Do physicians have authority over nurses in the hospital?

[sjalv]

Hi there. In a hospital setting, do physicians have direct authority over an RN/LPN? I realize there are charge nurses/a DoN/a clinical manager, and I also realize physicians tell the RN what to do regarding the patient's diagnosis, but would a physician ever have the authority to tell a nurse something like "You aren't working fast enough." / "You are spending too much time with that patient." / "You are going to the bathroom too often." or other general statements, provided the physician's patient is NOT being endangered by whatever the nurse is being counseled on?

Sorry for the mega sentence. I am assuming it is not a physician's place to make these accusations/statements but some might anyway. I don't have hospital experience and am just a student nurse, but this piques my curiosity.

[BloomNurseRN, ASN, BSN, RN]

It's my understanding that they have control over patient care and the orders involved with that but it's the charge nurses, nurse supervisors, and DON's that truly "order" nurses around and are responsible for them as employees. I've heard horror stories of physicians that wanted to dictate things to nurses but the charge nurse of nurse supervisor quickly nipped that in the bud. Effective nurse management will take care of that type of thing.

[Altra, BSN, RN]

Short answer, no.

Any responsible physician will want to see that the prescribed treatment plan is being carried out, and will want to see evidence of good nursing care for his/her patients. But in a hospital setting nurses report to nursing management and ultimately hospital management -- not physicians.

[SaoirseRN]

Physicians have authority over the care of their patients, but no, a physician in a hospital setting has no right or authority to direct the nurses as in your examples, OP. Some might try (I have yet to come across one, however), but they have no actual power in that regard. As someone said above, nurses are employed by hospitals, not the physicians, and generally physicians aren't hospital employees, but are like "contractors" who have been granted privileges to practice medicine in that facility.

[Horseshoe, BSN, RN]

I've seen doctors try to order nurses around, and those nurses nipped that concept in the bud themselves. Most nurses I worked with at the hospital worked very hard to have a collegial relationship with the doctors, but if the docs stepped out of line, these nurses were very quick to disabuse them of the notion that the doctor had any actual authority over them beyond directing the plan of care.

I am now working at a physician owned facility. I got the job because of the good relationship I had with the doctors at my hospital. Another nurse was not so lucky. Apparently she had a real attitude towards many of these doctors when they were residents at her hospital. When they saw her working in the facility, they went straight to the DON and said NO WAY is she working here. So that "I don't work for you" contentious attitude came back to bite her in the butt at a time when she really REALLY needed the job.

[KelRN215, BSN, RN]

Hi there. In a hospital setting, do physicians have direct authority over an RN/LPN? I realize there are charge nurses/a DoN/a clinical manager, and I also realize physicians tell the RN what to do regarding the patient's diagnosis, but would a physician ever have the authority to tell a nurse something like "You aren't working fast enough." / "You are spending too much time with that patient." / "You are going to the bathroom too often." or other general statements, provided the physician's patient is NOT being endangered by whatever the nurse is being counseled on?

Sorry for the mega sentence. I am assuming it is not a physician's place to make these accusations/statements but some might anyway. I don't have hospital experience and am just a student nurse, but this piques my curiosity.

Who are these doctors who are actually present to notice if a nurse is spending "too much time" with a patient, not working fast enough or using the restroom too often? Doctors are not a regular presence on most hospital floors. They stop by to round and then peace out.

[llg, PhD, RN]

To the OP:

You are seeing variety in the responses because there is a difference between "official authority" and "informal power." In most employment settings, the physicians do not have "official authority" over the nurse as an employ. The nurse works for the hospital, not the physician. However, physicians wield a lot of "informal power" within the health care system. While they cannot fire a nurse (in most places), they can complain about the nurse's performance and many nurse managers and hospital adminstrators will bow to the physician's wishes.

The amount of power the physician has depends on the politics of each particular workplace. In settings with strong nursing leaders, the physicians have less power. They can complain about a nurse, but it won't necessarily hurt the nurse if he/she is not doing anything wrong. In settings where the nursing leaders are weak, some physicians do get away with bossing everyone around.

So, what you are seeing in the reponses here in this thread is people's opinions based on what they have seen in their particular workplace. And as you can see, that varies.

[sjalv]

Thanks for the responses. It is a shame that some physicians wield informal power and can influence nursing managers in a negative way. I understand the physician reporting poor work performance if it is a valid concern, but it seems that in some settings, if a physician has it out for a nurse without proper cause, he or she can have the nurse disciplined anyway.

[MassED, BSN, RN]

You have to do what they tell you - provided it's not grossly ridiculous - but they have no direct control over your employment.

That is not true. You operate under your discretion and your nursing license. I have had a doctor tell me to "push that Morphine" - so when I did what I normally do, give it slow IVP over a few minutes, that doctor made a point of addressing me outside the room and said "every other nurse pushes it, why didn't you?" I told him because pushing that med can make a person have respiratory issues, nauseated, and plus he can't tell me what best practice is for any med! None of them have any idea about administration of a med, they only know what to give for what effect.

Also, I agree with other posters that doctors do have managements ear and if they are out for a nurse, that nurse better start packing their locker. I have seen it. Doctors always get their way eventually, because let's face it, they bring in more money.

[Esme12, ASN, BSN, RN]

Thanks for the responses. It is a shame that some physicians wield informal power and can influence nursing managers in a negative way. I understand the physician reporting poor work performance if it is a valid concern, but it seems that in some settings, if a physician has it out for a nurse without proper cause, he or she can have the nurse disciplined anyway.

That is with any place of employment. They are in the position of power. Nurses have different levels of interaction with physicians. Like the Cath lab, ICU ER and the OR which the interaction is very prevalent and important......so yes the MD's have every right to ensure the nurses surrounding them are competent and capable. Ar ethey your direct boss? No.

In my practice it's been fellow nurses I found more of a threat with petulant vindictive behavior than the physicians.

[DoGoodThenGo]

IIRC even in the "old days" of starched whites and caps when nurses (supposedly) went around going "yes, doctor" and "no, doctor", physicians do not have direct authority over nursing service. Nursing is it's own profession with a hierarchy in place that in most facilities is administered from the DON down to supervisors, head and or charge nurses.

That being said an attending, chief of staff, chiefs of department and so forth *can* make a nurse's life hell, but again much of that will come down through nursing management and or administration. In matters ranging from the small (being out of uniform) to large (professional conduct) all a physician can do unless terms of his employment give direct supervision and or control of nursing staff is to file a complaint (verbal or written) with said nurse's direct supervisor or nursing administration.

As noted above what "powers" physicians do have is over the direct care of their patients. A doctor can *request* a nurse not be assigned to his or her patients, and or a CofD can make a similar application for removal of a nurse from his unit, but again all goes through nursing administration.

Quite honestly a lot of this madness came or comes about from physicians being treated like some sort of god because they primarily build, run and bring in funds to facilities. Like prima donnas they must be courted and mollycoddled because the place *needs* their presence. Nurses OTOH are a dime a dozen supposedly who can as one has heard screamed at more than one nurse by a doctor, can be replaced "by a trained monkey".

Best protection nurses can have is strong nursing management and or administration right up to the DON (or whatever they are calling themselves today). You want someone is those roles who will be fair and also a strong advocate for her (or his) nurses, as opposed to transferring, floating, sending on vacation if not outright discharging a nurse because Dr. Dreamboat doesn't like her attitude.

[Sunflowerinsc, ADN, RN]

Even tho the physician is not the boss, administration

will want the doc to admit his patients to their hospital ,not the one down the road.so they may ask nurses to do some things to that physicians preference.

[tyvin, BSN, RN]

No; plain and simple. Sure you want to be nice and work together but the jist of the post was do the docs have the authority to boss RNs around (tote that barge, lift that pale) and that's just not true...a real doc wouldn't do that anyway.

We do nursing stuff they ask but if a doc told me I wasn't working fast enough, well; let's just say you would all probably want to stop and sit down to watch and learn what I would do.