Are RNs under the supervision of physicians?

  1. i would really like too know this since cnas and lpns are under supervision of a rn wouldn't the rn be under the supervision of the physician?

    thanks for all input.
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  2. 15 Comments

  3. by   ohmeowzer RN
    thats a good question , but no. I am a RN and i consider myself under the supervision of the charge nurse. are you in nursing school? good luck in your future.
  4. by   VegRN
    I think if a nurse worked in a dr's office or somehow for the physician then yes, the nurse would be under the supervision of the physician.

    However, if a nurse works in a hospital, they are under the supervision of the nurse manager and the DON and the hospital. The physicians are usually not employed by the hospital, they have "privileges" to admit pts to the hospital and bring in money to the hospital. They work sort of like independent contractors. This is why the pt often receives two bills for a hospital stay, one from the Dr and one from the hospital. If the Dr had a complaint about a nurse, they would bring it to the nurse
    manager.

    This is the way I understand it, feel free to correct me if I am wrong.
  5. by   ohmeowzer RN
    vegRN you are correct at least in my case. i work in a hospital , but my direct supervisor on the floor is the charge nurse then the nursing supervisor, i usually work when the dept manager isn't there so i go to the charge nurse.
    yes the doc's are independant contractors and have no say in nursing decisions. take care..
  6. by   deeDawntee
    Yes I agree with last post. I am under the supervision of my nurse manager...not the charge nurse...the charge nurse has no authority over me whatsoever...she just has a different set of responsibilities, namely pt placement and staffing for the next shift...she is also a resource for questions, etc as she is usually a senior staff nurse...
    In some ways, I answer to myself, since I am responsible for my own practice and for forming a beneficial connection to my patients....

    Doctors have no supervisory role whatsoever...I use them to get what the patient needs....

    Also, I don't supervise the CNA's, they have their own set of responsibilities, and are supervised by their manager. (we have no LPN's where I work). If I have a problem with a CNA, that I cannot resolve with them on a personal level, I go to their manager...I have no power in the matter....
    Last edit by deeDawntee on Sep 29, '07
  7. by   Azee
    i consider rn's to be part of "the team" along with dr's
    Last edit by Azee on Sep 30, '07
  8. by   rn/writer
    The short answer is no. Nursing and medicine are separate disciplines and each has its own hierarchy.

    Attending physicians have staff privileges at a given facility and may serve on various boards and committees, but unless they are also part of upper level administration, they are not in a typical sense considered hospital employees. They function as independent contractors.

    Nurse are employed by the hospital. A staff nurse answers to a nurse manager who answers to a department head and so on up the line to the director of nursing. The DON represents nursing services in the upper echelon of administration.

    When an irate doc threatens to fire a nurse, it's often blowing smoke. Although a doc may be able to lodge a complaint with the nurse's manager, he almost never has the direct authority to dismiss her. Docs sometimes forget this to their peril. Just as a doc can make trouble for a nurse, a nurse can protest about a doctor's actions and he may have to answer for his actions to his superiors.

    Residents, interns, and med students are all considered to be docs in training. They aren't hospital employees in the strict sense. They "trade" their services for the furthering of their education and whatever modest income they receive. Smart ones learn early on that cultivating a good relationship with the nursing staff is one of the best things they can do.

    Nurses need to keep in mind that they answer to their own nursing superiors and not to the medical staff. If a doctor asks a nurse to do something that will violate the hospital policy and procedures, she is not only allowed to resist, she has an obligation to do so. A doc that threatens firing or other dire consequences ("I'll have your license revoked!") should be reported, both for his improper request and for his use of intimidation tactics.

    Fortunately, the "old guard" is changing and the medical management at many (if not most) hospitals is realizing that everyone benefits when docs consider themselves to be part of a team.
  9. by   JBudd
    I work for the hospital, which gives them administrative authority over me. The MDs I work with are under contract to the same hospital. They are responsible to their medical director.

    If I worked for an MD in a private practice, only then would I be responsible to him/her. They would be liable in court for my actions performed under their auspices only.
  10. by   caroladybelle
    Quote from siemprebella
    i would really like too know this since cnas and lpns are under supervision of a rn wouldn't the rn be under the supervision of the physician?
    no.

    nurses are nurses and doctors are doctors. they are two separate entities, even though they (theoretically) work together.

    now, a nurse may work in the md's office, and as the nurses employer, the md could possibly fire the nurse. but by the same token, if the md asked the nurse to do something that fell clearly out of her scope of practice, she would still lose her license. so s/he still is under the jurisdiction of the bon, which is separate from the medical boards in most places. and as many mds really have no clue as to nursing scope of practice, this occasionally causes problems in small practices, though larger professional groups usually are responsible enough to educate themselves.

    in most facilities, such as hospitals, nurses govern nurses. mds may have privileges, or in the case of the icus (hospitalists/intensivists)/eds , be hired by the facility. they are responsible to the medical director, also an md, and/or to the local medical board.

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    mds (residents and interns) and laypersons often have this mistaken idea that mds "run" nurses or are "in charge" of nurses. they have difficulty with the notion that we "manage" ourselves and cannot perceive of care without a hierarchy) mds often are blind to what goes on outside their scope and see themselves as giving "orders" that we merely mindlessly follow and that they are the leader of the team. it aggravates them when we do not. they also forget that we have several hundred "bosses" all with different rules and can't handle that we cannot handle separate"rules" for each one.

    we are a separate entity like pt or ot or pharmacy. they write orders, we figure out the best way to facilitate them in a manner that best helps the patient, recommend changes that might better facilitate recovery, and occasionally question or refuse what would validly harm them....just as ot/pt/social work/pharmacy do. and if we refuse or disregard an order wrongly, medicine confers with nursing management, and we are disciplined by nursing management, as appropriate. just as if an md behaves inappropriately, nursing management consults with the medical director, and discipline may be recommended.
  11. by   suzanne4
    As an RN, you are under your own license for whatever you do and do not do. The nurse manager of the unit, nor the director of nurses is legally responsible for what you do in your role as an RN.

    If you are speaking in terms of hierarchy, then you go up the chain of command. A physician is not normally in the direct supervision of nurses, but again, the nurse functions under their own license in all cases. They are never under anyone else's license.

    Nurses are part of the health care team, just as the dietician is, the physical therapist, the respiratory therapist, and even the physician. They each bring different specialties to the table that are equally needed in the care of your patients. As well as the other specialties that have input as well.
  12. by   RN1989
    I think the answer depends on what is meant by "supervision". As nurses, we have to follow the doctor's orders. Although we have a lot of leeway in how we do things, and although the doc is not there all the time, we have to have orders to do anything. Without orders, the patient would not be in the hospital. The doctors assume that we know what we are doing and that we are going to take care of the patient in an appropriate fashion, but technically we don't do anything without an order. A CNA can practice independently in that nurses aren't over her shoulder all the time but she can still lose her certificate as well as cause the nurse she is working with to lose their license. Same with LPN and RNs - RN is technically ultimately responsible for the LPNs practice even though we all know that the LPN usually is doing her thing and the RN is doing their thing without immediate, constant overseeing by the RN. Then goes to chain of RN/doc. RN has ability to do things a certain way but technically has to follow the doctor's orders as the doctor is supervising the treatment of the patient. Yet I have never seen a doc lose their license because of the nurse - have seen a nurse in trouble for not realizing the doc screwed up and wrote wrong orders. So I think it depends on what kind of definition of supervision you are thinking of. RNs technically can't provide care without order "supervision" of a doctor. Just as most states limit what a NP/PA can do - they have to have a doc willing to "supervise" them and order the care - even if they are just following a pre-approved protocol.
  13. by   CHATSDALE
    i have seen a head nurse fired because an rn whom she had written up several times but had not fired messed up big time, caused a pts death
    nurse at fault lost license
    but it is usually a team effort even if you are not in direct supervision of the md..if he writes an order than you find suspicious and dangerous to pt call him back and verify it, if the answer does not satisfy you tell him that you cannot carry it out it and that you will discuss this with your superior..if that nurse chooses to carry out the order or if you are backed up - sometimes passing the buck is the best way to save your license
  14. by   SiempreBella
    Thank you all for making it crystal clear

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