Our jobs as nurses is to protect/help/serve the doctors.

Dixielee, BSN, RN · Jul 10, 2012

As a nurse, it is my job to ensure that the admitting doctor and all of the consults accurately assess the patients, order the correct labs, order the correct meds, read the consults notes, and do not miss anything with the patient. It is my job to report to the consulting physicians so they can write orders without ever seeing the patients. It is my job to point out trending high BPs and to convince the doctor that the patient needs an increase in BP meds. It is my job to ensure that doctors never have to deal with family members or answer any questions. It is my job to protect the doctors, make sure they are doing their job, make sure their orders are correct. I am an RN - an advocate for doctors.

I think you pretty much summed it up! Unfortunately, you are correct!! I was working with a PA the other night in a VERY busy Fast Track. We see 100 patients per day. He kept writing orders for the wrong things for the wrong patients, IV meds when he meant PO, knee immobilizers on people with lacerations of feet, discharge orders on people he hadn't seen, etc. I am trying to figure out what he really means because I actually triaged the patient.

When I would point out an order in question and asked for clarification, he responded saying, "you know what he needs, just fix the order to make it fit". He was not the only provider fortunately, so I could focus on "fixing" his errors. I finally told him, "I can do my job or I can do yours, but I'm not doing both". It never got any better, but I have a feeling he won't be working with us very long.

Nurses have to learn at a very young age that they are responsible for implementing a blatantly wrong order, so if it sounds wrong or you don't understand it, then INSIST they clarify and make sure you understand!

I saw a t-shirt once that said, "Thank a nurse! They are the ones who keep doctors from killing you".

nurseprnRN, BSN, RN · Jul 10, 2012

if you think about it, all those things are really protecting the patient from inept physicians. we're not protecting physicians by doing all those things. we're protecting patients. you are absolutely not obligated to implement a wrong order. the reverse is true-- you are mandated not to implemement a blatantly wrong order.

don't believe it? read your nurse practice act or the ana scope and standards of nursing practice, which applies to all rns. they mandate you to protect the patient first, not the physician-- the days of doctor-is-the-captain-of-the-ship, follow-doctor's-orders are looooong gone.

SoldierNurse22, BSN, RN · Jul 10, 2012

Though this is a pretty good explanation of what nursing has become and (I can only assume) meant to be tongue in cheek, I disagree with the fundamental assumption behind the philosophy that nursing still finds its helpless place under the dictatorship of a physician.

I am a nurse. I have my own license. I have an education that allows me to make intelligent, informed decisions in the care of my patients. I round with physicians whenever I can so that nursing concerns are voiced in the medical picture of the patient. I protect/help/serve the patients. I work alongside and next to the physicians, not below or behind them. If by some chance my duties to the patient include preventing a physician from ordering/implementing/completing a treatment that would harm my patient and thereby protect/help/serve the physician in the process, so be it. But make no mistake; I act on behalf of the patient, not the physician.

Dixielee, BSN, RN · Jul 10, 2012

if you think about it, all those things are really protecting the patient from inept physicians. we're not protecting physicians by doing all those things. we're protecting patients. you are absolutely not obligated to implement a wrong order. the reverse is true-- you are mandated not to implemement a blatantly wrong order.

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i could have worded my comment better. what i was trying to say was the nurse is responsible if she implements a blatantly wrong order. it is the nurses responsibility to make sure those orders make sense and will do no harm.

you are absolutely correct that we are doing these things to protect the patient, not the physician. the original post while tongue in cheek contained a lot of truth.

HouTx, BSN, MSN, EdD · Jul 10, 2012

In Texas, since 1983 we have a legally defined 'nurse-patient' duty that cannot be superceded by the physician-patient duty or physician 'orders'. Captain of the ship sunk a long time ago.

PMFB-RN, RN · Jul 10, 2012

not me. what i do i do for my patients. in my view the rns job is to heal the patient. the physicians job is to diagnose, and in the case of surgeons, do surgery. i heal them, or failing that assist them to the highest level of functioning possible for them, or failing that help them die as comfortably as possible. they are _my_ patients.

PMFB-RN, RN · Jul 10, 2012

don't believe it? read your nurse practice act or the ana scope and standards of nursing practice, which applies to all rns. they mandate you to protect the patient first, not the physician-- the days of doctor-is-the-captain-of-the-ship, follow-doctor's-orders are looooong gone.

*** great comment. as i can often be heard says "sure doc we can do whatever you want, as long as _i_ think it's a good idea". if not then either we arn't doing that, or you can explain to me, and convince me, why it's a good idea.

Esme12, ASN, BSN, RN · Jul 10, 2012

if you think about it, all those things are really protecting the patient from inept physicians. we're not protecting physicians by doing all those things. we're protecting patients. you are absolutely not obligated to implement a wrong order. the reverse is true-- you are mandated not to implemement a blatantly wrong order.

don't believe it? read your nurse practice act or the ana scope and standards of nursing practice, which applies to all rns. they mandate you to protect the patient first, not the physician-- the days of doctor-is-the-captain-of-the-ship, follow-doctor's-orders are looooong gone.

grntea you beat me again... :lol2: i couldn't have said it better!!!:yelclap: :yeah: :yelclap: :yeah:

amoLucia · Jul 10, 2012

Hey Dixie - any chance that PA was impaired the other nite??? All those kinds of errors point to a practitioner with probems?

I second the opinions of the other posters.

anotherone, BSN, RN · Jul 10, 2012

Our floor just hired a ton of new nurses and it is a big teaching hospital. The other night I was paging non stop and many drs called back to say , " what do you do in this situation?" , " is this what they typically do ?" Blind leading the blind and last month's intern is this weeks "upper level".

Dixielee, BSN, RN · Jul 10, 2012

Hey Dixie - any chance that PA was impaired the other nite??? All those kinds of errors point to a practitioner with probems?
I second the opinions of the other posters.

I do wonder if he was impaired (nothing obvious except of course his actions). He is fairly new and I have not been impressed with his judgement. He is sloppy and careless with the way he practices, and that is NOT acceptable. I went to one of the ED docs who is responsible for the PA's and explained what was happening. I am not the only one to point this out and we are documenting. I work in a very busy trauma center (120,000 pts/yr) so these kinds don't last long.

As I stated earlier, I do not advocate that nurses are here to protect the doctors. The original poster was being facetious and I followed in that vein. I have NEVER been afraid to call a doc on orders that are dangerous or just erroneously written (Like Rx for Vicodin 1 GM IV written by a very tired doc).

The nurses have a wonderful, trusting relationship with our ED providers and we have each other's back but we will not tolerate incompetence or poor practice.