RN rounding for Doctors?

[traumasurgRN]

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 this a common practice in other hospitals? The Md comes behind the RN and signs off the orders they write as a VO.

[missnurse01, MSN, RN]

I have also worked across the country and have never seen this! They use APNs and PAs for this. yikes.

[traumasurgRN]

Just like meandragonbrett said, they work in contact with the MD, not the hospital. More often than not, the nurse is usually rounding with the MD, or just a matter of a few hours before. I understand that this is usually the job of the APN.

[jadelpn, LPN, EMT-B]

Just like meandragonbrett said, they work in contact with the MD, not the hospital. More often than not, the nurse is usually rounding with the MD, or just a matter of a few hours before. I understand that this is usually the job of the APN.

I was under the impression that these were RN's that worked for the hospital, and not the MD. If they are the MD's office RN's there is in some states a leeway as far as others who perform duties that the MD directs--under the MD's license and malpractice. However, I thought this was the office medical assistant (unlicensed) debate--as an RN one has to work to the standard of their own license. And if they are in constant contact with the MD, then they are perhaps receiving telephone orders and not making up their own orders that then the MD signs off (or not) as verbals later. There's a huge difference between a nurse rounding, assessing and doing notes, suggesting and obtaining telephone orders and a nurse who is rounding, assessing, deciding what the patient needs next and writing their own orders for same, THEN informing the MD what they wrote so the MD can then sign off. Only a NP can do that. Otherwise, the RN is being a practioner, and the MD has no obligation what so ever to sign the orders that he did not direct. Which then begs the question--do you, as the care nurse in the hospital, carry out the order that the RN writes if the RN is NOT in contact with the MD? Again, utilization review would be all over this--as RN's that come into the hospital from the MD office round and write orders. (and I know you claim they are in constant contact with the MD--well, as the Rn who is caring for the patient, can you get your own orders from the MD?) You carry out said order. The MD then says "I never said that, I will not sign off on it...." then YOU are in hot water as well. Then the administration wants to know why it is that you are following verbals when the MD is not on the floor--from another RN who makes em up. Not to mention I am SURE that nudge, nudge, wink, wink, administration has NO CLUE that this is happening when the poop hits the fan......

[Corey Narry, MSN, RN, NP]

I 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

[Esme12, ASN, BSN, RN]

I 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.

[echoRNC711, BSN]

I 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 )

[dirtyhippiegirl, BSN, RN]

Seems like this could be done if the rounding RN was writing orders based off some sort of individual matrix/standing orders set that the doctor privately chooses to implement.

[tewdles, RN]

Most 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.

[traumasurgRN]

Tewdles, the rounding RN's that I am speaking of work the same way, within a protocol or order set between the nurses and the MD. I did not mean to imply that the RN's were practicing outside of their scope or illegally practicing medicine. I simply was curious if this was common among other facilities.

[tenarnc]

I round for a group of physicians on the weekends. At my hospital, I had to actually apply for privledges just as physicians and APN's do. I do know what I can and cannot do. Any orders I write are telephone orders from the physician. They round on all of their patients. I just make sure information is on the chart for them, write notes, some orders, notify them of anything urgent they need to know about. I work within the scope of my practice as an RN and privleges granted by the hospital. I do work full time at the hospital, but when rounding, I am employed by the physician group. It has been a positive experience. I am a BSN with 30+ years experience.

[jadelpn, LPN, EMT-B]

I round for a group of physicians on the weekends. At my hospital, I had to actually apply for privledges just as physicians and APN's do. I do know what I can and cannot do. Any orders I write are telephone orders from the physician. They round on all of their patients. I just make sure information is on the chart for them, write notes, some orders, notify them of anything urgent they need to know about. I work within the scope of my practice as an RN and privleges granted by the hospital. I do work full time at the hospital, but when rounding, I am employed by the physician group. It has been a positive experience. I am a BSN with 30+ years experience.

But isn't that what the primary care RN for the patient is supposed to do?

[missnurse01, MSN, RN]

I just can not see how the board of nursing would be okay with this. Would love to hear their input