I am fairly new to oncology, I have been working in Radiation Oncology for a little over a yr now, and may I say the learning curve is HUGE, not only am I trying to learn radiation but also oncology at the same time. The problem I am having is with some of the things the nurses are asked to do that seem to do nothing more than make the doctors job easier, but are being presented as "pt care". An example is something we have to do called a pt assessment which is done before we even lay eyes or hands on the pt, basically for every new pt the nurse has to sit down and go through the pts chart prior to the pts first consult visit with the Dr. and write a story about the pts diagnosis and anything that has been done since diagnosis. Our dept sees 40-60 new pts each month. We do this so the doctor does not have to research his own pt, we are the only dept in the whole hospital who does this. When we question it we are told it is giving good pt care, am I wrong in feeling this is good doctor care, not good pt care? I just do not understand how making your nurses spend 20+ hours a week writting what will end up being the Dr.'s dictation is better for the pt than having the Dr. go through the chart themself. I am just looking for some advice to see if I need to change my presepective or maybe my career. I just feel making a nurse stay 2 hours late to basically write a paper for a Dr is almost abuse of nurse staff. These are only a fraction of our job, we have to squeeze in the time to write them in between rooming pts for doctor visits, doing nurse teaches, and dealing with any pt issues that come up during the day. The sad fact is that usually we have to stay late to write these even though the Dr. gets to go home. I have been told that this is "standard practice" for Rad Onc and I just wonder if it is true.
Mar 7, '13
It is absolutely wrong, no doubt about it. Whoever told you this is "standard practice" has BS coming out of more than one orifice. I worked a med/surg/radiation oncology unit and we NEVER did anything like this.
You would be wise to stand up and say it now. Be prepared, if you plan to stand your ground, to lose your job. But ABSOLUTELY do not stand for this behavior. I hope you've been on the clock for the overtime you've been using to do this because perhaps that will assist in making your case that it is not financiallly beneficial to the hospital for the nurses to be doing the doc's job.
Also, I would be concerned legally about doing research for someone else. You're new to the field and nurses don't look for what doctors look for in charts. God forbid you unknowingly miss something important and get blamed because something goes wrong in this patient's care.
Nursing and medicine are two different jobs for a reason. I'd tell your boss that you are a nurse with a license to tend to, and your only concern is for your patients and for your license. The docs are going to have to put on their big boy/girl pants and do the hard work themselves.
Ugh, this kind of thing BUGS me because it pushes nursing back into the stone ages!
Keep us updated!
Mar 16, '13
Yeah that does sound weird. I work in an outpatient radiation clinic and I prep the charts to make sure everything is in there for the docs. Then I read the referring doctors dictations so I can get a basic overview of why the patient is coming to see us then of course, during the nursing consult I have the patient tell their story in their own words. Our nursing intial assessment form is a document in our electronic medical record which does contain a brief nursing summary of "history of diagnosis" but it is usually short and sweet.
Like for a standard breast consult it goes something like this : Hx - abnormal routine mammogram, breast US, breast biopsy, lumpectomy confirmed right breast invasive ductal carcinoma upper outer quadrant 0/3 nodes positive, ER/PR +, HER2 -, here to discuss breast radiation options, followed by medical oncology consult for 5 year hormone therapy.
Of course it would get a little more detailed depending on patient but that is the gist of what we the nurses do. It is the doctors' responsibility to go into more detail and our rad oncs do. As radiation oncology nurses at our clinic, it is our responsibility to assess, educate (we give out great patient info from National Cancer Institute and ASTRO), as well as side effects management.
Mar 19, '13
Ours is also in EMR form, but it is not short and sweet at all. We can not put just abnormal screening mammo, they want the date and what the impression was, as well as that info for any follow up images, the date of and full path report, if they had surgery date, path, and Dr. who did the surgery, if they had cz what kind, how many cycles, when was cycle 1, when was the last cycle, ect.. they want everything typed out in story form, "it should read like a book". Breast and prostate pts dont usually take to long to do but if you have say a melanoma that goes back 10 yrs it can take a few hours to write cause you have to go through 10 yrs of notes to see what cz they had 7 yrs ago or what have you, if the pt was in remission for 6 yrs you go through 6 yrs of notes and document that pt was in remission until... this is in addition to nurse ed, assessment of pts having treatment (skin issues ect..), rooming pts for MD visits, phone triage, and prior auths. They have to be written and ready to go prior to the pts arrival even if we have to stay after hours to write them.
Mar 19, '13
That totally seems excessive. I'm sorry you are dealing with that.
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