Don't do the physicians work!

[ModernRN]

Please nurses, stand up for yourselves and the patients! Healthcare is evolving to the physicians doing hardly anything and putting all responsibility on the nurse. I feel the shift is for the doctor to spend less time with patients so they can see more pt's which only equals more money for doctors. Conflict of interest in my opinion.

You have the right to say no to physicians and point out why certain situations require action from the MD and not the nurse. I will make a list and if you have something else to add please do.

1. Physicians still giving verbal orders - this has been noted as a national patient safety issue. So why can't the physicians protect patients safety? Are doctors truly concerned with pt's safety? If they are ignoring pt safety goals then I'd say no they aren't.

2. Why are nurses now responsible to make sure certain medications or therapies ordered such as Metoprolol or VTE prophylaxis? Nurses are getting burned because physicians aren't capable of being thorough enough to make sure they have ordered what is appropriate for their patient. This is just lousy of physicians in my opinion.

3. Nurses having to get physicians to renew 24 hour restraint orders and foley cath orders.

If your physician does not know the pt is in restraints or has a foley catheter that requires a new order then they are not fully aware of the pt they are managing care for and is not professional.

4. Physicians are not giving report of their patients when another physician is taking over call. Calling a physician for help with a pt issue and the MD has no clue who you are talking about is poor physician management in my opinion and is a safety issue.

If you want to elaborate on what I've mentioned or have some of your own similar situations please add as I'm interested in others opinions.

Thank you,

RN

[DextersDisciple, BSN, RN]

I cannot speak for what kind of hospital you work for or demographic (i.e magnet, teaching, community, urban etc.) But It's sounds like it is not a teaching hospital. Physicians in my unit do AM and PM rounds, give handoff between shifts and manage to know all 30+ pts on the unit.

As for order sets, drugs, VTE prophylaxis foley and restraints are placed only by the physicians. If for some reason they are not, I just call them (they are on site) and the issue is resolved immediately. I usually ask for a new restraint order during rounds to avoid expiration.

This sounds like an unfortunate situation. Maybe consider seeking employment at a different hospital?

[RNperdiem, RN]

Ok, sometimes a reminder about renewing restraints goes on during rounds, but where I work, nurses are not truly responsible for those other things.

I suspect this has to do with power and the ability of a hospital to enforce rules.

In a big teaching hospital like mine, the bulk of work is done by residents and these doctors are employees of the hospital. The hospital has the power to enforce these rules. Sign off is a big part of the resident responsibility here: I seldom encounter an unprepared doctor since we did away with extensive cross-covering between surgical services.

I have also worked in smaller private hospital where doctors have hospital privelege. The docs are not directly employed by the hospital, are free to admit their patients elsewhere, and enforcement by the hospital is weaker. Going after the nurses to be enforcers is the unfortunate result.

[smf0903]

I have no issue with taking the occasional verbal order. Sometimes our hospitalists are ridiculously busy and I'd be waiting for a month of Sundays for them to get a chance to put the order in themselves (this is the exception, not the rule).

As far as prophylaxis and other issues, docs are human and sometimes just miss things. I try to double check what's ordered to make sure it aligns with core measures and also that home meds are ordered appropriately.

That being said, we have one doc who is notorious for wanting the nurses to fix everything he messes up. Uh, no. Or he tells us the next shift can fix it. Uh, no. Being insistent with that doc has gotten him to the point where he knows we won't spend an hour fixing his stuff.

Our physicians give report every shift just as the nurses and aides do. No getting out of that

[NicuGal, MSN, RN]

We too have Am and Pm rounds, and we can send a sticky note in EPIC for reminders. But you should be making sure all those things are done, you are the patient safety net! And to cover your own behind.

[LovingLife123]

Where do foleys have to be reordered q24?

[Lauraingalls, BSN, RN]

I feel like all I do is take phone orders. But we still do some paper charting along with computer charting..... Because charting in only one system is way too easy!

[Penelope_Pitstop, BSN, RN]

Where do foleys have to be reordered q24?

If the CAUTI police haven't come for you yet...it means they're on their way.

[jessimee]

We have a few physicians who refuse to learn Epic. I had one recently who couldn't figure out how to put a patient on the particular insulin regimen that he wanted. He ordered "something similar", asked us to fix it, and left. Not only did I then have to take the time to figure it out, (double check with charge and pharmacy), put in correct orders, but also had to take time to write up incident report. Ugh.

[TheCommuter, BSN, RN]

Healthcare is evolving to the physicians doing hardly anything and putting all responsibility on the nurse.

Life is not fair, isn't it? Physicians are not paid for what they do; instead, they are paid for what they know. The sooner people figure this one out, the less time-wasting rumination about "physicians hardly doing anything" occurs.

This is one of the benefits of attaining a professional doctorate: being paid for abstract knowledge and consultative services while those with less years of educational attainment deal with the array of busy hands-on tasks. It is what it is.

[LovingLife123]

If the CAUTI police haven't come for you yet...it means they're on their way.

I do my Cauti checkoffs quarterly. No where do we get foleys reordered every day. That's crazy. We discuss with the physicians the need for a foley when they round and I document foley care each shift and prn foley care. Maybe it's because I work ICU and most pts have them?

[LovingLife123]

At my hospital it's my responsibility to call the physician for restraint orders if they don't do it. Some reorder at the beginning of their shift. I love those docs. Others I have to ask when they round. Many will put them in themselves, others don't.

I dont mind putting in orders. A lot of times if they have NPs or residents they put the orders in, otherwise, I do.