IL Supreme Court Rules Only Nurses Can Testify on the Standard of Care for Nurses - page 3

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
    From Ellenester


    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.

    #1 - Our respiratory therapists (who are wonderful and I wouldn't ever want to do without), spend a tremendous amount of time correcting problems created by overzealous residents making major ventilator changes.

    #2 - To suggest that a new resident has expertise in medical care after 4 years of medical school is hilarious, particularly since they have so little time at the bedside during medical school. Residency is usually a very humbling experience for them, since they realize how little they actually know once they embark upon it. It takes years of practical experience in order to become and expert in anything. I certainly didn't consider myself an expert in nursing after 4 years of nursing school and I still wouldn't proclaim to know much about other specialities. I doubt even the most arrogant of interns would state that they were "experts" on patient care after a few months on the job.

    #3 - You are confounding two varibles in attempt to make your argument that doctors are more qualified to attest to the quality of nursing care than nurses. Patient care as a whole requires a team-oriented, multi-discipline approach. Nursing care is only one component of patient care, and it is the aspect where nurses are the experts.

    Peeps, I get the impression that you have a very negative view of nurses, like we have too much power that we don't deserve. I also hear you saying that physicians with any level of training are beyond reproach, know everything, and should always be trusted over a nurse. This mentality shows a great deal of inexperience on your part and I don't know who you think takes care of patients in the hospital, but it sure as heck isn't the doctor.
  2. by   fergus51
    Quote from 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?
    No, he knew how to give meds and could find a vein and start an IV better than anyone I have ever seen but, he just had never set up an IV from start to finish before (he didn't know which hole to use on a bag with three). It makes sense when you consider that all the OR patients had their IVs started by nurses on the ward or on admit. And even when we have to call a doc for a hard stick, we have to have everything set up when they get there so they can just poke and stick on some tegederm and leave. I even set up everything for the residents that are just learning to put IVs in babies cause it saves me time.

    Our med students don't do an NICU rotation. It's just too specialized, though they are allowed in level 2. We take residents and even they come in without the practical knowledge they need to function. A lot of the time when I call a new resident it goes like this:
    Me: "Patient has blah blah wrong"
    Resident "Uh huh....... Well.... Maybe I should call the fellow...(this will take at least an hour)"
    Me: "In the meantime do you want me to blah blah....."
    Resident: "Um, ok."
    Me: "So I can write that as a verbal order?"
    Resident: "Ok, sure"
    There was a lot of serious discussion about limiting the unit to year 2 residents and above. The residents come out of med school with a ton of theoretical knowledge (certainly more than I have, especially on these bizarro syndromes), but are kind of thrown to the wolves as far as hands on working goes. Calling them experts on patient care is just ludicrous at that point, no matter how much time they spent in med school. They have to grow and learn FAST in the unit. Most of them do, but there are some that are truly scary (Thank God for the fellows and staff!).

    Our RT students actually do very well because they are always right beside a real RT. Our RT vacancy rate only goes up when one of them has a baby I think the NICU is a different place, and I have had my share of run ins with nasty nurses there too!
    Last edit by fergus51 on Mar 30, '04
  3. by   KarafromPhilly
    Whether or not you believe that medicine and nursing are separate, in practical terms, this is a huge victory for nurses. Doctors certainly don't mind unloading liability onto nurses, and I can't help but feel that a NURSE expert witness (even if hired by the plaintiff) is fairer to the nurse defendant.
  4. by   Peeps Mcarthur
    Fergus,
    You sound like a very reasonable person to work with.

    The concept of someone like an anesthesiologist not being current on everything that has to do with IVs is difficult to wrap my mind around. I believe what you're saying, yet, the visualization of such a professional that uses IVs for a living not knowing how to set one up without help, that's disturbing. Staying current, even with procedure seldom seen, is the job of every person with any degree or certification. Not knowing which "thingy" does what causes morbidity from the worst disease of all........inaction.

    Some people have made examples of medical students not knowing thier butt from a hole in the ground. I think that's to be expected of anyone with no clinical experience. i'm not talking about that sort of person being an 'expert'. What I was referring to is someone who has gone through graduate level medical training and has enough clinical hours to know what those "thingys" do. If someone is going to waste all that education to sit on thier butt while abdicating expertise because they think there's a job description.....well, that's just sad. When referring to 'nursing care', where does it end and 'medical care' begin? Why would the ultimate responsibility fall to a medical doctor but not the title of 'expert'?

    How is it possible to be in charge of medical care and not know how it works? It's analagous to firing a gun but not knowing what the bullet does when it passes out of the barrel even though you're a certified marksman.

    Sounds like the graduates of medical schools are looking for comfortable job descriptions instead of leadership in your hospitals. I can see how this attitude might force nurses to take the lead for them.
  5. by   Peeps Mcarthur
    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 would want someone who cares more about knowing what to do in such a situation........and has prepared for that event should it arise.

    I don't want someone who wears the title proudly but rather takes responsibility for knowing the expectations of that title.

    Actualy anyone with an inservice with one of those automatic defib devices would be just fine.
  6. by   RNPATL
    I think one has to look at both nursing and medicine as different professions. Where does one start and one end? Not sure that is a question that even needs to be asked. Nurses are responsible for the patients overall response to care and their environment. When asking a physician to define a standard of nursing care, I would think that few could list decent examples.

    When we ask about defining a standard of nursing care, we are talking about care that is provided by a prudent professional that holds like title. How can a physician evaluate the standard of care when they are not nurses. In addition, you make reference in your post that physicians are the managers of care. This is not the case. The registered nurse is the manager and coordinator of a patient's care. To assume that the physician has knowledge about nursing care and all that goes into our professional assessment of care as nurses is simply wrong. I am certain that a physician can not tell you the standard of nursing care for wound management, or pain control or and the list can go on and on. How many physicians can detail a nursing care plan or evaluate an educational care plan to provide patient teaching. Perhaps physicians know how to perform the skills, but they are not knowledgeable about what goes into each of these elements as a standard of care. Perhaps the physician can testify to what they would expect the outcomes to be for wound management or pain control, but I would submit that most physicians would not have the slightest clue about the elements that go into the standard of care for these and other issues with patients. Besides, if I was on trial for whatever reason and they brough in a physician to testify to the nursing standard of care, I would be very fearful of the outcome of the case.

    This does not take away from what a physician knows, but it makes it very clear that nursing is an independent profession that is not interdependent on physicians or on Medicine as a whole. To assume anything else would be in error.
  7. by   fergus51
    Quote from Peeps Mcarthur
    Fergus,
    You sound like a very reasonable person to work with.

    The concept of someone like an anesthesiologist not being current on everything that has to do with IVs is difficult to wrap my mind around. I believe what you're saying, yet, the visualization of such a professional that uses IVs for a living not knowing how to set one up without help, that's disturbing. Staying current, even with procedure seldom seen, is the job of every person with any degree or certification. Not knowing which "thingy" does what causes morbidity from the worst disease of all........inaction.

    Some people have made examples of medical students not knowing thier butt from a hole in the ground. I think that's to be expected of anyone with no clinical experience. i'm not talking about that sort of person being an 'expert'. What I was referring to is someone who has gone through graduate level medical training and has enough clinical hours to know what those "thingys" do. If someone is going to waste all that education to sit on thier butt while abdicating expertise because they think there's a job description.....well, that's just sad. When referring to 'nursing care', where does it end and 'medical care' begin? Why would the ultimate responsibility fall to a medical doctor but not the title of 'expert'?

    How is it possible to be in charge of medical care and not know how it works? It's analagous to firing a gun but not knowing what the bullet does when it passes out of the barrel even though you're a certified marksman.

    Sounds like the graduates of medical schools are looking for comfortable job descriptions instead of leadership in your hospitals. I can see how this attitude might force nurses to take the lead for them.
    I think I am reasonable to work with

    Peeps, doctors do not have "ultimate responsibility". If a nurse screws up, it's the nurses butt not the docs. That's why they aren't experts in what nurses do. That's why the standards in malpractice for nurses is "What would a prudent NURSE have done?", not "what does the doc think?". Docs are great and needed, but they aren't the "boss" (I don't know a better word to describe what you seem to think docs do). I can't go into court after screwing up and say "Well the doc told me and he's the expert". I'd have my lisence for about 2 seconds more! I have a responsibility to refuse to do perform any dangerous doctors' orders.

    I think you'll find a lot of professions that are intertwined, but that doesn't mean one person is an expert in the role of the other. Lawyers and cops are a good example. Where one profession ends and the other begins depends on specifics, and there are sometimes overlapping areas.
  8. by   caroladybelle
    Quote from Peeps Mcarthur

    When referring to 'nursing care', where does it end and 'medical care' begin? Why would the ultimate responsibility fall to a medical doctor but not the title of 'expert'?

    How is it possible to be in charge of medical care and not know how it works? It's analagous to firing a gun but not knowing what the bullet does when it passes out of the barrel even though you're a certified marksman.
    For one, MDs are not "in charge" of Nursing Care, nor completely in charge of medical care. They are merely part of a collaborative effort.

    And the ultimate responsibility does not always fall to the MD, but frequently to the hospital or Nursing.

    Donald Trump is "in charge" of many real estate projects.....but he probably doesn't know Jack about how to build most of those Buildings.
  9. by   Peeps Mcarthur
    Doctors not in charge of patient care, as in ultimate responsibility for the patient's overall treatment.

    Why spend 10 years completing medical school when one can just become a nurse in two and gain much more of the responsibility?

    Those poor idiots are just throwing their money away!

    Not to be inciting a riot here but I have never known a doctor (not a student)that does not feel that they are in charge of a patients care. A physician pays a third of thier salary for malpractice insurance because they ARE responsible.

    You have put thought into your posts and I really appreciate that you're being civil. Maybe it's changed alot since I've been away? I'll find out when I return from medic school and work with an ambulance crew.
  10. by   caroladybelle
    Peeps,

    You seem to have alot of issues with nurses that do not have much to do with us here.

    You might think about working those issues out or they will come back to haunt you.
  11. by   fergus51
    I'm sure you haven't, but until they can physically force me to do their bidding I will not risk my lisence or my patient's health by performing unsafe orders. Believe me, there are more areas of grey than most people realize. Physicians are just one piece of the puzzle. That's why residencies are set up the way they are (because if the resident is ordering something I think is unsafe, I can go to the fellow, then the staff). A few physicians like to think nurses simply work for them (though this attitude is rare where I work), but I work on my own lisence as an employee of the hospital. I am responsible to my patient, my employer and my board of nursing not to any doctor I work with. That's why I say they aren't my "boss". They do not have the power to hire or fire me or even evaluate my work performance and I don't work under their supervision or on their lisence.

    Physicians are responsible for what THEY DO (and that is managing medical care of their patients), that's why they pay so much for malpractice insurance. They are not responsible for what I do. I am. Seriously Peeps, can you imagine me going into court and saying "well the doc told me to" as a defense against malpractice?
  12. by   Peeps Mcarthur
    By Fergus
    Physicians are responsible for what THEY DO (and that is managing medical care of their patients), that's why they pay so much for malpractice insurance. They are not responsible for what I do. I am.
    How do doctors manage the medical care of thier patients without managing what nurses do to fulfill that obligation?

    I don't see a nursing license making a nurse into a private contractor. If that was the case you wouldn't have a need to go to the attending. If doctors weren't above nurses in a hierarchy there would be no basis for writing an order in the first place would there?

    On the other hand,

    If a nursing license granted authority, as an expert, over any decision that was within a nurses scope of practice as outlined by the BON, wouldn't that include the management of a patient's overall care? Patient care is what nurses do and according to the argument, more specialized than what a doctor is trained at. Nurses actualy do the procedures that orders are written for by doctors and have an allowance in the scope of practice as written by the BON to be protected from reprisals should they refuse to carry out that order. Are protections under the license which the BON has approved a declaration of expertise in patient care?

    OR

    Is the license which is granted a physician the legal authority to write the order or any order to prescribe anything the physician deems appropriate to be carried out by everyone from housekeeping to allied health, a declaration of expertise in overall patient care? Is its authority dependent on the opinnion of the nurse that is granted protection to refuse by the BON?

    When it comes to determining patient care expertise, hierarchy is precedent in determinig appropriate actions. Hierarchy must have an origination point and that point is the granting authority which conveys that declaration to the individual.

    Does the BON hold that authority to convey expertise to a nurse over the medical board which granted the physician the right to give that order to the nurse?

    The hierarchy of patient care clearly rests with the medical board in conveying expertise in patient care.
  13. by   caroladybelle
    Peeps,

    We have tried to explain it to you and you just are not getting it. And for the matter, a heirachy ideal has absolutely nothing to do with the topic of this thread, though it seems to have hijacked it.

    The care of a patient is a shared responsibility, with neither group having to dominate over the other. There is no need for one group to dominate the other. There is no need for a heirachy of one group (medicine) over another (nursing). They work together in a partnership for the best care of the patient.

Must Read Topics


close