Quote from Peeps Mcarthur
A definition of "medical care" would be that under the direction of a physician, so wouldn't that be any care that the physician has written orders for? Can you give an example of something which a physician has written an order for that a nurse is more qualified as an expert in? I guess I can't see what patient care, that is not under a physician's orders, would be needing a nurse to testify as an expert in that nonphysician domain of expertise.
Of course, psychosocial cause and effect is completely foreign as it is barely mentioned in a physician's training, as far as I know. Since it's not part of a physician's expertise they have no business in overseeing it, or presenting as an expert to testimony about it.
The incidents that I can see in a court of law would be things like medication errors. In a case where the order was written incorrectly, dispensed in the wrong dosage or form or administered in error. In the foodchain from doctor to pharmicist to nurse administering it, who is the expert? Wouldn't a physician be testifying as to the validity of the order, correct mixture, route and timing of administration? If we are talking about what a nurse should be held accountable for in regards to this medical care, wouldn't an expert in phamacological inteventions be indicated?
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.
At any rate, nurses seem to think that it's a good thing. I'm wondering why.
While the physician may be the expert in terms of prescribing a medication, he/she is certainly NOT the expert in terms of preparing, dispensing, administering, monitoring for side effects, etc. Those are the responsibilities of the pharmacist and nurse, who should rightly testify as to the standard of care of these aspects of medication usage.
Let me give an example: I was on injectible fertility drugs. My physician prescribed them to treat the medical condition that was interfering with my ability to conceive. The pharmacist dispensed them, and educated me on their uses and possible side effects. The nurse taught me how to mix the vials of medication with sterile water, prepare the syringe, and inject myself. One evening when my injection was due, I happened to be at work finishing up a procedure with my physician. I knew how to inject myself, but hated to do it, and so asked her if she would mind giving me the shot. She laughed and said that if I prepared it, and then told her how to find the proper landmarks, she might be able to muddle her way thru giving an injection. I thought she was joking, but she confessed that she had NEVER given an IM injection. It was simply not taught in medical school, and had never come up in her practice.
She would have been quite capable of testifying as to the proper uses of injectible fertility drugs, but not to their preparation or administration. Her physician training and experience did not include those aspects of medication usage, where pharmacists and nurses are truly the experts.
Another example: In my OB rotation in nursing school, I had CNM as a clinical instructor. She was newly hired as a nursing instructor, having come from many years in private practice with a group of OB/GYNs. Her focus over those years had become very medical, shifting away from nursing care. She was well versed in all aspects of pregnancy, labor and delivery, but had absolutely no idea of how to administer nursing care. She had spent so many years practicing in a "medical model" that she had no idea of what the routine nursing care of a labor patient should entail. She had no idea of what should be included in a nursing admission assessment, how often vital signs should be taken, what the protocols were as far as electronic fetal monitoring, which patients met the criteria for having peds present at deliveries, she couldn't draw blood, or start IV's, and didn't have a clue as to how to set up IV tubing, use infusion pumps, give a piggyback antibiotic.
She was certainly capable of managing the "medical " aspects of a patient's care, but not the nursing care, especially anything that involved "hands-on" contact with a patient. Aagain, she could testify as to why a particular antibiotic was ordered for a specific patient, but could not give any expert opinion as to how it should be prepared or administered.