Working the floor after a job interview!? WOW!...

[CritCareTech]

Not a nurse, but I think this section fits perfectly! I come from EMS and started at a trauma center on the COVID unit as a PCT in 2020. 

I progressed into a more advanced PCT role in a different ICU which gave me a lot of experience. 

I applied on Tyesday for a Medical and Surgical ICU position (Senior PCT) at a local well-known hospital. The job was posted on Monday and I did my interview yesterday. 

I came dressed in formal attire and the interview was very pleasant. It was honestly more conversational and casual than anything else. She even said I could skip some "What if questions" if I wanted to, but opted to not skip any. We shared a lot of interest, such as military service and working EMS.

She toured the unit with me which was ramping with COVID. I did my peer review with the on-shift advanced PCT who thought during the whole time, I was an RN. I laughed and was like "Oh no, definetly not a nurse!".

The hiring manager (clinician) said "Oh I wished you brought your scrubs with you so you can jump in and help by working the floor for a bit". I go "Oh I did, they're in  my satchel". She was like "You don't need to if you don't want to stay" and I go "It's perfectly fine!" 

Fast forward, I changed into scrubs and helped work the floor for 2-hours. I was introduced to all the staff and had some pleasant discussions with the RNs and attendings!

Then the hiring manager goes "Oh the CRNAs bought everyone lunch, go eat" and I'm like "I'm just interviewing" and she goes "No, you're gonna go eat!" Like I was stunned to be included in so much. 

At the very end they thanked me for coming and giving them a hand, and said "We'll be in contact with you in a few days". 

Does it seem promising to you? I told them I have an interview on Monday with their primary level 1 trauma center ICU and they really talked down on it - so maybe it'll light the fire under them to hire quickly due to staff shortages? 

I'm a PCT/CCT with my EMT, BLS, PALS, ACLS, and TCCC which they seemed to be heavily surprised at. 

Thank you all and stay safe! 

[Squidpdx, CNA, LPN]

Here are detailed test plans for the 2 most common national PCT certification exams- they give some idea of PCT scope. 

https://www.ncctinc.com/Documents/PCT Detailed Test Plan 2021.pdf

https://info.nhanow.com/hubfs/Test Plans/nha-2018-cpct-test-plan.pdf

[NICU Guy, BSN, RN]

It definitely looks like they were trying to convince you to work for them, instead of you trying to convince them to hire you.

[sleepwalker, MSN, NP]

On 10/9/2021 at 6:02 PM, amoLucia said:

OMG! My mind is just reeling with the liabilities possible!!

Exactly...not an employee but working in PCT capacity! ?

[CritCareTech]

12 minutes ago, sleepwalker said:

Exactly...not an employee but working in PCT capacity! ?

I thought of that as well. 

Not to mention I had some concerns with a few pending charges against me and they never once inquired about it (yet). 

I just can't imagine if someone had a serious charge (SA, etc...) coming in to shadow. 

[2BS Nurse, BSN]

Ask for the $24/hr. When you say "helped work the floor" did you just shadow in your scrubs or actually do procedures, etc? If Covid was rampant, that would be a good reason to change into scrubs. 

[NurseSpeedy, ADN, LPN, RN]

On 10/9/2021 at 1:38 PM, NotMyProblem MSN said:

Personally, I would not have admitted to having scrubs available. Just my $.02, but I’m thinking you’ve just opened the door for them to abuse your capabilities. I believe you’ve gotten the job, but I’d love to get a gander at your new work schedule. You gave them 2 hours of free labor. I fear you’ve raised their expectations of you. Let’s see how well they meet yours.

Good luck and keep us posted!

I had my first RN interview in 2016. Had my LPN since 2002. The interview instructions were to come in dressed in scrubs and be prepared for 4 hours shadowing on the floor (aka-let the staff decide if they want to work with you after your formal interview). I had that interview and then two more interviews that week with hospitals in the same large company. Had 2 offers but not one that hade spend half a shift there. Granted, it was my first real “interview” I’m so many years and I will say I was nervous. Good news-the other two had the exact same questions, so I knew how to answer them better than I did the first time around because I was more prepared. 
 

The interview sounds positive. I would still attend the other interview to weigh out options. Some hospitals or even units within hospitals can have bad things to say about the other one, especially if they want you to work for them-otherwise they would not speak negatively about them when they hear you have an interview.

My offers thought my drive might be much (only if rush hour- 7a-7p-not rush hour-got there in 30-45 minutes everyday). I told them the drive could be therapeutic-time to decompress before getting home and it was  12 hour shifts so not a M-F five day in a row thing-plus I never worked close to home with hospitals-I didn’t want to have patients who may recognize me outside of work or know me-I have my boundaries. They respected that and I got the jobs I wanted. 

My time with hospitals I think is over. While I enjoyed the career-it is not what it was when I started. Too much time in front of a computer and not enough time with the patients. Also, way too much focus on meal time satisfaction in regards to the surveys….seriously, if you have that kind of appetite you are ready for discharge. This isn’t the Hyatt and the food is not gourmet-it’s frozen. 

 

[klone, MSN, RN]

On 10/10/2021 at 2:01 PM, LibraSunCNM said:

I mean, it was in the pre-interview email to bring scrubs so I'm guessing they do it on the regular.

PCTs interpret EKGs?  That's a new one.  I'd run rapidly in the opposite direction of this job, but that's just me.

If they have specialized tele training, I see no problem. Tele techs do it all the time, and they aren't licensed. They're simply a PCT with specialized training. And by "interpret" - nobody actually INTERPRETS except a LIP.

[LibraSunCNM, BSN, MSN, CNM]

2 hours ago, klone said:

If they have specialized tele training, I see no problem. Tele techs do it all the time, and they aren't licensed. They're simply a PCT with specialized training. And by "interpret" - nobody actually INTERPRETS except a LIP.

Maybe I misunderstood then?  Of course a PCT can obtain an EKG, I thought the OP was saying they allow them to "interpret" them, which made no sense to me.

[JKL33]

On 10/10/2021 at 4:28 PM, CritCareTech said:

So we can theoretically do anything a nurse does- as long as they're aware of it. 

No you cannot. I mean this kindly but you cannot. It isn't just that since there's no official scope for you then you can do anything. Remember that there are also scopes of other professions that don't involve you that say that some things must be performed by those professionals or by certain persons qualified to do them. Again, make sure you look into all of this. Don't take anyone's word for it. If you are asked to do anything for which you know that you have rightfully not had proper training, qualification and formal approval by your employer and will not have much supervision, you would be very wise to not do it.

Your best bet is not to feel favored and special when someone asks you to do something iffy but to consult your resources to find out if it is something you should be doing.

Secondly, if you go out of bounds then you're responsible even if something was delegated to you. For example if you are asked to perform oral care (as per the policies and the way you were trained) and you decide to do oral care plus a bunch of stuff that is not in the procedure/policy for oral care and you were not trained to do and not asked to do, like messing with ventilator settings, for instance - that is on you and the employer. Not me.

 

2 hours ago, LibraSunCNM said:

Maybe I misunderstood then?  Of course a PCT can obtain an EKG, I thought the OP was saying they allow them to "interpret" them, which made no sense to me.

There's interpret and then there's interpret. ? Yes, properly trained techs can be responsible for being first eyes on something and alerting others to problems, or be the ones who routinely record strips into the patient chart at along with a basic interpretation, such as sinus brady or NSR w/ 1* block or whatever. Such is the role of telemetry techs, etc., and many of them are far more adept at "interpreting" an EKG strip than many RNs. But the one who can go on paper as having officially interpreted the strip/EKG and is qualified to bill for such services is a different matter and is as klone said, that will be a licensed provider authorized to provide and bill for that service.

[CritCareTech]

19 minutes ago, JKL33 said:

No you cannot. I mean this kindly but you cannot. It isn't just that since there's no official scope for you then you can do anything. Remember that there are also scopes of other professions that don't involve you that say that some things must be performed by those professionals or by certain persons qualified to do them. Again, make sure you look into all of this. Don't take anyone's word for it. If you are asked to do anything for which you know that you have rightfully not had proper training, qualification and formal approval by your employer and will not have much supervision, you would be very wise to not do it.

Your best bet is not to feel favored and special when someone asks you to do something iffy but to consult your resources to find out if it is something you should be doing.

Secondly, if you go out of bounds then you're responsible even if something was delegated to you. For example if you are asked to perform oral care (as per the policies and the way you were trained) and you decide to do oral care plus a bunch of stuff that is not in the procedure/policy for oral care and you were not trained to do and not asked to do, like messing with ventilator settings, for instance - that is on you and the employer. Not me.

 

There's interpret and then there's interpret. ? Yes, properly trained techs can be responsible for being first eyes on something and alerting others to problems, or be the ones who routinely record strips into the patient chart at along with a basic interpretation, such as sinus brady or NSR w/ 1* block or whatever. Such is the role of telemetry techs, etc., and many of them are far more adept at "interpreting" an EKG strip than many RNs. But the one who can go on paper as having officially interpreted the strip/EKG and is qualified to bill for such services is a different matter and is as klone said, that will be a licensed provider authorized to provide and bill for that service.

That is DEFINETLY not how it is done here. I mean that kindly as well. 

Different states have different laws. 

For example, if a paramedic told you to connect that syringe filled with whatever med, and push it because their hands are busy intubating - it falls on their license. Not the person who pushed it. 

In my state, I can speak for because I've seen lawsuits happen both in hospital and in pre-hospital. If a task is delegated by a professional licensee, they are responsible for anything that happens with their delegated task. It may not be that way in your state, but it is here. 

I know this due to years of working in public safety. We had a firefighter who was in EMT school that was at the YMCA. The medic told the EMT student to draw up Epi and push it at a code. The EMT student (who was not licensed) drew up Adenosine during the code. The pt ultimately died. Who was at fault and held responsible? The medic. Why? They were the LICENSED provider who DELEGATED the task and did not validate what was happening. 

And unfortunately if you go into a hospital anywhere in this area and request a scope of practice or what you can and cannot do - they say "just do what the RN tells you to". So even as a NA, they had me removing IVs and adjusting oxygen levels due to my EMS courses I took. It wasn't allowed for any other NA on that floor but me, because there's that "trust" they had. And even as my MSN unit director said, legally there's nothing that could happen to me, but could fall back on the licensee for delegating the task and not supervising per the "span of control". There's a reason why older RNs around here refuse to let PCTs do anything with their pt, because they are scared of it coming back on them. 

As far as 12-leads, an RN cannot legally bill for that. Only a clinician can (MD, cardiologist, etc...) but PCTs can interpret them. I have experience doing such as a monitor tech and working in EMS. Again - not being rude but my state does not recognize the PCT, so they fall under the nurses license whereas CNA/NA's do have a scope, and must strictly adhere to it. This isn't my first rodeo and I'm sorry if your state and region has stuff that's black and white - we don't yet were one of the largest cities with the most advanced Healthcare in the US. 

[CritCareTech]

34 minutes ago, JKL33 said:

No you cannot. I mean this kindly but you cannot. It isn't just that since there's no official scope for you then you can do anything. Remember that there are also scopes of other professions that don't involve you that say that some things must be performed by those professionals or by certain persons qualified to do them. Again, make sure you look into all of this. Don't take anyone's word for it. If you are asked to do anything for which you know that you have rightfully not had proper training, qualification and formal approval by your employer and will not have much supervision, you would be very wise to not do it.

Your best bet is not to feel favored and special when someone asks you to do something iffy but to consult your resources to find out if it is something you should be doing.

Secondly, if you go out of bounds then you're responsible even if something was delegated to you. For example if you are asked to perform oral care (as per the policies and the way you were trained) and you decide to do oral care plus a bunch of stuff that is not in the procedure/policy for oral care and you were not trained to do and not asked to do, like messing with ventilator settings, for instance - that is on you and the employer. Not me.

 

There's interpret and then there's interpret. ? Yes, properly trained techs can be responsible for being first eyes on something and alerting others to problems, or be the ones who routinely record strips into the patient chart at along with a basic interpretation, such as sinus brady or NSR w/ 1* block or whatever. Such is the role of telemetry techs, etc., and many of them are far more adept at "interpreting" an EKG strip than many RNs. But the one who can go on paper as having officially interpreted the strip/EKG and is qualified to bill for such services is a different matter and is as klone said, that will be a licensed provider authorized to provide and bill for that service.

Again - I fully understand where you're coming from but this state and health system is not what one would expect from such a large corporation. 

I am extremely policy driven so when I was told "Go find it yourself" and the literal scope only said "To complete tasks as delegated by the professional Registered Nurse" I was dumbfounded. 

I would like an actual scope in black and white print. In EMS, all of our scope is put into protocols on our app. We can go boom, here is what we can and can't do. It's nothing like that with the PCT positions around this area. 

[JKL33]

20 minutes ago, CritCareTech said:

The medic told the EMT student to draw up Epi and push it at a code. The EMT student (who was not licensed) drew up Adenosine during the code. The pt ultimately died. Who was at fault and held responsible? The medic. Why? They were the LICENSED provider who DELEGATED the task and did not validate what was happening. 

Emphasis on your very last words. They were responsible because they delegated completely inappropriately--not because someone did something.

20 minutes ago, CritCareTech said:

And unfortunately if you go into a hospital anywhere in this area and request a scope of practice or what you can and cannot do - they say "just do what the RN tells you to".

Understand that hospitals are not the law. They are compromised entities through and through. You can't trust anything they say unless you can independently verify it. Many nurses and hospital employees know very little about laws and the interpretations of them and actually believe that whatever some authoritatively-positioned administrator tells them is correct and true. In reality hospital admins routinely misrepresent laws, dumb them down in incorrect/inappropriate ways, and confuse everyone about the truth.

I know that techs don't necessarily have a well-defined scope of practice or any legal scope of practice at all. That does not mean that they can legally do anything an on-duty RN tells them to do, and it doesn't mean that the patient's RN is responsible for everything a tech chooses or decides to do.

I wasn't going to get into it but here's another issue: Hospitals are fond of pretending that an individual on-duty nurse delegated everything that the tech does. They come to this false narrative with the same mistake you are making, which is that since techs can't legally make independent care decisions then by default their actions are delegated by an RN. In reality, hospital administration already decided what techs generally would be allowed to do in their facility and assigned those tasks to them, very often without any directive input whatsoever from on-duty staff. Maybe an RN (such as the DON or the nurse manager) will be responsible for what the tech does, but unless I actually delegated something, I individually will NOT be. That's just the way it is.

If your policy says that you will do tasks as delegated by the RN (implied: staff RN on duty), I would expect that to mean that every day the techs line up at the nurse's station to get their ordered tasks. Unless that is what is happening then their action are not being directly delegated. I wouldn't want to work as a tech or especially a nurse in a facility with the type of policy you are reporting. Remember, just because something exists doesn't mean it would hold up to a significant legal challenge.