RN rounding for Doctors? - page 2
by traumasurgRN 6,733 Views | 27 Comments
In the hospital I am currently working at, I have noticed that many of the general surgeons, neuro surgeons, and even the pulmonologist have experienced icu Rn's who round for them, write orders, and take first call for them. Is... Read More
- 1Nov 14, '12 by meandragonbrettI have worked in facilities across the country and this is common practice.
It is VERY common for specialties to have rounding nurses that round and write out the beginning of the daily progress notes....such as labs, vitals, I/O's, etc. As well as writing basic orders for the AM labs for the next day, electrolyte replacements, transfer orders, etc. The rounding RN isn't making these decisions on their own. They are in contact with the practice physician that they work for.
It's a way to streamline the provider's daily workload as they then come in behind the rounding nurse....add to the progress note their assessment, write any additional orders they want, and then move on to the next patient on their list.
- 1Nov 15, '12 by jadelpn Guide
- 1Nov 15, '12 by juan de la cruz GuideI totally see how an experienced ICU nurse can assess patients, participate in rounds with the attending, get briefed on the plan of care, and be the first call as a "go-between" for open communication between the bedside nursing staff and the physician. In this case, an important detail must be ensured...the fact that these nurses are not acting independently. They can write notes in the capacity of a scribe. Insurance companies including CMS (Medicare and Medicaid) allows for the use of scribes (which do not have to be nurses actually) who can gather patient assessment data for physician documentation purposes.
It must be clear that these nurses' assessments are confirmed by the physician and all the actions written by these nurses reflect actual actions by the physician in providing care to the patient. Otherwise, filing a billing claim on these notes written by nurses but signed by a physician could constitute insurance fraud. As a final thought, I would advocate for the use of non-physician providers (NP's and PA's) in order to avoid the risks of being questioned as these professional are licensed independent providers.
See: Guidelines for the Use of Scribes in Medical Record Documentation
- 2Nov 15, '12 by Esme12 Senior ModeratorI guess they (the MD) are too cheap to hire a PA or NP. I'm sure the nurses feel they are very important.......as a patient if I am paying for the MD....I want the MD. I don't know pretty risky...there is some borderline legal stuff there.....I wouldn't do it.
For me.....I absolutely think experienced nurses can do this do I think they should? No I don't.....I personally think ot these scribes like the secretary of old when they ran around behind their boss writing in short hand very word the boss uttered. I know it sounds harsh.....but......if these MD's won't spent money for the appropriate personnel....I an skeptical how far they would go to have your back in a court of law.
- 0Nov 15, '12 by echoRNC711I don't know it just seems to scream "lawsuit "
While the nurse may work within parameters described,
if experience is anything to go by and a lawsuit ensued I seriously doubt any Dr. would be volunteering to "save " that nurse.
Curious, is it even within the scope of practice? ( licensure wise )
- 1Nov 15, '12 by tewdlesMost of the cases I am familiar with the nurses have standing orders and algorythms for their guidance that have been developed by the MD. Therefore, they are following MD orders when they implement those already developed order sets. This occurs based upon the professional relationship between the physician and the nurse, which is quite likely VERY different from the typical relationship between MD and the inpatient floor nurse.
Nurses practicing in those roles are typically VERY careful to stay within the confines of their professional role.