly. The tech was doing the nurse a FAVOR.

Am I missing something here? When a schedule is made, it is made in mind with the tech performing her normal tasks and the nurse performing hers. Now, if they want to make out the schedule so that a nurse can perform these "seemingly trivial" tasks (i.e. the nurse has less patients) then she should do them. A nurse is able to assess the patient without physically getting the vital signs herself. All she needs to do is look at them! So, yes, I think you are missing something.

mattsmom81 · Feb 8, 2005

Forgive me for not seeing the frustration...but I feel by the way you described your first patient, I think it should have been YOU to obtain vitals. You are the one with the license that says you are responsible for assessments. Being in an advanced nursing course myself, I too was unaware of what I was liable, responsible and accountable for until recently. For years, I relied on my LPNs and techs for many seemingly trivial tasks, until I realized I was ultimately responsible for the patient. I'm not trying to side with anyone here, but I feel that the tech may have done you a favor by allowing you to be the one in charge of assessing the new admit. Am I missing something? Please advise. Thanks.

I've worked with many CNA's who would 'do me the favor' of letting all the nurses me do ALL their work while they hid in rooms. :uhoh3:

You are talking about a personal decision here: If this is how you want to practice, fine, but its YOUR personal decision to not trust CNA's to do your vitals.

The OP's unit was NOT a primary care ward, the CNA's are there to 'assist' the nurses. Vital signs are within the skill set for CNA's and nurses should never feel badly for simply asking them to do their jobs. Period.

medpsychRN · Feb 8, 2005

Missed something? Well, yes! Beyond the tech not doing her job, she was sarcastic and rude in front of the patient and family. Whatever your personal differences are, patients and family don't come to the hospital to be a part of it. Really, if I was a patient or family member I'd wonder what's going on and be thinking I'd be better off getting treatment somewhere else fearing where else or what else is the tech going to try to get out of!

Marie_LPN, RN, LPN, RN · Feb 8, 2005

Forgive me for not seeing the frustration...but I feel by the way you described your first patient, I think it should have been YOU to obtain vitals. You are the one with the license that says you are responsible for assessments. Being in an advanced nursing course myself, I too was unaware of what I was liable, responsible and accountable for until recently. For years, I relied on my LPNs and techs for many seemingly trivial tasks, until I realized I was ultimately responsible for the patient. I'm not trying to side with anyone here, but I feel that the tech may have done you a favor by allowing you to be the one in charge of assessing the new admit. Am I missing something? Please advise. Thanks.

Yes, she had 2 admission back-to-back. You missed that.

beanhead61 · Feb 8, 2005

sounds like insubordination to me. probably could get her fired for it, at least if she worked at my institution.

of course, most of us don't want that. we just want our vital signs without a hassle!

please remember that the more you do it yourself and don't ask her, the easier her life is. so she continues to harrass you, knowing you won't ask her to do things if she bullies you. so you ask the cnts that are reasonable to do things for you and you don't ask her. then the cnts that you like (because they're helpful) get burned out and leave because everyone asks then to do things.

then you're stuck with you-know-who as your cnt again.

it's a vicious cycle - been there before.

remember your role as the rn is to provide strong, clear leadership of the nursing team - for the patient"s sake.

when she tries to give you a hard time, stop what you're doing and look her straight in the eye and say"let me understand what you're saying. are you refusing to get the vital signs?" if she has any sense, she'll realize where you're going - making a case for getting her fired.

if she says yes, then it's insubordination because she's refusing to take care of the patient.

if she says no, then tell her to get them and forget about it. she's not worth getting upset over.

at least she'll know you can't be messed with, and eventually she may respect you (or at least everyone else will) for standing up to her.

i know, it's not as easy as all that. it takes practice.

DutchgirlRN, ASN, RN · Feb 8, 2005

I think it should have been YOU to obtain vitals. You are the one with the license that says you are responsible for assessments. Being in an advanced nursing course myself, I too was unaware of what I was liable, responsible and accountable for until recently. I relied on my LPNs and techs for many seemingly trivial tasks, until I realized I was ultimately responsible for the patient..

I have NEVER been unaware that I am liable, responsible and accountable for my patients. I have NEVER thought of vital signs being a trivial task. Please do not assume to know how I think about my job. Vital signs are basic nursing 101. You have to have vital signs before anything else but that doesn't mean that I have to be the one to perform the function. The tech CANNOT be the one to start the IV, push the Phenergan, take the history, do the assessment, write down the doctors orders as he was verbally giving them to me, write the orders, or process the orders, with another new ER admit across the hall also needed my attention. This is why I politely asked her "please get the vital signs". I only asked her to do her job and what she should have been doing in the first place. She saw the patients going down the hall in their beds, she saw which rooms they went in, she knew those rooms were part of her assignment yet she choose to stand in the hall and talk to the housekeeper. Any other CNA would have grabbed a dinemapp w/o being asked and come to the room and taken the vitals. I asked her politely, I get lip about how "you can do it yourself since you're in the room". The doctor asked for the vitals and I was honest and told him the tech refused to take them. I had to stop what I was doing, hook up the dinemapp, wait for it to warm up and then take the vitals. For God's sake I was only asking her to do her job! I don't know what's not to get about that??????? This was the second time in several weeks. The first time it was a fresh post-op heart cath that was bleeding and I was holding pressure on the right groin. I called out for vital signs and she comes in the room, pushes the dinemapp in and says "here". Please get the vital signs for me Sarah. Again I get lip "well if you don't know how to use the dinemapp to get vital signs would you like me to show you?". I just ignored her for the patients sake and pushed the call light for the charge nurse to come in and get the vitals. It has happened twice and I hope that will be it since she has been talked to and is now getting vitals on new patients before I can even get in the room but I tell you if there is a third time there will be a big go-round between she and me in a room with a witness. I feel I have been more than nice to her in spite of how she has refused to do her job. I wouldn't have even asked her to get the vitals if the patient wasn't so sick. I never ask the CNA's to do anything for me unless it's really imperative that it's something that needs to be done right away and I know I can't do two things at once. Other RN's ask the CNA's to do everything. They'll spend 5 minutes hunting one down to change a sheet when they could have done it themselves and been done in 2 minutes. Please do not assume to know what I think is important in my job. I know my job and I do my job very well. The largest percentage of questions on the NCLEX is "delegation" there's a reason for that.

THANK YOU Actioncat, your point is well-taken!

julesRN12 · Feb 9, 2005

Ok then! I just was giving you my opinion about how I practiced nursing when I worked the floor. I was always there during an admission to assess and do vitals, not to mention other important tasks that I was responsible for like oxygenation status, pain, or other signs that made something as important as a new admission my first concern. I delegated passing my meds to another competent nurse before I would have someone do my vitals. Usually family comes with admissions and I wanted them to see a nurse caring for their loved one, not an aide or tech. I thought of the patient first, me later. After 2 minutes of vitals and assessments, I would be able to spend time with another admission, checking on the same issues for that patient. Then I would decide who needed me most. I would explain to the patient and family that there was another pressing matter I had to tend to, but came back as soon as I could. I did see and work with many who were not as dedicated, but I chose to be the nurse that I needed to for me. I can't ask that of anyone else. I work OR now and as a circulator, I only have to be responsible for one patient at a time. As a recovery room nurse, I may have 3 patients who get my attention to the best of my ability. I do not have techs or aides to do my job and therefore I may not understand the work that you do. Forgive me if I sounded harsh. Not intended. I do realize it's hard to be everywhere at once.

DutchgirlRN, ASN, RN · Feb 9, 2005

I guess it's like the old saying "you'd have to walk a mile in my shoes", or in my case 18 or so miles. We all wore pedometers one day and in 12 hours we averaged 18 miles each. No wonder I'm so tired when I go home. P.S. No other competent nurse on the floor has time to give someone else's meds. For those of you who work days on a busy floor with 6 patients you can understand. Apology accepted, thanks!

Brita01 · Feb 9, 2005

I guess it's like the old saying "you'd have to walk a mile in my shoes", or in my case 18 or so miles. We all wore pedometers one day and in 12 hours we averaged 18 miles each. No wonder I'm so tired when I go home.

Sheesh, no wonder I was so much thinner when I worked the floor. :chuckle The walk was also an incredibly fast one too.

Town & Country · Feb 10, 2005

The largest percentage of questions on the NCLEX is "delegation" there's a reason for that.