So I got fired...

[Jeremy89]

... from an ER Tech position for allegedly being "in the process" of starting an IV (I'm an EMT-B but we have advanced skills training through the hospital).

Here's what happened:

A patient came in c/o weakness/fatigue. He was brady into the 40's with an A/V block on his EKG- Dr ordered an iStat (quick blood test in the ED for electrolytes and the like) and a line/labs. I took the pt back to a monitored bed from our "fast track" area, got him hooked up and went to prepare him for an IV since the MD ordered it. I simply put a tourniquet on to look for veins (and start it if the nurse would let me) since the RN wasn't there yet. I didn't even clean the skin, nor did I take out a needle. Finally the RN walked in, I asked if I could do it; he said no and took over (He's very egotistical and doesn't like Tech's starting lines or doing anything but bedpan duty. We have never gotten along and I always felt like he was analyzing everything I did to find every little mistake). I left thinking nothing of it, but apparently he told my manager that I was "in the process of starting an IV" that was not delegated to me (an RN must delegate, not a physician), which resulted in my termination.

This was a complete shock to me. I had been warned previously regarding IVs: once I got in trouble for switching EMS IV tubing to a Saline lock- (I was unaware we couldn't do that) and another time for looking for veins and offering to start an IV on a patient who was coding on one of the Med/Surg floors (it wasn't specified that our skills were only good in the ED).

Just wanted to get everyone's opinion on this and see if I'm the only one who thinks this is complete bull....

Thanks!

 

[bstone]

Appeal it to HR. Are you in a union? Talk to your union rep.

 

[socalmedic]

sounds like you where warned before and should have known better, what did you expect to happen. when management tells you not to do something twice and you go and do it again you are now a liability.

"doing the same action repeatedly and expecting different results is the definition of insanity" --Albert Einstein

 

[bstone]

sounds like you where warned before and should have known better, what did you expect to happen. when management tells you not to do something twice and you go and do it again you are now a liability.

"doing the same action repeatedly and expecting different results is the definition of insanity" --Albert Einstein

He may have pushed it a little bit- possibly been a little bit too excited- but he didn't do any procedures and only was setting things up. We don't fire EMT-Bs for setting up a drip set or putting on a constricting band when the Intermediate or Medic comes along to start the line, do we?

In fact, there is a course called Paramedic Assistant that teaches exactly how to do these things!

 

[JPINFV]

He may have pushed it a little bit- possibly been a little bit too excited- but he didn't do any procedures and only was setting things up. We don't fire EMT-Bs for setting up a drip set or putting on a constricting band when the Intermediate or Medic comes along to start the line, do we?

So I've got a patient who needs an IV, I have a tourniqute on the patient and am palpating for a vein. What exactly does it look like I'm getting prepared to do outside of preparing to start an IV?

You do expect termination if you've been told not to do something before and he's been warned twice before for fiddling with IVs sans permission and oversight. Perception is reality, and if it's perceived that you're attempting to do something you aren't supposed (even if you aren't), then you were attempting to do something you weren't supposed to. Just because someone was caught (again, perception=reality) him before he was able to start an IV just means he got caught before he started an IV.

Based on the information provided, I would definitely appeal and do my best to change perception from "starting an IV" to "preparing for the RN and taking a look for my own experience." If an appeal is granted, I would definitely in the future limit fiddling with a patient in regards to an IV (and, to use a crude analogy, you don't put on a condom to go out and eat dinner. You put it on to...) prior to permission from the patient's RN.

 

[LonghornMedic]

In light of the fact you had issues with IV's before, why would you even attempt this? And why attempt this with a nurse you have had problems with in the past? It says in your sig line that you are a RN student. RN's do NOTHING until given orders. It's best you learn from this mistake now and carry that over to your future nursing career. Best of luck.

 

[JPINFV]

RN's do NOTHING until given orders.

Neither do paramedics if you want to argue this to the same letter you're arguing. However both RNs and paramedics can follow standing orders/offline protocols.

 

[JJR512]

sounds like you where warned before and should have known better, what did you expect to happen. when management tells you not to do something twice and you go and do it again you are now a liability.

"doing the same action repeatedly and expecting different results is the definition of insanity" --Albert Einstein

Wrong. Go back and re-read what the OP actually wrote regarding what he'd been warned about in the past. Hint: neither of the two previous warnings dealt with what he was fired for in this instance. One warning was for switching IV tubing to a saline lock; the other warning was for offering to start an IV on a patient coding on a Med/Surg floor. In the latter situation, the problem was specifically that he is only allowed to do that in the ER. Well, it was in the ER where he offered to do it this time, so the warning about not doing it out of the ER does not apply.

Oh, and just for the record, Albert Einstein was not a psychiatrist or psychologist. That quote, and variations thereof, have also been attributed to Benjamin Franklin, an old Chinese proverb, and several other sources. I wouldn't put too much stock in that saying, though, unless you also think that parents who teach their kids, "If at first you don't succeed, try and try again," are teaching their kids to be insane.

 

[LonghornMedic]

Neither do paramedics if you want to argue this to the same letter you're arguing. However both RNs and paramedics can follow standing orders/offline protocols.

Depends where you work. Where I work now and where I have worked before, I rarely have to call a hospital to get any orders. It's been over a year since the last time. We have very liberal standing orders and protocols. We can do more in the field with autonomy than any nurse in a ER.

 

[Shishkabob]

Depends where you work. Where I work now and where I have worked before, I rarely have to call a hospital to get any orders. It's been over a year since the last time. We have very liberal standing orders and protocols. We can do more in the field with autonomy than any nurse in a ER.

Just because I want to beat jp to thee punch....

Protocols ARE orders.

 

[aewin90]

Wrong. Go back and re-read what the OP actually wrote regarding what he'd been warned about in the past.

The OP had not been warned about starting IV's, but he had been warned about things with regards to IV's. This last incident was with regards to an IV, though not identical to past warnings.

Here we have an EMT who was flirting with things outside his scope of practice, which is a huge liability for the emergency department should something go awry. Even so, I do not necessarily believe termination was justified, and I would appeal it.

 

[LonghornMedic]

Just because I want to beat jp to thee punch....

Protocols ARE orders.

Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't. I have standing orders to do what I want when I see fit. I don't have to call an ER and ask for morphine. I can just do it. A RN can't.

 

[Flight-LP]

Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't. I have standing orders to do what I want when I see fit. I don't have to call an ER and ask for morphine. I can just do it. A RN can't.

Incorrect. Many ER and ICU nurses also have standing orders, just the same as yours.

 

[akflightmedic]

Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't. I have standing orders to do what I want when I see fit. I don't have to call an ER and ask for morphine. I can just do it. A RN can't.

What century are you operating in??? RNs have "standing orders" as well, so I am not sure where you come off saying that. I have worked in ERs and on the floor for many years and nurses had a lot of "scope to practice".

Also, most other allied health professionals are that...allies. They communicate, cooperate and coordinate a plan best suited for the patient. If you think our one on one in the back of an ambulance and the coolness factor of being able to give morphine without asking trumps a team approach to the best health care delivery, then maybe you are a lost cause.

 

[akflightmedic]

In regards to the OP...I am going to take the cynical side and say maybe you were a square peg trying to fit in a round hole. You had been counseled previously and these were the events that actually made it in writing.

Experience has proven to me time and again, there is always more to the story either by intentional omission or simply the inability to perceive the severity of previous non written warnings about these IV incidents or other things as well.

None of us know as we were not there and we can only rely on your side of the story. You also were very quick to turn it into a persecution (the nurse who hates you) situation and also used the defense of "I wasn't really gonna do it".

I wonder if I walked into a bank and said give me all your money...would they believe me when I said, I was just testing/teasing, not really gonna do it despite what it looks like (as the officers surround me)?

 

[Flight-LP]

... from an ER Tech position for allegedly being "in the process" of starting an IV (I'm an EMT-B but we have advanced skills training through the hospital).

Here's what happened:

A patient came in c/o weakness/fatigue. He was brady into the 40's with an A/V block on his EKG- Dr ordered an iStat (quick blood test in the ED for electrolytes and the like) and a line/labs. I took the pt back to a monitored bed from our "fast track" area, got him hooked up and went to prepare him for an IV since the MD ordered it. I simply put a tourniquet on to look for veins (and start it if the nurse would let me) since the RN wasn't there yet. I didn't even clean the skin, nor did I take out a needle. Finally the RN walked in, I asked if I could do it; he said no and took over (He's very egotistical and doesn't like Tech's starting lines or doing anything but bedpan duty. We have never gotten along and I always felt like he was analyzing everything I did to find every little mistake). I left thinking nothing of it, but apparently he told my manager that I was "in the process of starting an IV" that was not delegated to me (an RN must delegate, not a physician), which resulted in my termination.

This was a complete shock to me. I had been warned previously regarding IVs: once I got in trouble for switching EMS IV tubing to a Saline lock- (I was unaware we couldn't do that) and another time for looking for veins and offering to start an IV on a patient who was coding on one of the Med/Surg floors (it wasn't specified that our skills were only good in the ED).

Just wanted to get everyone's opinion on this and see if I'm the only one who thinks this is complete bull....

Thanks!

Are these "advanced skills" you mentioned covered in your written job description?

Regardless of your personal interpretation or assumptions of the RN's intentions, you are still an ancillary, unlicensed individual working under the delegation of an RN. If the RN says no, thats the end of that conversation. If you know that this particular RN is somewhat limiting in their delegation, then you should consider not pushing their boundaries. Chances are you will not win this battle. Chock it up to a learning experience and move on...........

Just my $.02 worth.

 

[Flight-LP]

Whoops, sorry AK, guess we were on the same wave length this morning!

 

[Scott33]

Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't.

May have been the case during the Crimean War, but not these days.

Seeing that the RN is usually the first point of contact for the patient who presents to the ED, most facilities will have standing orders which will cover your typical "rule out" presentations (bellies, PNA, CP, N/V, etc).

In some instances, it is not uncommon for a complete set of lab work and imaging to be available to the Doc, long before they have seen the patient. Most EDs in the country would grind to a halt if it were to be done any other way.

As for the Morphine argument, different states have different protocols and you will find that some EMS systems still have to ask for permission to use it.

 

[aewin90]

[tangent]

RN's my local ER do not have standing orders. However:

-It is a rural hospital with only eight exam rooms and two trauma rooms.
-It is ranked as the worst ER in the state (and has a reputation as one of the slowest).

I have been to that ER about ten times and have been correctly diagnosed only once, by the one doctor who chooses to use diagnostic tests. We usually go to the "real" doctor after a trip to the ER.

Maybe one day they will be introduced to the wonderful world of standing orders and protocols...?

[/tangent]

 

[Level1pedstech]

Depends where you work. Where I work now and where I have worked before, I rarely have to call a hospital to get any orders. It's been over a year since the last time. We have very liberal standing orders and protocols. We can do more in the field with autonomy than any nurse in a ER.

Really, any nurse does that include any nurse in any ER or just nurses in your part of the world? Got the old broad brush out and gave it a swing with that statement. I bet there are a few ER RN s out there that would love to diagree with you.