I work as a Vascular Access Specialist at one of my two jobs and place many PICC lines a shift. I work as an Intensive Care Unit Nurse at my second job. I am often asked to step out of my ICU role in order to place a PICC line for different patients. I often feel that leaving my patient in a different nurse's hands disrupts patient care and sets me back. I am not allowed over time to justify for the extra time at the end of the day so I always feel rushed and distracted when I get back to my patient's care.
Do I have the right to refuse to place a PICC line during my ICU shift? If so, what would my rationale be? Whenever I complain about the inadequate quality and continuity of care while I am gone, management claims that nothing should be disrupted as another qualified RN is taking my place.
Thanks for your answers.
PICC RN
You absolutely can refuse because
1. Inserting PICC is not in your ICU job contract/job description.
2. The most important thing, like you already said, is putting your own patients at risk due to disruptive patient care. It is so unfair for the patients.
Write a formal letter to your Manager, cc to CNO, HR Director, and Risk Management Manager (most important person). If they offer to give you overtime, dont take it. No matter how much you can get, the stress you get when doing PICC but the back to your head is still with your ICU patients is too much. Been there done that so I know how you feel. My case: I just said a big NO at the beginning.
I appreciate your comment. It's been a struggle and sometimes it feels so personal that it's impossible to stand back and see the whole picture. Comments like yours help.
Many years ago, a hospital in Atlanta had the same problem. This hospital had disbanded their longstanding IV team. Several ICU nurses had been assigned to place PICCs, but had the same concerns as you have discussed. It got so bad that they finally started refusing to place PICCs when called. It took about a year, but the doctors finally convinced the chief nursing officer that they needed a team for PICC insertion. Several years ago when I was doing PICC insertion classes, I would refuse to provide a class to any hospital that was wanting to train nurses from different units. I have never seen this work. I would only provide my class to a hospital that had organized a dedicated team of nurses to do this procedure. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I am now a PICC nurse but did critical care for 10+ yrs.
When you take report you are taking responsibilty for your patients for your shift, until you report off. If you delegate care (be it to another RN for a lunch break, or to a CNA for baths) it is your responsibilty to be sure you are delegating to a person that will provide appropriate care.
Leaving your patients for the amount of time it takes to PICC is a BAD idea. Especially in critical care.
I have had a similar problem with being asked to act as a translator. I speak Spanish and used to get called all over the hospital to translate. I would be taking care of a fresh heart transplant and get called to the ER to translate. I was supposed to have my charge nurse (who had her own patient load) and go help. It was never a good idea.
I finally stopped telling people I speak Spanish and when I change jobs I keep it my dirty little secret. I will help in my unit but never leave anymore.
Martha