Pct refused delegation

3 A couple weeks back I was caring for a very high maintenance patient with a new colostomy. I had taken care of the patient three nights in a row. On the third night when the patient was more stable physically I asked our PCT to empty the patient's colostomy before the end of her shift at 11PM. She refused. She stated that it was not within her scope of practice. I let her know that other PCTs empty them and she rebutted that if it came off she couldn't put it back on. Because ultimately I am responsible, I emptied the costostomy. At our monthly night nurse unit meeting I asked if it was outside the scope if practice for PCT's. I was told it wasn't and it was taken down in our meeting minutes so it could be clarified later. The notes are then turned into our manager. I don't think any names were used, but I'm sure if the senerio was mentioned infront of the PCT she would recognize the situation as the one shared between us.
Friday my manager called me on the phone and asked me about the situation. She said, "Deana (name changed) says you won't change patients or empty colostomies because it makes you vomit." Admittedly poop is my weakness. Some people are grossed out by sputum or vomit. I went to school who was grossed out by eye drops. Poop is hard for me. Ocassionly, I do dry heave. I try to do everything I can to be discreet about it, I even carry a small bottle of body spray in my pocket for super Code Brown situations however it does happen that I dry heave. I have never, however, vomited because of it and I most certainly don't clean up my patients to avoid it! Many times this PCT has helped me clean patients in the 3 years I've been at this position.
I'm really bothered by this. I would like to confront the PCT in the presence of our manager just do the record can be set straight. I don't know if it will just start all this to snowball. Should I just leave it alone. Or should I schedule a meeting.

I'm concern about here accusation and feel I must do something. Last edit by Manatee111 on Sep 5, '11
How much experience does this PCT have with colostomies? Are you certain that s/he knows how to empty one?

The PCT has worked on our unit for several years and on our sister unit before that. Her know how is not in question.

I can see her not feeling comfortable applying a new one (although if she can put on a tupperware lid, it shouldn't require a lot of imagination to get the job done- some states allow that- some don't ) . But emptying them? I did it all the time as a CNA- alone with the pt as a private duty CNA....if the thing fell apart, I had to figure out how to deal with it. If nothing else, the NM needs to reinforce w/PCT about her duties and expectations- imo As for the poop thing- if it's the smell, try some Vicks Vapor Rub under your nose, or a mask with peppermint extract drops on it (like 3-5 drops- not a ton, or you'll smell like a candy cane, and that could make the pt queasy- Getting some ostomy odor product could help as well, and will help the pt post d/c.

Maybe she DOES need more training or experience doing it; humans tend to avoid situations they are just not competent with. Especially what to do if there are complications.

Quote from Manatee111 Should I just leave it alone. Or should I schedule a meeting.

I'm suprised by her claim of the scope of her practice. In my training as a PCT, we trained for every delegatable, unlicensed duty, period. I thought the training was universal. It seems to me that this tech just didn't want to do it, (I must say it is one of the most unpleasant of tasks), & when questioned used your revulsion as an excuse. I really don't see how your discomfort can be used since she said she didn't possess the skill set. Your manager should've told her that regardless of your motives, it's still a delegatable task and if she needed a retraining session, she'll see to it that she gets it @ her own expense. Period. I like the previous posters idea of documenting the incident and response to it, other than that I don't know what you could do. I just felt the need to give a fellow PCT perspective.

This is one of the most frustrating and discouraging aspect of bedside nursing. The PCT saw you empty the colostomy for 3 nights and doesn,t have a clue as to why you did and now you are asking them to do it. Perhaps the PCT needs a informational session about the freshness of a colostomy that needs to be tended to by an RN and then, as you stated,when more stable( describe what more stable critieria is), is able to be delegatd to the PCT. It is at times, like teacjing these PCT's nursing and the rational for the decision. I grew personally resentful as to why I had to justify my decisions to a PCT/CNA.The documentation suggestion is a one solution but if your mananger is not on board- it is a waste of your time and it may end up bitting you in the end. Notice who got the phone call from the NM. An be aware, the next tine you work with that PCT, they will make your life unpleasant, get others in board with them ( retaliation),continue to refuse to do things and more of these tasks with become "not in their scope of practice" and their watching you do all the work alone. Until their "scope" becomes to just show up for work to read the paper or magazines. I love how they pick up the lingo quick. To me it sounds like they want to elevate themselves to the level of RN. Some of them come from the position "They are Rn's by experience- I have some of them tell me that, they forget one little thing- they need a license and to get one of those, they need to go to school. Love how they always leave on time. After 30 yrs I could go on and on- to become a website of my own. After 30 yrs, I have the chance to be paroled from bedside to case management- Good luck

Quote from Manatee111Friday my manager called me on the phone and asked me about the situation. She said, "Deana (name changed) says you won't change patients or empty colostomies because it makes you vomit." Admittedly poop is my weakness.

Friday my manager called me on the phone and asked me about the situation. She said, "Deana (name changed) says you won't change patients or empty colostomies because it makes you vomit." Admittedly poop is my weakness. I'm concern about here accusation and feel I must do something.[/quote] So what's the problem here?? Yes, it makes you queasy (as it does alot of people), but that doesn't keep you from doing it as evidenced by the last couple of shifts when you emptied the colostomy.

I Can't believe she refused to empty the bag. I am a PCA and I have to do that, and it is not outside of our scope of practice. The first time I had someone there to make sure I was doing it correctly, but it was simple: unfold, empty, fold. I would be angry that she went above you to tell your boss that, but I think this is something that needs to be straightened out with the PCT, not with your boss as the middle man. You should confront the PCT. Maybe she is grossed out by colostomy bags like you are gross out by poop. (i dont know haha). Anyway, I definitely think you should straighten it out with her and once that is done maybe you can go talk to your manager to let him/her know it is all straightened out, and it was a misunderstanding. Good luck to you!

Interesting, what did you tell the Nurse Manager? Sometimes I have to follow up on a complaint and ask about a recent situation. She may have been calling to clarify the other side of the story. I imagine this isn't the first time this PCT has said this to get out of work, then get out of trouble by blaming the delegator. I usually ask, say ok, and document, close the book on that one. Offer training to the PCT and move on. I also might have to ask other people how you work on the floor, do you jump in a help handle code browns etc. Most people who make accusations like this after a general meeting are guilty of the very thing they try to pin on the you.

I think this is a common thing. I worked as a CNA on the floor that I work on currently as an RN... now from one CNA inparticular there is animosity as I have transitioned into my new role. It can often been seen that she hides her unwillingness behind her "inability" or passing off that now that I am an RN I don't do patient care (which is completely untrue, because patient care is my favorite aspect of nursing). And my reputations has been backed up by all of the other CNAs on the department. Although it is not right, often it is easier to do things yourself than argue with your aides. However, at least in my states, this is a delegatable task. If the PCT is unsure of how to complete the task she needs to seek the needed education to do her job. Good luck and sometimes making teamwork actually work is the biggest challenge.