Today I had to “write up” one of our nurse techs. And he will probably be fired.
Basically, he refused to do something I asked him to do--something within his scope of practice, something that should have been easy. He should have jumped his butt up out of his chair and said, “Okay, I’ll get right on that.” Instead, he said, “No, I won’t.” Not, “I can’t right now, I’m helping so-and-so” or “I was just called to do an EKG,” or “Can I do it in ten minutes.” Not even some lame-o excuse that I knew was a lie, but that would have prevented me from saying the magic, union-required words that usually provoke the laziest tech to jump the hell up: “Are you refusing to do this?”
He looked at me and said, “I am not going to do it.”
Them’s firin’ words, folks.
Please note that this was not the first confrontation I’ve had with this person. Since I started in the ED, at very best he’s been cold to me; at the worst, he’s disappeared rather that do work when assigned to me, undermined me in front of patients and other techs, and apparently does this to other of my coworkers as well. He also had the nerve to tell me, as his excuse when I confronted him about this later, “I had to stay with my STEMI patient. What, you wanted me to leave the bedside?” First of all, he was NOT at the bedside (not even NEAR it) when I asked him to do what he refused to do. Second, there were two nurses and a doctor at this patient’s bedside; the EKG had been done, the bloods had been drawn. He wasn’t needed there. I told him to give me a break.
Please don’t get me wrong. Some (and note I didn’t say most) of the techs are very good and will bust their asses to help you--even when they’re not assigned to you. These techs get used up and wrung out and eventually leave for easier assignments because they can’t take it anymore (or if they’re smart, they go to nursing school or become EMTs and paramedics). Other techs are decent, and will help out if they’re assigned to you, but may balk if you ask them to do too much. Some are nice, but are completely useless. And others are surly, rude, mean to patients, disrespectful to any authority, foul-mouthed, loud, and generally unpleasant to be around. And it’s really hard to get rid of them, because they are unionized: they have to get “written up” several times to build a case against them. Then there’s the long, drawn-out process of dealing with the union. The only time they can be fired outright is if they refuse to do something. Like this tech did.
Our techs are “specially trained” by the hospital, and can do vital signs (temp, pulse, bp, resps, O2 sat), draw bloods, use the glucometer, and do EKGs. They’re also expected to do patient care, hand out food trays, feed patients who need it, and generally do whatever the RNs tell them to do (go get blood from the blood bank; run to the pharmacy; help a patient to the bathroom; etc etc). They are not allowed to insert IV lines or Foley catheters (although they used to be trained to do that). This “special training” given to them by the hospital allows the hospital to justify our outrageous nurse-patient ratios to the nurses’ union. The rationale is since we have these techs to share with the nursing tasks, we should be able to take on more patients. Which of course, as anyone knows, is crap. Especially when we have six nurses and two techs. We’re supposed to have four on the floor AT LEAST, plus one in the pediatric ER. Most of the time we have four total, and sometimes we have three--and when we do have what we need, the nursing office pulls one or more away to work on other floors. I understand what it’s like to work short, and I try to handle as much as I can. But there just are some things that will have to be delegated to the techs, and I expect them to be done, and done without the bitching and complaining. (If you want to bitch and complain, get a blog.)
What the administration needs to do is get rid of them (which they already have in critical care, where the patient-nurse ratio is 2:1), hire more nurses, and then live up to the 4:1 ratio we’re supposed to have in the ED. Just hire a person to do EKGs and I’ll be happy. I’ll scrub butts allll daaaay loooooong. Hell, I do it now, but with eight patients. Give me four to six and I will nurse the HECK out of them. I might even have time to do proper assessments and even CHART on my patients! Whoa, getting ahead of myself there...
Things I hear from the techs every day:
Me: “I just put patient X on the bedpan. Can you get her off in a few minutes, please?”
Tech: (sucks teeth) “I’m on my 15 minute break.”
Me: (at 10 pm) “I really need a favor; can you get me vitals on bed 16?”
Tech: “I just DID the vitals.” (Last vitals were entered at 4 pm)
Me: “Can you please help me change the (big fat diarrhea-soaked) man in 12?”
Tech: “I have to go do an EKG; I’m covering so-and-so’s dinner break.” (Meanwhile, you haven’t heard a page for an EKG in the last half-hour.)
Me: “I still haven’t gotten my four pm vitals yet; could you please do them?”
Tech: (to another tech) “This white girl thinks she can order me around because I’m black.”
Once, back when I worked nights on the floor, I actually had a tech raise her head off the desk where she was sleeping and “remind” me there were only two techs on (and both of them were sleeping at the nurses’ station) when I asked her to please answer a call for a bedpan as I sat there furiously charting away on my 12 patients at four AM.
Also, since techs are unlicensed personnel, I’m ultimately responsible for their doing their work correctly, something that makes me crazy, especially since I don’t review their job performance. So the only way I can make sure that management knows what’s going on is to complain when something is bad (which feels like tattling). And I try to make the good techs feel appreciated and like they’re part of a team. But I’m at a point now where the crappy ones can kiss my ass.