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Autonomy

MICU   (2,490 Views 12 Comments)
by Hoozdo Hoozdo, ADN (Member) Platinum

Hoozdo has 15 years experience as a ADN and specializes in ICU, Research, Corrections.

1 Follower; 13,580 Profile Views; 1,541 Posts

OK, I feel kind of burned out after working four 13+ hour shifts in a row. Too many admits and not enough admit orders being written. I work night shift.

Do any of you feel that at times you have too much autonomy for your scope of practice? When I call a doctor for a problem I have to tell him what drug I want prescribed at what doses. I am waking them up and feel bad for that......but I am not a doctor and I am not a nurse practioner. I need to tell the primary physician what speciality consults the patient needs and write all the orders for it. Sometimes I think, why should I even call the doctor? I am telling him what I need and he tells me OK.

So, now I have to do all the work, have no CNA or unit clerk, and have to decide how to treat the patient too? Do all of you feel like this? Am I burnt out or are my ICU hospitalists slacking off?

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lifeLONGstudent specializes in MICU.

264 Posts; 4,492 Profile Views

I feel for you. I work at a teaching facility and our teams are always on the units and accessible. We go through the intern first and if that doesn't work, we awaken the resident. I have made it a habit to know the drug and dose that I want to ask for before I even page them - makes my life easier.

The whole situation you described is why I chose to work at a teaching hospital.

lifeLONGstudent

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Christie RN2006 specializes in SICU, EMS, Home Health, School Nursing.

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We have a few docs that will do the opposite if you suggest something, but then we have others who will ask what we think they should do... The other day I asked a doc for neo and he gave me an order for dobutamine and my HR was already in the 120s!!! Needless to say I called him back shortly after I started it for a pressure of 68 and a HR of 175... thankfully he let me consult the hospitalist and I got what I wanted and I didn't even have to code the patient :)

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sailing9734 has 34 years experience and specializes in ICU, ER, High Risk L&D, PHN, Hospice RN,.

9 Posts; 586 Profile Views

We have a few docs that will do the opposite if you suggest something, but then we have others who will ask what we think they should do... The other day I asked a doc for neo and he gave me an order for dobutamine and my HR was already in the 120s!!! Needless to say I called him back shortly after I started it for a pressure of 68 and a HR of 175... thankfully he let me consult the hospitalist and I got what I wanted and I didn't even have to code the patient :)

Is that autonomy to you?

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love-d-OR has 3 years experience and specializes in Transplant/Surgical ICU.

542 Posts; 9,582 Profile Views

A newbie here, so definetly not burned out. But as someone else said earlier, the situation you described is one of the reasons I chose to work in a teaching hospital and in ICU.

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richard1980 has 7 years experience and specializes in SICU/CVICU.

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I feel for you. I work at a teaching facility and our teams are always on the units and accessible. We go through the intern first and if that doesn't work, we awaken the resident. I have made it a habit to know the drug and dose that I want to ask for before I even page them - makes my life easier.

The whole situation you described is why I chose to work at a teaching hospital.

lifeLONGstudent

They still have residents to run care in ICUs? And they let them sleep? LOL ;-) In the facility I work at if residents come to SICU they are basically holding hands with one of the intensivists. We always go through the surgeon/SCC or MCC if it's a overflow patient. The hospitalists don't really manage patient care at least in SICU, they'll post MCC or SCC to run the show.

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sicushells has 3 years experience as a RN and specializes in SICU, Peds CVICU.

216 Posts; 5,430 Profile Views

We have a few docs that will do the opposite if you suggest something, but then we have others who will ask what we think they should do... The other day I asked a doc for neo and he gave me an order for dobutamine and my HR was already in the 120s!!! Needless to say I called him back shortly after I started it for a pressure of 68 and a HR of 175... thankfully he let me consult the hospitalist and I got what I wanted and I didn't even have to code the patient :)

I've had that too. Sometimes I'll "suggest" the drug I don't want so I can get the drug i do want (manipulative but if that's what my patient needs...):chuckle

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racing-mom4 is a BSN, RN and specializes in ICU/ER.

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i feel like i could have written your post--I too have done 3 weeks of 4 12s in a row and it is getting to me....just last night I had to call a doc to inform his his pt was crashing fast only to hear in a mumbled half asleep voice "what do you suggest?" --I learned a long time ago to always have a drug book in hand with a list of what I want before I even call. Granted I am glad they listen to me, but sometimes I dont know, I may have an idea but I am not a doc. I am glad I have a good partner but some nights I wonder how we actually get through the night.

to answer your question----I am guessing your temp burnt out...4-12 hour shifts is really 52 hours out of 96. As you dont clock in at 7:01p and clock out at 6:59a. You are prob not getting your full break and your probably not getting good sleep during the day.

Hopefully you will get some good rest and come back refreshed---your pts and your docs are counting on you!!

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ghillbert has 20 years experience as a MSN, NP and specializes in CTICU.

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The autonomy to participate in care decisions was a huge part of what I loved about working in CTICU! I was not prescribing things, but it's definitely within my scope of practice to suggest things and work collaboratively as part of the ICU team.

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bellehill has 9 years experience as a RN and specializes in Neuro Critical Care.

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I agree with ghillbert, the autonomy is one of the reasons I chose to work in critical care. I know the patient better than the doctors and when I call I know what the patient needs. I can give them suggestions but ultimately it is their decision to listen to me or not listen. If there are residents it is a great way to learn together and keep the patient safe. I can't imagine working on a floor where the doctors did not ask for my opinion and respect my opinion (well, most of the doctors).

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geminigirl11 specializes in Med/surg, ICU.

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Regarding working four 12h days in a row, we have a union contract that states management may not do this unless the nurse wants to. We have a limit of three 12h days or three 12's and an 8h day in a row. At my teaching hospital, our residents usually seek our opinion, especially if the doctor is a woman; the men sometimes don't ask outright. We sometimes write orders without discussion, knowing that the doctor will just sign it later, but only for more minor stuff.

However, a nurse should never feel bad for waking them up. They are on-call or in house, etc. It is their job to also take care of the patient and work. If they get a chance to sleep, great. But it is not a sure thing. Please don't hesitate to call them if you need them. Go forward without guilt, RN's.

It sounds like you are taking on too much for the workload and perhaps you could turf writing of the orders back to the doctor...? At my faciltiy, we are not required to write orders and if we do, it is a courtesy. It is an on-going problem with newish residents, that they do not write orders in a timely manner. I usually tell them that we need them to write orders a little more quickly. I also call them and remind them. It is difficult sometimes to do this along with my other work, but since it's a teaching hospital, I am expected to teach and in turn I expect to be taught new things daily as well.

I wonder how different it would be to work in a non-teaching hospital. I never have and I have heard that the relationships bw docs and RNs is much more of a power dynamic than at a teaching facility...

Take care!

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