IL Supreme Court Rules Only Nurses Can Testify on the Standard of Care for Nurses - page 2

from psna enewsletter: the american association of nurse attorneys (taana) recently announced that the illinois supreme court responded positively to taana's amicus brief submitted in the case of... Read More

  1. by   Elenaster
    Quote from Peeps Mcarthur

    I know this is only one example, so it certainly is not the whole argument, but shouldn't physicians be so called 'experts' in patient care? I believe I know what the overwhelming response on this board would be to that question but I think it needs to be pondered with more than just the typical knee-jerk reaction to expand the nursing empire at all costs.
    God help you if you ever end up critically ill in a teaching hospital without an experienced nurse. From your incredibly insulting comments, you obviously have no experience working with inexperienced residents or detached attendings.

    Without a doubt, nurses are by far the best people to testify on the quality of nursing care. Did you ever consider skilled nursing facilities, who incidentally get sued on a daily basis. In some of them, the physician or physician extenders only surface about once a week. Do you honestly think that physician is better qualified to attest to the quality of nursing care than say, an experienced DON or a bedside nurse that has 20 years under her belt?
  2. by   Peeps Mcarthur
    Jolie, Fergus,
    Thank you for your insightfulness. I am just shocked that an MD would not know about such basic care as drawing blood and giving an IM for gawds sakes!!..............AN IV bag??......seriousely? with all those frigging alarms going off all the time they never learned how to handle one? I've seen residents putting in chest tubes, central lines, art lines, intubating...........and as a fricking MD on thier name tag they can't handle and IM or an IV line?

    Those folks need to do some rural medicine for awhile. I can see why you think that way. I have a greater expectation of medical training for myself. I'm about to go through Combat Medic training with the army. I'll be doing everything from chest tubes to IV lines and intubation and I just can't imagine a doctor that doesn't know how to administer something as simple as an injection!!

    Incredible.
  3. by   RNPATL
    None of this matters. Nurses should be the only people defining and testifying as to the standards of nursing care. Physicians are not nurses, are not trained as nurses and therefore are not the end all be all of nursing knowledge. Nurses are the only professionals that should be permitted to testify about standards of nursing care. It this really hard to understand? I am certainly glad that the law recognizes nursing as a defined and credible profession wherein the only individual qualified to testify about nursing .... hello .... is a nurse! As far as advancing the nursing empire at all costs .... come on ... it is about time that nurses are in a position of advancement! We have been held back far to long.
  4. by   Katnip
    Peeps, I had a doc chase me down because he was in a room with an IV pump that was beeping. Had no clue what to do about it. Come to think of it, he wasn't the only one.

    Once it took an entire group of residents to shut an IV pump off...after they screwed with the settings. I'll give them points for trying to be helpful on that one.

    I had to teach a doctor how to properly swab a patient's back for a lumbar puncture.

    As far as nursing care is concerned, very few have a real grasp of it. They know what their own ideals are, but that is usually so far from the truth.
  5. by   fergus51
    Quote from Peeps Mcarthur
    Jolie, Fergus,
    Thank you for your insightfulness. I am just shocked that an MD would not know about such basic care as drawing blood and giving an IM for gawds sakes!!..............AN IV bag??......seriousely? with all those frigging alarms going off all the time they never learned how to handle one? I've seen residents putting in chest tubes, central lines, art lines, intubating...........and as a fricking MD on thier name tag they can't handle and IM or an IV line?

    Those folks need to do some rural medicine for awhile. I can see why you think that way. I have a greater expectation of medical training for myself. I'm about to go through Combat Medic training with the army. I'll be doing everything from chest tubes to IV lines and intubation and I just can't imagine a doctor that doesn't know how to administer something as simple as an injection!!

    Incredible.
    It's because that isn't a normal part of their job. They tend to focus on the skills that only docs do, like inserting chest tubes. It was in the OR that I asked the doc to just change the IV bag (I had the new one hanging right there) and he just looked at me and said "How? I've never done that". He was a very good anesthesiologist, but just hadn't changed an IV bag. Now I am in an NICU and most of the docs don't know how to turn off the alarms on the monitors or the IVs.

    I think that until people actually work in healthcare, they have no idea what doctors do and don't do. There are many bedside issues that nurses deal with and docs don't. Another good example is assessments. Our babies are assessed when we feed and change them in order to cluster care. How often they are assessed (q2h, q4h, q6h?) is based on the nurse's judgement and guided by hospital policy, not on a doctor's order. Same thing with weaning oxygen, increasing feeds, starting po feeds, changing babies to cots, taking them off ISC, deciding whether they are stable enough for kangeroo care, etc. So it seems illogical to assume the doc should be the one to testify about the appropriateness of the nurse's actions.
    Last edit by fergus51 on Mar 29, '04
  6. by   Peeps Mcarthur
    From Ellenester
    God help you if you ever end up critically ill in a teaching hospital without an experienced nurse. From your incredibly insulting comments, you obviously have no experience working with inexperienced residents or detached attendings.
    You are correct.

    My experience has been only with medical professionals. The residents I've worked with as a respiratory therapist were not taught my job in medical school either, but they were far from incapable of doing it. They are used to getting thrown to the wolves I'm sure. To suggest that they are incapable of having expertise in medical care after 4 years of graduate education in medicine is what's insulting. To say that an MD with residency years on top of that experience is incapable of understanding the process of patient care as to be an expert....well, if that's true, God help us all.
  7. by   caroladybelle
    Peeps.

    I just worked a three night weekend in a teaching hospital rated as one of the top 15 hospitals in the nation.

    I had 2 patients on experimental chemo. I had one on regular regimen chemo. Two med/surg overflows. And religious minority pt with unknown ca and serious complications as well as psycho social concerns.

    I had to explain to two residents how to order the meds and give them to declot lines. I had to explain coude' caths and urojet, how to order it and teach the interns how to insert them, as well as talk them through them. I had to talk some backbone into a SubI regarding pushing for a GU consult and pick up his spirits after he got treated like crap by them. I had to talk an intern through his first art stick and then drawing blood from a femoral line ( he initial came in the room with all the wrong equipment). I also had to teach on flushing foleys (another brought in all the wrong stuff) as well as inserting NGs.

    And I had an attending that came in at 0300 AM tell a family that I was an excellent nurse, that caught some problems two days before the med team did.

    And that while a good MD is worth his weight in gold, a good nurse is worth her weight in diamonds, especially when she can get those MDs to do what is right for the patient.

    I think that says it all.
  8. by   Peeps Mcarthur
    In regards to interns: Isn't that a student being exposed to the clinical rotation for the first time? It took me two run throughs with IV's before I could set one up as fast myself. Sounds as if the nurses at your hospital are teaching medical students.

    Territorial rights are fought for in blood by nurses in the NICU. It wouldn't suprise me at all if even the RT asked for help as not to step on any toes in that bloodbath.
  9. by   fergus51
    Quote from Peeps Mcarthur
    Territorial rights are fought for in blood by nurses in the NICU. It wouldn't suprise me at all if even the RT asked for help as not to step on any toes in that bloodbath.
    Huh? Did I miss a post?

    I have to say, the RTs I work with are all core NICU RTs and are AWESOME. Love them to bits! They are more knowledgeable than the residents (since med-school doesn't prepare them for the unit at all) and always helpful. I have never seen one of them be rude or innapropriate, even when dealing with nurses who have severe cases of "mybabyitis".
  10. by   Peeps Mcarthur
    Yes, that was 15 years ago when last I experienced decapitation at the swift blade of an NICU nurse. They would even go as far to dictate where one could stand or walk. Ask a question and thier eyes would roll back in thier sockets as if possesed by the devil herself and you wouldn't get anything but judgemental silence until she finally ripped whatever it was out of your hand while bumping you aside, only to pretty much do it the same way you were. Maybe I just got assigned to the most difficult nurses as a student and that put me off, but I turned down 1/3 more pay (which still was crap anyway) to work in there full time.

    I imagine that neonatology wasn't a very popular clinical rotation for student doctors either.

    Ya know, in regards to the anesthesiologist that said he didn't know how to hang an IV, he must have been jerking your chain. Sure, most of what they do in an OR is read magazines for $200,000 a year but they have to know how to handle IV's. IV medication is what they do isn't it?
  11. by   MellowOne
    If you were walking through the mall, and suddently went into v-tach, would you want a critical care nurse or an internal med doctor to be the one that helps you out?

    I'm a House Administrator, and I have the joy of dealing with doctors daily. It's amazing how clueless many are as to what happens after they get done writing orders. No, doctors are not qualified to testify on nursing standards.

    Be well...

    The Mellow One
  12. by   caroladybelle
    Quote from Peeps Mcarthur
    In regards to interns: Isn't that a student being exposed to the clinical rotation for the first time? It took me two run throughs with IV's before I could set one up as fast myself. Sounds as if the nurses at your hospital are teaching medical students.

    Territorial rights are fought for in blood by nurses in the NICU. It wouldn't suprise me at all if even the RT asked for help as not to step on any toes in that bloodbath.
    It has nothing to do with setting it up fast, it has to do with them coming to me because they (interns, residents and SubI's) being able to set them up AT ALL!!!!!!!!!. And if they have difficulty setting them up while in training, when they have their most hospital experience, do you really think that they will know much about the process after a few years in an office, where they have little to no regular experience in the process.

    As I do not work NICU, I have no input to that. But as a med/surg nurse, teaching interns takes time away from my other patients. And I spent an hour or so of my own time after shift or on break time lost to make it up. An independant MD would be helpful.

    The point is that MDs have no business testifying to NURSING standards of care as they are hardly experts at it.
  13. by   canoehead
    What about the docs that routinely give the order "don't take any more vital signs tonight" or "don't call me again on this patient" with a patient's BP in the 70's. He thinks we are obligated to follow those orders (NOT) and a reasonable and prudent nurse on the stand would say the complete opposite.

    When I worked in a teaching hospital the docs were expressly forbidden to touch IV pumps because of the risk of changing the settings or giving a bolus and not knowing it. Probably everyone has dealt with a situation where the patient says "I'll just tell the doctor to make you..." when they wanted to go out to smoke, or be fed, or have 15 visitors at a time, and the stupid MD has said "sure" and you have to deal with the family on some ridiculous issue.

    Obviously docs do not know the standards that nurses must live by, and in some cases, the hospital policies we have to enforce. In court I think we deserve someone who knows the role inside out.

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