Are nurses behind in their knowledge?

Nurses General Nursing

Published

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?

Specializes in ED, CTSurg, IVTeam, Oncology.

LOL, do we also not remind patients to have their coags drawn if they're on COUMADIN?

But seriously, I think a lot of people in the thread are taking this too personally, that it's an affront on their profession. Knowledge is a wonderful thing, but one is never going to get to a point where one has it all. I've probably forgotten half of the inane stuff that I've learned, and I'm still accumulating more cerebral filler on a daily basis.

From the perspective of the nurse being asked by the physician about the Hydroxychloroquine (the other name for Plaquenil), the nurse should have suggested that since the drug is generally an antimalarial being used off label (in the treatment of Rheumatoid Arthritis), and that most nurses are not going to be familiar enough with it, wouldn't it be incumbent upon the prescription writer to be even more careful about informing their patients and ensuring that they're scheduled for bi-annual eye exams?

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.

Yeah, I think I'd ask this doctor about some meds that are outside his specialty! My boyfriend is a GI resident and he's been like, "cardiology ?..haha I don't KNOW cardiology!" Of course, he knows a lot about basic cardiac facts/meds but he also DOESN'T know a lot about cardiac! Some physicians want people thinking they know qthing. The truth is there's a reason for specializing, referring pts to other physicians, etc. I think this physician friend of yours in actuality isn't being so nice as you gave him credit!

I bet you if you ask a doctor that is not a rheumatologist, they may not know what Plaquenil is either. I work in the ICU and there are drugs that the doctors do not know completely either. That is why we have a pharm D working with them during rounds. Also, that is why they call in consults with physicians that are experienced in such areas. There are things we do that doctors do not know anything about. That is why they consult a wound care nurse when a patient has a wound they do not know how to treat.

Understandably the public does not know the sheer depth of knowledge a med surg nurse must possess in order to get through the day.

I'd say that the public (& many physician colleagues) don't understand the sheer *bredth* of knowledge a med surg nurse must process in order to get through the day. As others have noted, the med surg nurses' speciality IS *acute care* of *several* patients with *various* conditions at the *same time.* The reality, given limited time and infinite potential pt needs, basics like monitoring breathing & circulation, carrying out STAT orders and the like take precedence over knowing the details of all the conditions, treatments, test, etc a med-surg nurse may possibly work with. In addition to that, the nurse also has to hunt for supplies, make sure meds are ordered and delivered from pharmacy, try to prevent patient falls, assist with bathroom needs (if aides aren't available), etc.

But who wants to acknowledge that practicing med-surg nurses may not have much more than the most tenuous grasp of all the patient's medical issues? Nursing instructors, nurse managers and colleages do reinforce the need to look things up that one isn't familiar with, but on a unit with a so many different types of patients coming through & the ever-increasing level of acuity of those patients, there may not be enough time in the day to provide patient care AND to self-educate about the various patient conditions, tests, treatments, etc to one's satisfaction.

According to the standards preached in my nursing program, in such cases, that means that you've *failed* as a nurse. In reality, though, accepting a fairly shallow level of comprehension of some things and providing a bare minimum of education to patients is an important prioritization skill needed to be a *successful* med-surg nurse because acute care comes first and time for other nursing care may never be realized.

*let me qualify my statements about depth of knowledge. Most nursing education resources (not talking about research or specialty resource) usually provide 4-5 pages of information on the condition being covered. To me, these resources don't impart "in depth knowledge". However, to be able to APPLY that info successfully in an acute care setting takes the broad knowledge and experience of a med-surg nurse.

Specializes in Surgical Nursing.

It's impossible to know everything about every drug.... especially uncommon drugs...

That being said .... If a patient asks me about a medication I always print out a facts sheet and go over it with them....

Nurses aren't behind on their knowledge....

We're constantly learning and finding out more.... That's part of the art of nursing.

I wouldn't worry about the concerns of one specialized doctor that ofcourse would only know about his area of care. Sometimes doctors rattle off orders to me that I'm unfamiliar with and I have no problem asking them to spell it or tell me what the medication is for.... If I didn't ask I wouldn't be practicing safely.

Maybe you can remind the doc of that....

although visual changes are a rare se, it is ALWAYS up to the prescribing doctor to ensure pts get a baseline eye exam when starting this med.

and, it's an old drug that has been replaced my newer dmards (disease modifying anti-rheumatic drugs)...

so it's not as if this med is a well known drug.

i do believe that maybe 1 pt may have complained to the doc, but several?

no way.

doc is just trying to place the responsibility on the nurses.

put it back on him, where it belongs.

afterall, we're not talking about commonly used meds with more frequent se's, i.e., dilantin, coumadin, digoxin, etc.

seriously, he's talking out of his you-know-what.

politely laugh in his face and remind him that it's his job to establish safety protocols.

then don't give it another thought.

the audacity of some docs, yes?:rolleyes:

leslie

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.

Certainly some patients can take on the responsibility you suggest. But many cannot. They wouldn't know where to begin. Some people are too sick or might be too disabled or might be illiterate with regard to medical issues, lots of reasons why we can't expect the patient to do as you suggest. For those patients who are able, I vote for this wholeheartedly.

Blind and uninformed reliance on others is called paternalism and it is still widely practiced. Right or wrong, it is alive and well.

Doctor comes from the Latin word for teacher.

It's appropriate to be familiar with the outpatient monitoring and use of medications that are either being used to treat a condition that the patient is admitted for, or might interact with medications that are newly prescribed. ie, Coumadin. Any anticoagulants or anti-platelet meds. Antibiotics. Narcotics. Anticonvulsants, neuroleptics, Etc. It's great if you have time to look up all the meds, but if a patient knows why he/she is taking a certain home medication that you are unfamiliar with, it's ok to let them teach you. I have had Drs ask me about my medications in the past as different meds can be used to treat a wide scope of diseases. If it's a medication that is newly prescribed (like, during the admission), or the patient is unfamiliar with it, you should spend a little more time researching it--side effects, interactions, reason for use, etc. But I would say q6 month eye exam reminders should be left to the prescriber or the RN who works with that prescriber.

I am more familiar with plaquenil since many of my patients have RA. In the context of my work, I don't need to know about eye exams. I DO need to know that plaquenil might make the patient hurl if they take it without food (so, hold it if they're NPO except meds). It's all about context :D

politely laugh in his face

I like your style Leslie :up:

+ Add a Comment