Are We "Glorifying" Nurses?

nynursey_ · Jul 12, 2015

I absolutely agree... with the understanding that the provider listens. They don't always, especially if they don't know you well.
Had a patient recently react badly to an IV dose of Ativan at my PRN job. It's on her home med list for anxiety, so I was really surprised when it knocked her out cold and she started agonal breathing. There was a bunch of other stuff going on at the time (spiking a crazy temp with sepsis and having rigors), so the physician didn't believe the Ativan did her in. I did, and recommended some Romazicon. I didn't get it. I had to sit there and sternal rub the patient for almost 45 minutes to make sure she didn't stop breathing (she was a DNI) until the physician finally relented and ordered some Romazicon. She, naturally, woke up just fine after that, but with some horrendous bruising on her chest and I had sore knuckles for a couple of days.
That's the difference between us and physicians - all of our knowledge and decision making skills aren't worth anything if we can't convince a physician we're right in the first place. [/size]

I'm sorry that you had such an awful experience. It's frustrating when physicians aren't willing to get out of their own way and listen with a careful ear.

That said, even when a physician refuses to listen, it doesn't negate that nurses have the knowledge in the first place. And when a physician does listen and finally agree to order that diagnostic test or order that medication ... who does the credit really belong to?

It's not a question of whether or not a doctor listens. Or whether or not the nurse was the one to place the order using her credentials. It speaks to the fact that we do have the knowledge to, in fact, save lives. Not the knowledge of a physician. I am not attempting to make the two anagolous. What I simply mean is that more goes into life-saving than simply entering orders into CPOE.

Susie2310 · Jul 12, 2015

I believe that most of the time nurses don't make decisions that save patients' lives, period. We report what we see - we don't actually make the treatment decisions. I will hang a bolus before I get a physician order if the BP is critically low, but that's about it. I don't order Vanc for that infection, or blood products for my patient with a low hemoglobin. I don't do surgery to fix bleeding ulcers. Sure, when I call a provider, I may say, "I think the patient may need a diuretic" if they are sounding overloaded, but it's still ultimately not my decision. I carry out interventions that save patients' lives, but I'm not the decision maker. That's outside of my scope of practice.
Even "decision-making" RN positions like rapid response require an order set authorized by a physician - it's still not the nurse's decision.

By "making decisions that save patients lives", I was not referring to treatment decisions that are the prerogative of the physician. Our scope of practice requires that we assess our patients, and intervene appropriately as needed. For example, recognizing abnormal assessment data or abnormal labs that require prompt action, which may involve following existing orders/protocols, or which may require calling/speaking to the physician to advocate for our patient's needs. The difference between timely recognition of abnormal assessment data/timely initiation of the appropriate intervention, and delayed or non-recognition of abnormalities that continue to progress until a crisis develops, does mean the difference between life and death for some patients, or injury or disability that could have been prevented. These are the kind of nursing decisions I am talking about that save patient lives. On a unit where the patients are not monitored, where the nurse may have 6, 7, or more patients, the nurse's assessment skills and timely interventions are especially important, and in the process of assessing the patient and intervening the nurse is using critical thinking and making decisions.

The author appears not to understand the above. If you agree that nurses (including yourself) do, and should do the above, by virtue of their scope of practice, then it seems to me that you would agree that nurses do make critical decisions that save patient lives.

VANurse2010 · Jul 12, 2015

While nurses are not the ultimate decision makers, there is an "R" in SBAR indicating that RN's can and do make recommendations to prescribers, which often can result in improved, if not live-saving, outcomes for the patient.

they are under no obligation to listen to you. The point was about autonomy, which stands.

Libby1987 · Jul 12, 2015

Umm big deal what we do. We're trained to do it and paid for it.

The whole logic that nurses are somehow special only points that those with higher education and responsibility are more special. That's crap and a terrible attitude towards team efforts.

I make 4 x more than our clerical staff who put in as many hours, I'm paid more for my education, experience and replacement value, not because I have stuff to blow my horn about.

About Van's post on ICU nursing, I wholeheartedly agree. ICU requires a limited knowledge and experience that isn't any more complicated than the volume of knowledge and experience my job requires to do well. If I can remember and apply the sheer amount of detail that my job requires, I can also do the same with critical care protocols. That my patient acuity is different is irrelevant. I have 25 patients to manage all with different variables on top of needing to know regulations and reimbursemet criteria inside out and managing a team. An ICU nurse could no more walk into my job without bungling it than I could theirs. It would still take both of us a couple of years to become independently competent. We're trained period, not reinventing the wheel.

NurseGirl525, ASN, RN · Jul 12, 2015

That article made me angry for several reasons and I wrote a very long response to her. I couldn't tell if she was a bitter nurse or someone that knows nothing about life in general. She obviously is not a writer. I told her as much. Her grammar was terrible and the article should have been proofread before posting. She also put elect few instead of select few. I had to laugh at that. We don't get elected into a nursing program, we get selected. Anyway, she seems to have no idea of the different roles of nursing. I beg to differ on the limited education. A NP has anywhere from 6-8 years of schooling under there belts, plus many have years of bedside experience before going to school to become a NP. Most people come out of college with a 4 year degree.

Also, those other majors that she stated were so much harder and required more intellect than nurses was way off base also. You don't have to apply to programs for most of those other majors. A kid gets out of high school, applies to college, and declares a major. Then they take classes and graduate with that degree. There is no you need to get a 4.0 in the engineering prereqs, then take the engineering school entrance exam, and if your grades and test scores are high enough we will accept you into the program. No, they take the dang classes and if they pass them, they are awarded a degree in engineering. Also, they can get by with graduating with a 2.0 GPA. Our grading scale is much higher. That 2.0 is failing for us and we would be kicked out of the program and would not be awarded a degree. Her thought process is ridiculous.

I do not see people taking the martyr role as nurses. I have yet to hear someone complain about their hours or having to kiss their kid goodbye (seriously?). Most people I know love the hours. They work 3 12 hours shifts and have 4 days off with their family. And yes, I am sure it is hard on Christmas having to leave your family. I have worked on Christmas before when I worked in retail, but you don't work every single holiday and I know places try to make it so you may work Christmas but be off Christmas eve. That is more important to some families anyway as that is their big celebration. Some families work things differently. I don't have my son every Christmas. We switch years, and let's face it, Christmas is for the kiddos anyway. I know that for me and my boyfriend, it wouldn't matter one bit if I worked Christmas. We would work around it. That is what most families do. You know what you are signing up for when you get into this profession. Most of us are in it because we don't want to work 9-5 in a cubicle. That's not our personalities.

Nurses do have an extremely difficult job. Her comparing a teacher to cleaning up some poop and vomit to what a nurse does is crazy. They are not even in the same realm. This was an extremely uneducated, misinformed article. I cannot believe this site lets someone write an article who has obviously not even researched the subject. I'm also going to say she has applied to several nursing schools and could not get it and she is quite bitter about that fact, so she decided to write an article. I'm guessing she had a hard time in English Comp 111!!! :laugh:

My comment on there is under the monkeygirl32. It has more points in it and I am sure you guys can probably tell it is me by this post.

nynursey_ · Jul 12, 2015

they are under no obligation to listen to you. The point was about autonomy, which stands.

I'm not so sure why you think autonomy equates to being the life saver in any given situation.

It's rather sad that nursing autonomy is so often overlooked.

VANurse2010 · Jul 12, 2015

I'm not so sure why you think autonomy equates to being the life saver in any given situation.
It's rather sad that nursing autonomy is so often overlooked.

After you've been on the job longer, you may recognize that autonomy depends on the setting; and that you don't have as much as nursing school leads you to believe.

Libby1987 · Jul 12, 2015

Heathermaizy, this article in question was not published on this site, it was posted on Thought Catalog along with "How To Tell if He's Cheating".

nynursey_ · Jul 12, 2015

After you've been on the job longer, you may recognize that autonomy depends on the setting; and that you don't have as much as nursing school leads you to believe.

2, 5, or 10 years isn't going to make the difference between my ability to recognize my autonomy in certain situations. I'm not talking about my medical autonomy--clearly I have none. Nor am I addressing treatment autonomy, which I also have none of. I'm addressing nursing autonomy which does exist. Every nurse makes decisions on behalf of his/her patient each and every day. Are they always life saving decisions? No. Most assuredly not. But they're choices we make not guided by or ordered by physicians. They are not law. It is a collaborative effort that depends on the decision making abilities of both parties in a mutually respectful environment.

And again: autonomy does not equal life-saving decisions. Simply because you have the credentials to write an order for a drug or a diagnostic test does not mean the credit is owed to you.

Libby1987 · Jul 12, 2015

You can call it autonomy but it's really performing what you should do, not what you choose to do.

I have some true autonomy in my job, I can decide how to schedule most of my patients if I don't have specific MD orders and I can choose things such as teaching methods but other than that I need to follow appropriate set protocols. It's learning all of them and applying appropriately that builds competence.

Libby1987 · Jul 12, 2015

What I think is that I'm doing the job I'm prepared, trained and paid to do, that I also enjoy it and receive gratitude from patients and families and a little bit of undeserved awe from my friends and family is just bonus.

nynursey_ · Jul 12, 2015

You can call it autonomy but it's really performing what you should do, not what you choose to do.
I have some true autonomy in my job, I can decide how to schedule most of my patients if I don't have specific MD orders and I can choose things such as teaching methods but other than that I need to follow appropriate set protocols. It's learning all of them and applying appropriately that builds competence.

Regardless of the value you place on those decisions, they are still yours to make. That's my point.