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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.
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.
Would I have time to make a quick snack? Nothing fancy just some microwave popcorn!
*LOL*
They may command nurses and other personnel only so far as patient care goes. They have nothing to do with supervision and management of nursing and other staff. If you have a CEO or similar position who happens to be a doctor then yes, however, the gap in command is similar to comparing Steve Jobs' role at Apple and someone on an assembly line testing iPads.
One of my favorite instructors in school was fond of saying "physician's orders are for patients, not nurses."
What she meant is that docs order a plan of care for their patient and we as nurses are responsible for implementing same. We still, however, need to look at each order critically and ensure that it is appropriate. We do not complete orders "because the doctor said so" but rather because they are an important and appropriate course if action for the patient.
If a physician is ordering something inappropriate or unsafe (eg wrong dose of med, intervention for wrong pt etc) we have a duty to recognize this and point it out. While I would never simply not do an order without any communication I have told physicians that I would not complete an order that I felt was unsafe and that they could order an alternative, or do it themselves.
As for monitoring my bathroom time or telling me that I need to move faster all I can say is "Awww Haaaaaiiiill no!" I can't even picture it happening, never mind what my reaction would be.
One of my favorite instructors in school was fond of saying "physician's orders are for patients, not nurses."What she meant is that docs order a plan of care for their patient and we as nurses are responsible for implementing same. We still, however, need to look at each order critically and ensure that it is appropriate. We do not complete orders "because the doctor said so" but rather because they are an important and appropriate course if action for the patient.
If a physician is ordering something inappropriate or unsafe (eg wrong dose of med, intervention for wrong pt etc) we have a duty to recognize this and point it out. While I would never simply not do an order without any communication I have told physicians that I would not complete an order that I felt was unsafe and that they could order an alternative, or do it themselves.
As for monitoring my bathroom time or telling me that I need to move faster all I can say is "Awww Haaaaaiiiill no!" I can't even picture it happening, never mind what my reaction would be.
much like in aviation where all are encouraged to speak up if they see something is amiss in preflight or during a flight. It has saved lives. All need to feel free to speak up because MANY eyes are better than two.
http://www.ncbi.nlm.nih.gov/pubmed/17566541
They may command nurses and other personnel only so far as patient care goes.
*** Wow, I can't believe there are nurses who think like this. No physicians can not command nurses. They are the LEADERS of the care team, they are in no position to give any sort of commands. The "orders" they write are not for the nurses, they are orders for the patient.
Occasionally I meet a physician who THINKS they are in a position to tell nurses what to do. I quickly disabuse them of that silly notion.
To the original question:
In the tiny, rural facility in which I started, the docs had enormous unofficial influence over the nurses. It wasn't direct but their comments to nursing management and the hospital CEO carried enormous weight.
In the large academic setting, none at all. That said, if the docs regularly provided negative feedback about a nurse, that would be noticed and addressed... vice-versa.
I'd say a fourth of my shifts I never see or speak with a doctor. I use routine orders as needed. Handle things myself. I make decisions without any doctors dwindling over me. I appreciate the autonomy I have at my job. So no. Doctors aren't my bosses. I rarely see administration working nights. I typically feel very independent and in control.
Ruby Vee, BSN
17 Articles; 14,051 Posts
You have to follow legal and written orders -- unless to do so would endanger your patient. But "do what they tell you" implies a whole lot more, and that just isn't true.