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.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
This is the kind of unprofessional dangerous scenarios I am talking about. No one disciplines the physicians or they would straighten up their act! Physicians should be directing the nurses on what to do and not the nurse telling the freaking doctors what needs to be done!
With respect, the discipline physicians do or do not get, like the discipline nurses do or do not get is confidential. We don't get to know about it unless they choose to share. As for who directs whom -- healthcare is teamwork. If you approach it, instead, as an adversarial relationship it won't be as effective or as much fun.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
You don't believe that part of your job is advocating for your patient? Then you're not doing your job. Keeping the sick alive is a collaborative process between multiple health care disciplines. All this anger about what physicians are or are not doing and are or not being disciplined for doing or not doing it seems unhealthy for you AND your patients.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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 are rude and dismissive of people who disagree with you, angry about what you perceive as "unfairness" re: physicians and seem awfully fixated. Perhaps step back from the computer until you've reflected for a day or so on what people are telling you.
If the CAUTI police haven't come for you yet...it means they're on their way.
We don't need new orders, but we have to chart a list used to indicate if the foley is necessary. This is one of the hospitals way of preventing CAUTI. This is done qshift if not Epic will continue to remind you until completed. We also have anorder for "Care and management of foley" so this could also be why.
We don't need new orders, but we have to chart a list used to indicate if the foley is necessary. This is one of the hospitals way of preventing CAUTI. This is done qshift if not Epic will continue to remind you until completed. We also have anorder for "Care and management of foley" so this could also be why.
We've had docs who " forgot" about the verbal orders they gave, and then they refuse to sign them later. Then "we " have to research it and prove otherwise.
That is why I am going to refuse to take verbal orders anymore . A few of my co- workers feel the same way.Too risky now.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
well , this post couldn't be more timelier.
We've had docs who " forgot" about the verbal orders they gave, and then they refuse to sign them later. Then "we " have to research it and prove otherwise.
That is why I am going to refuse to take verbal orders anymore . A few of my co- workers feel the same way.Too risky now.
I once had a physician lie about giving a verbal order and say he never gave it. Fortunately, I had a witness (the attending physician of another service). My manager put a photo of the physician on the wall in the breakroom with a big red circle around it and in BOLD lettering, "Do NOT take verbal orders from this man." It happens that the managers of all the ICUs met in our break room that morning, and of course they were all curious about the sign. By the end of the shift, the guy was BEGGING us to take down the sign, saying "I'll do anything. Just tell me what I need to do to get that sign down." He gave me a public apology and promised never to deny a verbal order again. The sign went down, but I don't think many people ever took verbals from him again.
I don't entirely agree with all of this. Let me say first i am an ICU nurse. Our intensivist rounds with a multidisciplinary team daily. He assess the patient and puts in new orders for therapies or medications he thinks would benefit the patient. That being said, i am always present in the room when each doctor on the case comes in. I will take the verbal orders without a second thought, especially when i go to them about an issue.
Ex. Me: Doctor room #32's BP is 170/90 and has no PRN's. I will receive and input any verbal order at this point.
That being said sometimes doctors have no IDEA how to order certain medications. At our facility ordering blood and etc can be difficult. They usually ask me nicely to do this and i have no issues helping them out. In fact, most of our physicians works at many different hospitals in town and i'm sure its difficult to manage different charting systems.
Lastly, if physicians do not report off to each other i have no problem filling them in. In fact when i need to call whoever is on call over night i usually start of by giving them background info on the patient. example "Hi doctor, i'm calling about pt jane doe in room 32. She was a hemorrhagic stroke brought in on 3/31. She is intubated and sedated. I am calling about a critical potassium...etc. really not that hard.
I understand that your facility may be different than mine but i work VERY closely with all my doctors and would never refuse to put in a verbal order unless i believed it could potentially harm the patient.
Nurses who work Agency often go to more than one institution to work. They are expected to fully function with minimal orientation.
Doctors who go to more than one facility need to learn to function fully instead of having nurses (who mean well but who enable them to remain helpless) baby them.
As for VO or TO, I have never had a problem by accepting them. I do see, though, where someone could get into a lot of trouble because of them. Doctors need to write orders, enter them via computer, or fax them, not expect nurses to do it for them.
As for VO or TO, I have never had a problem by accepting them. I do see, though, where someone could get into a lot of trouble because of them. Doctors need to write orders, enter them via computer, or fax them, not expect nurses to do it for them.
I never had a problem with the orders for > 10 years, but now, since we're being spanked, and the doc are being more DB's about things, is why we wont take V.O from them any more.
Too bad, as pt care will probably suffer more now.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Guess I will count myself lucky. I have had to take verbal orders from physicians in my clinic and never had problem with them signing off on them and backing me up.
I don't think nurses are "doing all their work" however. If I wanted to be a doctor I would have been. Not interested. If YOU wanted to be doctor (since nurses do ALL their work), you should have gone to medical school. Maybe you still can, so you can see for yourself, just how easy they really have it. (grin)
Ruby Vee, BSN
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