I just completed the first week of my BSN program. I am a little confused with the way some of the material is being presented both in class and in my textbooks. We are discussing taking a history, performing a physical assessment, MAKING A DIAGNOSIS, DEVELOPING A PLAN OF CARE, implementing and evaluating the plan of care. We have been discussing what interventions we would perform if the patient develops certain conditions and what medications we would give.
So far, there has been almost no mention of the involvement of a clinician such as an MD, DO, NP or PA. I know that a nurse often sees the patient before the clinician, takes a brief or more extensive history depending on the healthcare setting, and does a nursing physical assessment. But making a diagnosis and developing a plan of care? Isn't the DOCTOR (or NP, etc.) supposed to make the diagnosis, develop the plan and give the orders for the patient? I have just learned there is something called a "nursing diagnosis" but shouldn't such a diagnosis be considered preliminary until the clinician makes the actual diagnosis and then gives orders?
Nurses are smart yes, but clinicians have much deeper training in pathophysiology and pharmacology. They also have the legal responsibility and liability for the diagnosis and treatments. Why are my instructors not sprinkling their lectures with statements like, "When the patient has XX condition, the physician will typically prescribe YY, which the nurse needs to understand is because of ZZ."? Why is there barely any mention of doctors and their orders?
I just realized you were the OP in the thread where you wondered if you're wasting your time learning how to do thorough head to toe physical assessments.
You seem educated, intelligent. How much did you research about nursing before you decided to enter a nursing program? You seem unclear on what a nurse is expected learn and do. I realize you will learn this, but I would think you would have a slightly more clear understanding of the career you are choosing.
I researched several different healthcare careers, and did some shadowing. However nothing I saw led me to understand that I might be taking the lead role in meeting a new patient and then taking a history, then doing a complete physical assessment and then making a plan for their care all before they even meet a doctor (or PA or NP). This is actually a pleasant surprise. I expected the nurse to be more limited in what they could do without explicit orders from a doctor.
I'll wind down this thread with the same message I used in another thread, which started with a different topic but turned out to cover a lot of the same ground...
Alright everyone. I'm a starting to get a clearer picture of what RNs can do in various settings. For the last few years I have been working at entry level jobs such as nurse aide, medical scribe and health aide at a kid's camp, and all I'm used to hearing is, "No, you can't do this. No, you can't do that. That's out of your scope of practice. Only doctors to that, etc, etc." It's taking me awhile to wrap my head around the tremendously expanded scope of practice of an RN. Thanks for you're replies! I feel a bit more settled now.
What you're able to do independently versus what you need explicit orders to do will vary by your location, position, protocols, etc. For example, in a SNF, it seems like you need an order to wipe someone's nose, and you spend your whole shift furiously throwing meds at everyone. In my outpatient urology job and in labor and delivery, we have protocols for a lot of things that come up frequently, and deviations beyond a certain level require a provider to step in. However, the nurse is the one assessing that, and again, often informing the provider what needs to be ordered. You'll need to know when you get wherever you're working what you can and cannot do and under what circumstances.
Lemon Bars
144 Posts
I researched several different healthcare careers, and did some shadowing. However nothing I saw led me to understand that I might be taking the lead role in meeting a new patient and then taking a history, then doing a complete physical assessment and then making a plan for their care all before they even meet a doctor (or PA or NP). This is actually a pleasant surprise. I expected the nurse to be more limited in what they could do without explicit orders from a doctor.
I'll wind down this thread with the same message I used in another thread, which started with a different topic but turned out to cover a lot of the same ground...
Alright everyone. I'm a starting to get a clearer picture of what RNs can do in various settings. For the last few years I have been working at entry level jobs such as nurse aide, medical scribe and health aide at a kid's camp, and all I'm used to hearing is, "No, you can't do this. No, you can't do that. That's out of your scope of practice. Only doctors to that, etc, etc." It's taking me awhile to wrap my head around the tremendously expanded scope of practice of an RN. Thanks for you're replies! I feel a bit more settled now.