Do physicians have authority over nurses in the hospital?

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Hi there. In a hospital setting, do physicians have direct authority over an RN/LPN? I realize there are charge nurses/a DoN/a clinical manager, and I also realize physicians tell the RN what to do regarding the patient's diagnosis, but would a physician ever have the authority to tell a nurse something like "You aren't working fast enough." / "You are spending too much time with that patient." / "You are going to the bathroom too often." or other general statements, provided the physician's patient is NOT being endangered by whatever the nurse is being counseled on?

Sorry for the mega sentence. I am assuming it is not a physician's place to make these accusations/statements but some might anyway. I don't have hospital experience and am just a student nurse, but this piques my curiosity.

Specializes in Peds ED, Peds Stem Cell Transplant, Peds.

Not really sure why they would even care?

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Specializes in Public Health, L&D, NICU.
*** Wow, I can't believe there are nurses who think like this. No physicians can not command nurses. They are the LEADERS of the care team, they are in no position to give any sort of commands. The "orders" they write are not for the nurses, they are orders for the patient.

Occasionally I meet a physician who THINKS they are in a position to tell nurses what to do. I quickly disabuse them of that silly notion.

The nurses who think like this have probably spent part of their careers working at small hospitals where the doctors really are gods. It's one thing if Crazy Dr. X is one of 12 obstetricians who brings insurance patients to a hospital. He can be ignored to an extent. It's quite another if Crazy Dr. X is one of TWO obstetricians bringing in patients (and revenue). Then his opinion becomes much more noticeable. I worked at such a hospital, and watched Crazy Dr. X dictate who worked and when, what patient they cared for, and he definitely had a say over who was hired and fired. I was lucky enough to be a nurse he respected and liked, but that had its drawbacks, too. It sucks to have to care for ALL the patients on the unit because he has issues with the other nurse working that night. I protested that there were limits to what I could do, he said he would "help me" make it through the shift (I shudder to even think what this might have entailed). I called my manager, her answer was for the unfavored nurse to do as much as she could, but for me to chart it all (as he would come behind us and read our charting and argue with us about it).

Nuts? Absolutely. Reality? Yes, in some places it is.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
The nurses who think like this have probably spent part of their careers working at small hospitals where the doctors really are gods. It's one thing if Crazy Dr. X is one of 12 obstetricians who brings insurance patients to a hospital. He can be ignored to an extent. It's quite another if Crazy Dr. X is one of TWO obstetricians bringing in patients (and revenue). Then his opinion becomes much more noticeable. I worked at such a hospital, and watched Crazy Dr. X dictate who worked and when, what patient they cared for, and he definitely had a say over who was hired and fired. I was lucky enough to be a nurse he respected and liked, but that had its drawbacks, too. It sucks to have to care for ALL the patients on the unit because he has issues with the other nurse working that night. I protested that there were limits to what I could do, he said he would "help me" make it through the shift (I shudder to even think what this might have entailed). I called my manager, her answer was for the unfavored nurse to do as much as she could, but for me to chart it all (as he would come behind us and read our charting and argue with us about it).

Nuts? Absolutely. Reality? Yes, in some places it is.

*** Yes I have worked in some tiny hospitals, 12-25 beds. I know what you are saying is true. However even in those environments no physicians is in any position to "command" me. If they think so I will change their minds, maybe in a private discussion in the parking lot. Helps to be a large and strong man.

I prefer the physicians I work with to like me and for us to have a friendly working relationship. If I can't have that I will make them too afraid of me to dream of messing with me or complaining to nursing management.

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Specializes in Addictions/Mental Health, Telemetry.

The doctor gives orders, but the nurse is responsible to clarify the orders and insure that the orders are correct for that patient and that patient's situation. We do not blindly do what they tell us. If a doctor tells a nurse to give a particular medication and the patient is allergic to it, as an example, the nurse should know this information (as well as the doctor, of course!); not give that medication; and inform the doctor, so new orders can be given.

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Specializes in Pediatrics, Emergency, Trauma.

We do not blindly do what they tell us. If a doctor tells a nurse to give a particular medication and the patient is allergic to it, as an example, the nurse should know this information (as well as the doctor, of course!); not give that medication; and inform the doctor, so new orders can be given.

^THIS.

If a nurse falls pray to "blindly" following orders, they will run the risk of not only following their scope of practice, but potentially harming the patient...we are advocates-not for nothing!!!

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Specializes in FNP, ONP.

IME this depends largely in hospital culture. In the distant past when I worked in hospital environments, I worked in some where physicians did in fact have more than a reasonable amount of dominion over everything, including it seemed, the weather, lol. In those places, they did have too much influence over the functions and policies of the department of Nursing. I have also worked in places where physicians on the whole had no such power, but a select few did curry special favor with those that did, and therefore had de facto authority. And I have worked in places where they didn't have enough control to really get Nursing to do so much as get a patient a ham sandwich even if they were paying for it themselves it in gold bullion. So, it just depends.

I spent my early career in large University centers, where that later mostly held true. We carried out medical orders, but we didn't answer to the physicians in any kind of hierarchical scheme. They just weren't part of our chain of command. They were medical staff, we wre Nursing staff, and never the twain shall meet, lol. We worked easily alongside them, and I was very shocked when I joined SDN and read that there was animosity between med students/residents and nurses, because I never saw it. We worked together, and we had fun.

Later I went to a smaller community hospital in a different state. :culture shock: I was hired as the hospital supervisor. I was walking through the units and one of the docs said something along the lines of "I need to get Dr So and So on the phone" Well, I looked up the telephone number, wrote it down on a stickie note and handed it to him. He made his call and that was that. But that move sent SHOCK WAVES through the Nursing department. They could not believe I had DARED be so impertinent. Didn't I know WHO HE WAS? Didn't I realize I was expected to dial the number, get the other guy on the phone, ask him to hold, and then put him through to the 1st guy? I was dumbfounded. I'd been a nurse for about 10 years by that time and never once in my career had I EVER been asked to do such a thing, and I'd worked with some world class docs. They all knew how to make their own calls, and did, lol.

The funny thing is, the doc I handed the number to didn't mind a bit. He might have been used to people dialing the phone for him, but he didn't demand it. And after that, little by little, people stopped doing it. And they stopped getting up and giving him, and others, their chair. I'm a guy, so I get up and give my chair to a lady, no matter if she is the Dean of Medicine or the new hire in laundry. But I'm not bloody likely to get up and give it to another guy for no reason other than he has a different educational path than I. Um, just no. Cultures are usually set by the expectations of the people in them. I, unknowingly, helped change that culture. I'm tall, confident, and told I have a certain charisma, lol. When I handed that guy the number instead of dialing it for him, I started a small change. Other new people came, and probably they two had more "new fangled" ideas about workplace egalitarianism. Two years later, the culture of that system was remarkably different, at least in part because of a sticky note.

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Specializes in Pediatrics, Emergency, Trauma.
IME this depends largely in hospital culture. In the distant past when I worked in hospital environments, I worked in some where physicians did in fact have more than a reasonable amount of dominion over everything, including it seemed, the weather, lol. In those places, they did have too much influence over the functions and policies of the department of Nursing. I have also worked in places where physicians on the whole had no such power, but a select few did curry special favor with those that did, and therefore had de facto authority. And I have worked in places where they didn't have enough control to really get Nursing to do so much as get a patient a ham sandwich even if they were paying for it themselves it in gold bullion. So, it just depends.

I spent my early career in large University centers, where that later mostly held true. We carried out medical orders, but we didn't answer to the physicians in any kind of hierarchical scheme. They just weren't part of our chain of command. They were medical staff, we wre Nursing staff, and never the twain shall meet, lol. We worked easily alongside them, and I was very shocked when I joined SDN and read that there was animosity between med students/residents and nurses, because I never saw it. We worked together, and we had fun.

Later I went to a smaller community hospital in a different state. :culture shock: I was hired as the hospital supervisor. I was walking through the units and one of the docs said something along the lines of "I need to get Dr So and So on the phone" Well, I looked up the telephone number, wrote it down on a stickie note and handed it to him. He made his call and that was that. But that move sent SHOCK WAVES through the Nursing department. They could not believe I had DARED be so impertinent. Didn't I know WHO HE WAS? Didn't I realize I was expected to dial the number, get the other guy on the phone, ask him to hold, and then put him through to the 1st guy? I was dumbfounded. I'd been a nurse for about 10 years by that time and never once in my career had I EVER been asked to do such a thing, and I'd worked with some world class docs. They all knew how to make their own calls, and did, lol.

The funny thing is, the doc I handed the number to didn't mind a bit. He might have been used to people dialing the phone for him, but he didn't demand it. And after that, little by little, people stopped doing it. And they stopped getting up and giving him, and others, their chair. I'm a guy, so I get up and give my chair to a lady, no matter if she is the Dean of Medicine or the new hire in laundry. But I'm not bloody likely to get up and give it to another guy for no reason other than he has a different educational path than I. Um, just no. Cultures are usually set by the expectations of the people in them. I, unknowingly, helped change that culture. I'm tall, confident, and told I have a certain charisma, lol. When I handed that guy the number instead of dialing it for him, I started a small change. Other new people came, and probably they two had more "new fangled" ideas about workplace egalitarianism. Two years later, the culture of that system was remarkably different, at least in part because of a sticky note.

I wanted to pull out and emphasize your comment that "Cultures are usually set by the expectations of the people in them"....because that is really the issue.

It comes down to our own "expectations" and examining our perceptions of how we hold others expectations.

I had a conversation a few days ago about people's "expectations" of others, especially of their co-workers, and sometimes when they don't match, there is a certain resentment and feelings if powerlessness, etc, ties with that. What I draw from your experience I think having an expectation to work together made an excellent evolution to a cultural change that is more ideal :yes:; it's healthy to challenge those "cultures"...sometimes out own expectations can help drive a better culture.

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