Are nurses behind in their knowledge?

[Ayvah, RN]

I met a doc the other day who was talking to me about his clinic practice, and he mentioned that when his rheumatoid arthritis patients were in the hospital, a lot of them commented on the lack of knowledge of med surg nurses. For example, he said, one patient told him about a nurse who did not know that when a patient is on Plaquenil they should have an eye exam every 6 months. He also said some nurses confessed to not knowing that Plaquenil was used for rheumatoid arthritis.

While I agreed that prior to administering medication a nurse should look up any unfamiliar drugs, the part about the outpatient eye exam schedule seemed rather nit-picky of the patients.

The doc was a nice guy but was genuinely curious about the state of nurses knowledge on med surg. I explained to him that I could not even remember the last time that I administered Plaquenil, and that you could not expect the minute details of uncommonly given drugs to be remembered on a med surg floor where you have practically every diagnosis/medication on your floor. (What med surg nurse has the time to ask the Plaquenil patient if they've had their 6 month eye exam anyway?)

The doc said that a number of patients had expressed concern and disappointment. Understandably the public does not know the sheer depth of knowledge a med surg nurse must possess in order to get through the day. So at first I was thinking this patient's concern was just an isolated incident (as I've mostly heard the opposite thought) but now, since it bothered the doc that much to ask, I am wondering if this is a more prevalent untold thought by our patients? Thoughts?

[feisty]

I agree that a nurse should know contraindications, etc. about a med, but to know details like needed eye exams....I don't think so. Seriously, if I wanted to be that detailed in my knowledge of drugs I would be a pharmacist.

I wish I had the time to really slow down and absorb knowledge while working but I am trying to keep my work from burying me under and my license on the wall, so to speak. I believe we should be life long learners, but short staffing makes it hard to research something while at work. Once I get home, I have the rest of "my responsibilities" draining the life out of me:D. My brain needs a break sometime.

[VegRN]

First of all, a bedside RN is not going to be the one prescribing plaquenil and therefore not the one that is in charge of reminding them of the need for a 6 month eye exam.

Second, this drug is not commonly prescribed and it is unrealistic to except a med surg nurse to know the minute details uncommonly prescribed drugs that are given. How many patients are admitted to the hospital for rheumatoid arthritis?

Third, was this a general practitioner or a specialist such as a rheumatologist? If they were a specialist, I doubt that he would know the minute details of a uncommonly prescribed cardiac drug or another drug outside their specific medical specialty. If he was a general practice Dr then well, Drs go to school for 8 years plus 4 years of residency, of course they would be more well versed on the details of the drugs and in fact, their medical license requires them to advise and order needed follow in cases like this. Bedside med-surg RNs go to school for 2-4 hours and have an entirely different role than the MD role of prescriber.

It sounds like these patients are just flapping their yap and would find something else to complain about had it not been about the med surg nurses not knowing the "minute details of every drug they are on". The dr sounds like he doesn't really understand what nurses do and what they are expected and required to know.

[txredheadnurse, BSN, RN]

Here's a radical idea....how about the patient makes themselves informed about their conditions and medications so they can monitor what types of tests, intervals of check ups etc. they need. Blind and uninformed reliance on others to manage ones health care is generally not in anyone's best interest.

[PostOpPrincess, BSN, RN]

I do not know that drug nor frankly do I care. Now, if he is interested in the physiology oh how a South American patient can ge worms in their longs and end up in ARDS, I can spend the ENTIRE day on that......guess it is all about prioritization. What nurse---any nurse in an acute hospital setting is going to care about the darn eye exam when the patient next door has a PO2 of 88 on a 100% NRM????? Puhleeze.

[Sewbusy~RN]

Thats ridiculous. I look up meds if I don't know them BEFORE I give them but I couldn't care less about the stupid eye exam. I want to know what its used for (does it make sense for this patient), normal dosage levels, side effects to watch for, and contraindications. I have important things to do, and they do not include nagging a patient about some eye exam they may or may not need with this med. Now if I see something interesting in epocrates about a crazy side effect I may ask the patient about it, but more for my own learning and curiosity than anything.

[lauramae18]

I agree with fiesty. Most nights I feel like I don't have enough time to get all my work done at a bare minimum, let alone the way I like to do it. You know, make sure my patients receive some education, try to get them washed up in the am for the morning crew, spend a few minutes talking to the old lady with no family. I look up meds that I am unfamiliar with, read cardiology periodicals and do what I need to maintain my license, and all the other little things that fall under being a licensed professional. I don't think knowing that a patient needs an eye exam for a drug that I rarely see is going to be a smart use of my time. Of course, I will never forget that you need it now!

[meandragonbrett]

I would have asked the physician what his rationale is for why an ACUTE care RN would need to know CHRONIC implications of a medication such as needing an eye exam. We're not talking about chronic complications of long term steroid use here.

[Baloney Amputation, BSN, LPN, RN]

If I had a dime for the number of times I had to explain to my DOCTORS (except my pulmonologist) what one of my medicines on my med list, Xolair, was for and how it was spelled and how it was administered and why I needed an Epi-Pen for it....

Doctors don't know every drug known to humans, but like nurses, they are more than capable of looking them up in the trusty PDR.

[Tait, MSN, RN]

I am an acute care nurse.

Eye exams are not acute care.

Tait

[Smitty08]

That would be the role of the prescriber. Sure it would be nice if the nurse might remind the pt, but its not the nurse's role or within the fund of knowledge necessarily and certainly not a priority. It IS however a priority for anyone prescribing the medication.

[Ayvah, RN]

Thanks for the replies. I'm glad to hear this isn't a common secretly held concern of our patients - it did seem pretty ridiculous to me too! And yes, this was a specialist who asked me.