Who are PCTs accountable to?

[StephanieZie]

I've noticed two schools of thought on PCT responsibilities:

1) PCTs are there to relieve nurse workload and their accountability lies to the nurses on their shift

2) PCTs have their own workloads and assignments and their accountability lies to one another, between shifts

I've been working through school as a night shift PCT on an MSU floor. We are a floor of 42 beds with around 13 nurses per shift. At any given time we can have anywhere from 5 to 25 total care patients who require feeding, changing, turning, bathing, etc. The average is 12 We are supposed to have two PCTs per shift, but more often than not we have only one. I'm supposed to be responsible for around half the baths.

When I got the job, I was trained by a daytime PCT who told me that I shouldn't let the nurses delegate tasks to me as it was neither their responsibility nor their place to do so. She emphasized that the PCTs have their own set of responsibilities. In my first few weeks, I even had a nurse on my shift tell me that she reported something I did wrong to the supervisor and felt badly about it, but she did it because they weren't allowed to address me directly about my mistakes. I told her to please feel free to tell me in the future if I do something wrong.

Things have improved since then, and I get along well with the nurses I work with. I've largely dismissed the dayshift status quo in favor of the team approach. Most nights it works fine. I'm able to complete my individual tasks (cleaning rooms, turning and changing, stocking supply carts, bathing), and still help the nurses with whatever they need. However, on nights with alot of total care patients, I often feel pulled in 100 different directions. I'm supposed to be responsible for around half the baths, and when there are alot of TC patients, that's a considerable chunk of time in which I have to focus on my own responsibilities and am not generally available to help.

Yesterday morning, I was running so behind. A nurse asked me if I could help her with her isolation patient, and I fleetingly told her I really needed to start passing ice, because if I didn't do it I'd have to pass it on to the day shift. Of course I realized how ridiculous my prioritizing had become, and I agreed to help her.

I guess my point is that some nights, I feel like I have to choose between making my own tasks my priority, and being helpful to the nurses. I sometimes find myself running ragged trying to do it all, until I remember I don't get paid enough to do that, especially since we were all promised 2 PCTs per shift, and it rarely happens. My question is, how does it work on your unit? Is the purpose of aides to be available to assist nurses? Is that their top priority, or do their own responsibilities come first? Do you practice a teamwork model or a "no delegation" model? And which do you think is preferable? Just for the record, I really prefer teamwork.

[jadelpn, LPN, EMT-B]

I am curious if a "no delegation" model is in place, as if a licensed nurse delegates it, then they are responsible for it.

Which is a little odd, however, keeps the nurses responsibility for a CNA's work to a minimum.

I would think in that case, you would be responsible to your policy guidelines, your job description, and your scope. This is something that the NM needs to discuss with the nurses. If there are specific responsibilities that you are to take care of first, then that needs to happen.

Some CNA's are responsible for generalized tasks on the unit, others for specific patient care activities. Some a combination of both. I would discuss with the charge nurse what you know you need to do each shift and ask if appropriate to say "I am sorry, I can't help you, I have my own tasks to complete". Then it would be up to the charge nurse to bring it to the NM to advocate for more CNA's to help with patient care.

[classicdame, MSN, EdD]

Depends on whether or not they are certified in their state. If not, they follow the job description of the employer. If so, the job description should comply with rules from the certifying agency (Health dept probably). In Texas the unlicensed person may be delegated jobs by the nurse but cannot take any assignments as they do not have legal authority to determine their own assignment. The RN is responsible for giving assignments.

[HouTx, BSN, MSN, EdD]

I can't imagine a scenario in which the RN is not accountable for the total scope of nursing care - no matter how it is divided up among subordinates. It's all based on scope of practice. Folks who do not actually have a license don't have a legally defined scope of practice. Certifications just serve as 'proof' of the completion of training - they do not outline a scope of practice.

[nurseprnRN, BSN, RN]

There isn't a nurse practice act in the country, to my knowledge, that allows nursing care to be supervised and delegated by anyone but a registered nurse. I think that the PCT who told the OP that has something very wrong. It's probably not an either-or thing; the PCTs may have job duties that are employer-specific, but are also accountable to the RN for any patient care activities.

OP, I would get your state nurse practice act (it's online) for RNs, LPNs and assistive personnel and read it. The answer is in there somewhere.

[NurseFrustrated]

In my hospital, nursing assistants work under direction of the nurse. You need to ask your unit manager what your responsibilities are. The day shift person who trained you said that you are not to allow nurses to delegate to you? I don't know if I would necessarily believe that. Maybe she just has a problem with authority. Find out the truth from your actual boss because you don't want to get reported for not doing what you are supposed to do. It sounds like a not so great place to work anyway because you were told you would have more help than you have and that it is next to impossible to get your work done. A lot of places seem to offer you the moon to get you hired, then reality hits. Good luck to you.

[StephanieZie]

Thanks you guys, I appreciate the feedback. I agree that the situation seems a little odd, but PCTs are new on my floor, so they're still figuring out the most effective ways to utilize them. There have been alot of adjustments and management has given us some freedom to work out a system amongst ourselves and with the nurses on our shift. I will definitely be digging into the state literature a little bit for some policies and guidelines.

[meandragonbrett]

Unlicensed assists e personnel practice under the delegation of the RN in the hospital setting. While I might not ask you to bathe 201, it is still the RN responsibility to ensure that gets completed as the RN is the supervisor of all nursing care for that patient.

[englishgeek]

I am working as a PCT while going through nursing school. I know several who have the attitude of the one who trained you, but I feel like my entire job is to be there to assist the nurses so that they can more easily do the things that I am not yet liscenced to do. 90% of the nurses understand that I am taking care of ALL of the patients on the floor, while they only might have seven or eight. Because of that, they are understanding of things I may or may not be able to get to. There are only a couple of nurses that try to take advantage. When that happens, I either tell them no based on the fact that something I'm doing has higher priority, or if I'm not sure about priority, I will ask the charge nurse what she wants me to do.