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

[SmilingBluEyes]

Again, I must be lucky cause that does not happen either. We have a really solid, collegial relationship with our docs built on mutual respect and trust.

[Apples&Oranges]

So, for some reason the quote feature just will not work for me (certain I am doing it wrong) but this response is clearly in reference to the OP's claim that my practice of suggesting, accepting and carrying out verbal orders is somehow practicing beyond my scope.

Have you actually worked in a real, busy teaching hospital for more that a month? Seriously, sorry for the sarcasm, but please don't spread these unrealistic expectations to new nurses. Our docs work 14-40 hour shifts with no sleep and get paid the equivalent of 6$/hr for the first 3-4 years of residency. They have ratios of up to 20 patients PER RESIDENT, and as much as you, the OP hate to admit it, have and EXPONENTIALLY higher level of responsibility, accountability, liability and intellectual input for EACH patient than we do.

I might get some flak for writing this, but we all know, deep down, these 1st year residents have more medical knowledge and (medicine, NOT nursing) critical thinking than any of us will after 20 years of nursing. Again, I was the one who insisted we are a TEAM - and we are, but for the love of Pete, to blast a doc who has 3x as many patients, is covering up to 8 other teams' patients, admitting in the ED and managing other specialty services...and refuse to suggest and take verbal or phone orders? You are out out of line, my friend. You really, really are.

I don't know if I have ever meant this as strongly as I do now: YOU DO NOT KNOW WHAT YOU DON'T KNOW.

If ANY of you have that level of disrespect, misunderstanding, lack of compassion, inability to be a team player...I'm just glad we don't work together. Cause that self centered, "i'm the only one who works hard, knows what's going on, is doing it right..." crap would never fly when I'm in charge.

Docs must treat nurses with respect when I'm in charge. Nurses are held to the same standard.

[Mollypita]

I work Med/Surg and I agree with much of this. I understand the need for occasional verbal orders in ER or ICU, but as the OP suggests, they are often given on my floor as the MD is running out the door, to save time. I would also add that administration is a huge enabler of situations like this, and it's more their fault than the doctors. For instance, at my facility, nurses get dinged for core measure "violations", such as an MI patient being discharged without being ordered a statin, or continuing an antibiotic beyond 24 hrs after surgery because the doctor entered the order that way. Why can't they be held accountable to put in orders correctly and thoroughly and why should the nurse be punished when they don't?? That's what I disagree with. If I only had three or four patients, it wouldn't be an issue, but I have six and don't have time to clean up all their sloppiness. And to those that work in teaching hospitals and have much better experiences, that's great for them, but many of us have never done so and can't even imagine providers paying that much attention to their patients. That said, I am happy to do my part to improve health care in any way I can, and do often go out of my way to correct things that I can, even if they are the result of someone else's mistake. In our less than perfect world, this is and will remain a part of our job.

[K9lover, ASN, RN]

When I last worked in acute care it was 72 hours but it would not surprise me if this has changed; when patients asked "why" on meds expiring, Foley, Heparin shots etc... I was quite honest with them and said "CDC, FDA, DEA et al regulatory agency".

It would be dishonest to let them think their doctor can actually make an independent decision...

[Szbeylik]

And that's exactly her point. We shouldn't be responsible making sure that those things are done. The DOC needs to be responsible. My job is to carry out his orders, not to guess what his orders would be and then suggest them. They are taking advantage of the people who cater to them that way and then it becomes a culture. And if there are a few nurses who actually stick to their guns they will become the Problem People.

[she244]

I work for 9 Physicians and many residents working with Orthopedic Surgeons. I have no problem saying No when asked to do things I know are outside of my scope of practice. I took a Medical Ethics and Liability CME taught by an Attorney who handles medical malpractice cases. She enlightened everyone in the class at the little mistakes in the medical field that has helped her win a lot of her cases. My nephew is also an Attorney and has let me know being held Liable for things can ruin you. So I work for and with my Physicians to protect them as well as myself and our facility from mistakes as well as I can. Have been at my job 11 years so I have no problem saying No!

[Jusween]

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.

Really? It is what it is? Abstract knowledge is hardly worth anything if it is not correctly utilized. Nursing has presumably evolved from handmaiden to a profession in its own right. Nurses who abdicate their responsibilities by failing to augment their skills perpetuate the hegemony that is inherent in the field. The fact is that understanding what is wrong with a patient does not heal the patient; fixing the problem and facilitating health is. Nurses have the potential to excel in this niche but instead, they wallow in their own subjugation and whine about disrespect. Earn the respect you deserve and demand accountability from physicians who fail to meet their responsibilities. That is what professionals are supposed to do.

[damassie]

I work in procedures and often have to complete the procedure notes. I have noticed that if I don't do it, it doesn't always get done. I have brought it to the doctors attention and it still is not completed. Even though I am aware of what is being done, I am uncomfortable completing that document. It is their responsibility not mine!

[quazar]

I work in procedures and often have to complete the procedure notes. I have noticed that if I don't do it, it doesn't always get done. I have brought it to the doctors attention and it still is not completed. Even though I am aware of what is being done, I am uncomfortable completing that document. It is their responsibility not mine!

I would absolutely not do that. It should bounce back to the physician as incomplete, it is their responsibility to complete that document, not yours. If medical records and/or billing is getting in a tiff about that not being completed, direct them to the physician, as that is who is legally supposed to be completing it, not the nurse. You did not perform the procedure, the physician did, therefore the physician should be the only one completing the procedure note. Even in my specialty, I will post a short note in my nurse's notes about the delivery, and fill out the nurse parts of the delivery summary, but I absolutely WILL NOT fill out the parts that the physician is supposed to fill out (e.g., EBL, type of laceration, official indication for induction, etc.). If the document is incomplete when submitted, it's on the physician, not me.

[Ruby Vee, BSN]

we may not be doing their work, but we sure are the first to be blamed when they flub up.

I'm sorry that this is your experience; it hasn't been mine. Nor has it been my experience that "nurses do all their work." I think perhaps these negative statements say more about the person who makes them than those whom they're made about.

[Ruby Vee, BSN]

So, for some reason the quote feature just will not work for me (certain I am doing it wrong) but this response is clearly in reference to the OP's claim that my practice of suggesting, accepting and carrying out verbal orders is somehow practicing beyond my scope.

Have you actually worked in a real, busy teaching hospital for more that a month? Seriously, sorry for the sarcasm, but please don't spread these unrealistic expectations to new nurses. Our docs work 14-40 hour shifts with no sleep and get paid the equivalent of 6$/hr for the first 3-4 years of residency. They have ratios of up to 20 patients PER RESIDENT, and as much as you, the OP hate to admit it, have and EXPONENTIALLY higher level of responsibility, accountability, liability and intellectual input for EACH patient than we do.

I might get some flak for writing this, but we all know, deep down, these 1st year residents have more medical knowledge and (medicine, NOT nursing) critical thinking than any of us will after 20 years of nursing. Again, I was the one who insisted we are a TEAM - and we are, but for the love of Pete, to blast a doc who has 3x as many patients, is covering up to 8 other teams' patients, admitting in the ED and managing other specialty services...and refuse to suggest and take verbal or phone orders? You are out out of line, my friend. You really, really are.

I don't know if I have ever meant this as strongly as I do now: YOU DO NOT KNOW WHAT YOU DON'T KNOW.

If ANY of you have that level of disrespect, misunderstanding, lack of compassion, inability to be a team player...I'm just glad we don't work together. Cause that self centered, "i'm the only one who works hard, knows what's going on, is doing it right..." crap would never fly when I'm in charge.

Docs must treat nurses with respect when I'm in charge. Nurses are held to the same standard.

Well said.

[EKUGRAD, BSN, MSN, RN, CNS]

In my area of the country (Southeast) there is a very dangerous nocturnal creature: The "Professional Call Physician". So many times I have called a physician about a patient need and reached a doctor that only takes call for other physicians. These docs are retired, working part-time or just making the boat payment taking call. The company (that shall remain nameless to keep me out of court) recruits, manages and pays these guys and gals to take call for other docs. They range in specialty from GP/none, to psychiatrist to pediatricians. There are some working overnight ER's and still taking call!! Fine if it is for one practice. BUT, and this is a big BUT, they take call for multiple doctors or practices. A little internet searching showed that each On Call doc could be covering for over 50 physicians! I want to believe some sort of hand-off was done but I have serious doubts. I was filling in at a SNF one evening and made 4 calls for some med and treatment orders on 4 different patients. One call was for an HS blood sugar of 360 with no coverage ordered. The SAME GUY answered the phone on all the calls. He knew nothing about any of the patients and even challenged me on whether I should be calling him for one of them. I agree that working in a teaching institution can be Elysian Fields but those of us in the hinterlands don't have those resources, dependability or confidence. I have worked over the years in foreign and domestic teaching and university Centers of Excellence. I also have practiced in 25 bed hospitals that closed their ER at midnight.

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My point to this harangue is that we, each individual nurse, must have a clear, confident, personal definition and belief in their own NURSING practice. I am frequently asked, "Why didn't you become a doctor". My answer is, "The same reason I didn't become a plumber. I am a nurse. A damn good one and I love what I do." Nurses, please, know your own practice and keep your boundaries. We need the doctor's knowledge, skills and abilities to care for our patients. If you can find it, look for Independent Nursing Practice with Clients by M. Lucille Kinlein. This book was published in 1977 and I read it in 1978 while serving as a Navy Nurse In Guantanamo Bay, Cuba (pre-prison). It changed my entire view of what I was supposed to be doing in order to call myself a nurse. To pound it home again, work, develop and believe in your self and your abilities to practice nursing. Always be ready to verbalize, to anyone, your clear, well-defined practice of NURSING.