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

[foggnm]

Please don't take your frustrations out on physicians. I know our healthcare systems dump a lot on nurses, but the providers also get things put on them. They have hard jobs and many don't get paid that much. We can't change other people's behaviors but we can change our reaction to them, our own behaviors, and our choices and circumstances. If you're unhappy in your work environment, consider trying something else. I worked in an office where I had to electronically sign the providers refill requests and I quit the job because I didn't believe it had anything to do with nursing (it was one of many things). But I didn't blame the provider for it, because it was the way the clinic was set up...it wasn't their decision.

[DTWriter]

I am all for having the physician putting in their own orders on the EHR system, or at least have it written somewhere that said physicians prefers x protocols for z patients.

I hate when physicians expect other nurses to pass on their preferences. I do not know about others but I feel unnerve going off the word of another nurse as to what a physician likes to do.

[CFrancine, BSN, RN]

I am all for having the physician putting in their own orders on the EHR system, or at least have it written somewhere that said physicians prefers x protocols for z patients.

I hate when physicians expect other nurses to pass on their preferences. I do not know about others but I feel unnerve going off the word of another nurse as to what a physician likes to do.

In those cases, I tell the other nurse "If YOU were told by the doctor, YOU need to put the order in before I can do anything."

[Extra Pickles]

I just looked up the definition for "sweet cheeks" and opps..Honestly didn't know it meant that so I apologize for who ever I offended.

I'm genuinely curious as to what you thought it DID mean. Surely you didn't use it as a means of praise? Color me confused!

[la_chica_suerte85, BSN, RN]

Yea, avoid the topic content and aim at the "sweet cheeks" comment. LOL.

No, not 'LOL.' That was gross and it's use obviously distracted from the topic, hence people bringing it up. It you wanted to more effectively communicated your point, you shouldn't have said it. Duh.

[Creamsoda, ASN, RN]

What I am saying is that the physician should know their patients and write the orders accordingly. We have enough on our plates keeping the sick alive and having to question the physicians orders is absurd in my opinion.

This is absurd. If thats how you think it should be, then get rid of RN's. Replace with robots or other unlicensed personel. In a perfect world all of us...nurses and doctors would all know everything perfectly all the time and there would be no need to ....the horror....question things. But we are all humans, doing the best of our ability/knowledge. And get this...we work together to get things done and do whats right for the patient. And nurses are the ones at the bedside. We are the best person TO QUESTION AND ADVOCATE for our patient because we are at the bedside all day. The doctor is not and should not have to hover at the bedside to know every single thing. That is what being a bedside nurse is for. To assess the patient throughout the day, and update the physician of changes we note. They have millions of other patients to round and see, admit, discharge, answer annoying calls, get called to emergencies all over the hospital etc. So yes, you as a nurse, it is your job to analyze and question every order you get. Because doctors don't have a million eyes and ears all over the place.

[la_chica_suerte85, BSN, RN]

Guess what? Get the verbal order and initiate it but the physician must put in the order himself/herself eventually otherwise you leave room for error. Its not rocket science Ma'am! That better for you?

You must have never had to deal w/ new residents or docs that couldn't care less about the specialty you work in and are just going through the motions to get through that rotation. We get weird/incorrect/unclear orders all the time and, when you work nights, it's inefficient to have to keep paging the resident (who may have just happened to run off to an RRT or code) to fix an incorrectly entered order. When I'm drawing STAT labs on a pt and need my Abx and my STAT labs print out incorrectly because the order was entered incorrectly (and lab won't accept a label that doesn't correspond to the pt's CVC), it's just better if I fix it and we all move on w/ our night. It's annoying that they didn't hear me when I said "double-lumen Medcomp" and I get a "single-lumen PICC" but whatever, I'm not sweatin' it.

For medication-related things, I just tell the pain team doc that is telling me to adjust a narcotic order myself that that is out of scope and they can do it when they have a minute. I'm usually asking them to adjust something I'm anticipating anyway, so, no need to initiate a verbal order. This generally applies to all other services but pain team, so far, has been the only ones to ask me to put orders in for them myself.

[Creamsoda, ASN, RN]

Your practicing outside of the scope of nursing and risking the pt's safety and your license. When a nurse catches a physicians error the docs just say oh ok thanks and keep on rolling. But if a physician catches a nursing error he or she is liable to write you up or tell your manager and the nurse is scolded. Id like to see physician scolded for their errors as well. Just my opinion and frustration I suppose..

With todays age and time, I feel it is important to define the boundaries between nurses and physicians as I am the only one looking out for my license. Healthcare is a team effort but I promise when your in court it you WILL be examined on a individual basis.

And what is the deal with you wanting to scold everyone. In a decent hospital with a decent culture of safety, rarely does a nurse or a physician get "scolded". There are many times where things may be done incorrectly, but rarely is it an issue of blatant malpractice. Theres always many system issues. (lack of education, lack of resources, short staffing, emergencies etc) that contribute to any one problem. When there are mistakes, even big ones where I work, typically a root cause analysis is done to identify the problems and things are remedied from there. A nurse is never "scolded". Doctors also have room for growth and practice changes. Which is why you write an incident report or whatever they're called in your hospital. That is how issues can be brought forward. Yes there are times where a doc flys off the handle and says to the nurse"give me the name of your manager!". And you politely give them their name. Does the manager then go and scold the nurse? No. A discussion will be had, but thats it. And the nurse is not in trouble.

I guess I think I work at a pretty good hospital I guess. Maybe its not like this everywhere.

[cjcsoon2bnp, MSN, RN, NP]

To the OP:

I was initially interested to read this thread and you make a few really good points (especially with regard to eliminating the practice of nurses taking verbal orders) but I think that the delivery of your points and some of your responses to the other users on this forum has been rude and unprofessional.

Just because YOU are ok putting in the verbal orders, YOU are putting the patients safety at risk! Plus you are enabling the physicians to continue to exercise bad habits in healthcare!

We absolutely should be making every effort to eliminate the practice of nurses taking verbal orders but to say that it can be eliminated 100% of the time or in every situation is simply unrealistic. I work in the emergency department and if I were to tell a physician that I would not take a verbal order in the middle of a code (or a similar emergency situation) then I would be putting patient's safety at risk.

In the majority of situations, the physician has time and can reasonably be expected to put in the order themselves but we should be taking verbal orders in certain special circumstances where patient care would be negativeily impacted/jeopardized if we did NOT take the order.

Your practicing outside of the scope of nursing and risking the pt's safety and your license. When a nurse catches a physicians error the docs just say oh ok thanks and keep on rolling. But if a physician catches a nursing error he or she is liable to write you up or tell your manager and the nurse is scolded. Id like to see physician scolded for their errors as well. Just my opinion and frustration I suppose..

With todays age and time, I feel it is important to define the boundaries between nurses and physicians as I am the only one looking out for my license. Healthcare is a team effort but I promise when your in court it you WILL be examined on a individual basis.

I think that telling the other user that he/she is practicing outside of their scope of practice and placing the patient's safety in jeopardy is an unfair and a bit hyperbolic.

Regarding the "risking your license" argument, having worked in nursing academia and reviewed many cases where nursing licenses were suspended or revoked, I find that many nurses have an irrational fear of losing their license that is not reality based. It is a bit off topic but I have found the "losing your license" phobia tends to be more common in new grad/novice nurses or more experienced nurses who are not as familiar with their state practice act or reviewed many cases in which nursing licenses were suspended or revoked.

Yes you are BSN16! The goal is to eliminate ALL verbal order entry by nurses! ALL!! The doc can put in the Levophed order himself when he takes his ass to a computer or chart. Stop kissing ass and keeping us from getting physicians on board with the system and technology where they should be sweet cheeks!

See my first comment regarding special situations where it may be necessary for a nurse to put in a verbal order. This is also an example of a post where your tone and choice of language is abrasive and rude. Posts like this take us from having a mature and thought-provoking discussion amongst colleagues to an internet shouting match.

Guess what? Get the verbal order and initiate it but the physician must put in the order himself/herself eventually otherwise you leave room for error. Its not rocket science Ma'am! That better for you?

I find it interesting that you would get the verbal order from the physician and act on it but then insist that the physician enter the order him/herself. If I am taking a verbal order and acting on it then I am definitely going to enter it because I want it to be clear what was said and then there is no way for the physician to forget to enter it or decide later that they want to change an order I have already acted on. The last line in this post is yet another example of text that comes across as passive-aggressive and belittling to your peers.

I hope that the OP becomes a bit more flexible in his/her thinking about how we work together with physicians as a healthcare team and that he/he takes the feedback from other users on this forum about how you can present yourself in a way that less abrasive and passive aggressive (this type of behavior only weakens any argument that you make and diminishes your credibility). Best of luck!

!Chris

[bgxyrnf, MSN, 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.

Which probably isn't such a bad thing... I spend more time arguing with physicians why patient's *don't* need Foleys than I do arguing for their insertion.

[RegularNurse]

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.

Truth. End of discussion. Doctors also make money for hospitals. Businesses cater to employees generating revenue.

[Ruby Vee, BSN]

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?

I work ICU, and most patients have them. They still have to be reordered every 24 hours. Just one of the things we address on rounds. AND the physician has to write a note about why the Foley is still needed. I'm all for evidence based practice, but it sure generates a lot of silly documentation rules.