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Doctors not assessing COVID patients?

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by orchidflower orchidflower (New) New

Doctors at my hospital are not physically assessing the COVID patients. They are asking nurses to enter the room and ask them what they have assessed. I am working at a teaching hospital. We were told residents weren't allowed to enter the patients rooms and just attendings and fellows. Well, no physicians are entering the patients rooms. It's so bad, we had a patient code and the physician asked the respiratory therapist to assess the patient from outside the room to confirm death. Is this happening at any of your hospitals? I feel as if the doctors feel as if we "nurses" are expendable and they aren't.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

There are certainly reasons for the physician to go into the room, but they also shouldn't be going in just for the heck of it. With COVID there isn't actually much purpose to a direct Physician assessment. It's reasonable to limit the number of staff entering the room and not have multiple staff members doing different tasks that could be done by a single staff member instead.

CMSrn2009, ASN, BSN, MSN

Specializes in Critical Care, Public Health, Addiction. Has 12 years experience.

I think docs not going into rooms has regularly been a trend prior to this but is more prevalent now that its literally hazardous for anyone to go in due to the current environment (lack of PPE etc..). Where I work they only go in if its an emergency, to place a line etc but do not go in for rounding (some consultants do). Interesting only fellows and attendings can go in where OP is at, though. Where I'm at plus at another health system nearby- the attendings do not go in the room, but residents do.. so its like they're throwing their young to the wolves. I feel bad for THOSE residents. I've confirmed death before so that's not surprising.. However I do feel your sentiment. Nurses are literally up in peoples business more than anyone else, and are probably the most exposed just because of the nature of the job. More PPE and adequate staffing would make me feel less expendable...

theoneandonly

Specializes in RN. Has 5 years experience.

This is correct. Physicians are smart. They don't want to expose themselves, so they use you instead. It's sad, but yeah they should be rounding on their patients. Patients want to see their physician, they have questions that a nurse cannot usually answer. They are using the PPE shortage as an excsuse.

Ya, same in my hospital, doctors not physically assessing coivid patients. nurses main health care worker attending/seeing patient

Dhooy7

Has 5 years experience.

We do not have COVID patients on our units but the doctors are still seeing patients.

GSDlvrRN, BSN

Specializes in Telemetry. Has 4 years experience.

On 4/10/2020 at 1:35 AM, theoneandonly said:

This is correct. Physicians are smart. They don't want to expose themselves, so they use you instead. It's sad, but yeah they should be rounding on their patients. Patients want to see their physician, they have questions that a nurse cannot usually answer. They are using the PPE shortage as an excsuse.

The doctors I work with have no shortage of PPE. They call the patient’s room phone and talk to them that way, they can also see the patient through the window next to the door. I have seen doctors go in for an initial assessment like if they are new from the ED, but not usually for daily rounding.

travelingrn2001, ASN, BSN

Specializes in ICU. Has 23 years experience.

In Broward county Florida, I believe that the standard is that the physician must "see" the patient in order to bill. This is my understanding of the drive to have nurses carry an ipad/camera etc into room for remote exam.

I do not understand how this reduces the use of PPE, physical exposure or any of the additional reasons to justify a nurse entering the room instead of a physical visit by a physician. The PPE is used by the person carrying the equipment, exposure to a contagious patient is not minimized and entry/exit by physician is swapped for entry exit by nurse.

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 42 years experience.

On 4/12/2020 at 1:22 AM, GSDlvrRN said:

The doctors I work with have no shortage of PPE. They call the patient’s room phone and talk to them that way, they can also see the patient through the window next to the door. I have seen doctors go in for an initial assessment like if they are new from the ED, but not usually for daily rounding.

Talking on the phone is a good move, but if the patient still has questions, it would be easier for the doc to hang up as opposed to when he/she is actually in the room. 

I haven't worked in the hospital in over 30 years, but I remember how patients could not always get their questions answered. This was especially true when the doc had an accent. (I instructed these patients to repeat back what they heard to the doc.)

And, sometimes - knowing the doc - I would stand in the doorway and ask those last few questions for the patient. These were questions that the patient had already asked me.

The doctors do visit non covid patients so I could see this as a way to decrease exposure. Not really a benefit to the other staff though

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 29 years experience.

On 3/26/2020 at 11:23 AM, orchidflower said:

Doctors at my hospital are not physically assessing the COVID patients. They are asking nurses to enter the room and ask them what they have assessed. I am working at a teaching hospital. We were told residents weren't allowed to enter the patients rooms and just attendings and fellows. Well, no physicians are entering the patients rooms. It's so bad, we had a patient code and the physician asked the respiratory therapist to assess the patient from outside the room to confirm death. Is this happening at any of your hospitals? I feel as if the doctors feel as if we "nurses" are expendable and they aren't.

What setting is this? (ICU, floor?)

In our medical center, at the start of the pandemic, we made a decision to limit provider, nursing, and ancillary support contact in COVID-19 rooms.  Our COVID-19 patients of all acuities are assigned to non-teaching primary teams - no residents, medical students, NP students, nursing students, RT students, pharmacy students.  Fellows are different because they are in a way classified as junior attendings having completed a residency program and are board eligible. 

I only work in the ICU and with COVID-19 patients, it's strictly attending, NP, and fellow only entering rooms.  Only one provider does a physical assessment per shift and only if necessary (ie, change in status).  Many decisions can be made by looking at hemodynamic numbers, labs, respiratory mechanics, etc, all available on Epic. There are surely times when a more in depth assessment needs to be made including a bedside point of care ultrasound and if those will help guide decisions, they are done.

If procedures have to be done, the most experienced provider does them. Intubations are done by attendings or fellows with strong airway management background.  Lines are done by NP's usually as we have done hundreds if not thousands of lines pre-pandemic. This is to avoid unnecessary time spent in room fumbling and not being able to finish the required procedure.

Our code teams for COVID-19 patients are streamlined...a visual diagram actually tells us where essential staff would be standing...attending and RT on airway, NP assisting with or doing procedures, RN doing chest compression, RN giving meds, RRT on defibrillator or documenting.  We have 2 phones, one in room and one outside on speaker for Pharmacist and everyone else outside waiting for instructions and grabbing equipment as the need for it arises.  Line up of staff for chest compression are also outside. Rule is, no one goes in room until they are fully PPE'd, no exceptions! Does it work smoothly in a real code? not always, of course but they never do even for non-COVID-19 patients.

neuron

Has 5 years experience.

On 3/26/2020 at 1:23 PM, orchidflower said:

Doctors at my hospital are not physically assessing the COVID patients. They are asking nurses to enter the room and ask them what they have assessed. I am working at a teaching hospital. We were told residents weren't allowed to enter the patients rooms and just attendings and fellows. Well, no physicians are entering the patients rooms. It's so bad, we had a patient code and the physician asked the respiratory therapist to assess the patient from outside the room to confirm death. Is this happening at any of your hospitals? I feel as if the doctors feel as if we "nurses" are expendable and they aren't.

Doctors are doing this to the nurses and the nurses DON'T  EVEN KNOW the patient and not even working on the isolation unit, asking what the last labs were, what happened with this patient, etc. They are paid more to go in  and the nurse doesn't take the place of doctors assessments. 

Edited by fibroblast