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.
When I cover call for my group I am on-call for 19 providers and normally it's pretty calm, I would think 50 would be feasible overnight if doing just call full-time.
Specializes in NICU, PICU, PCVICU and peds oncology.
I said, "No" to a physician yesterday and was publicly lambasted for it. A little background: We do sternal closures on the unit, with one of our intensivists providing anaesthesia. The nurse is responsible for making sure the patient is properly positioned with cautery pad applied and a heat source is in place, large-bore tubing is connected to some sort of venous access, small-bore tubing is connected to central venous access, code drugs are drawn up, fluid boluses are drawn up, pacemaker is at the head of the bed, packed cells are allocated and so on. In the past, the nurse would also pull the controlled drugs - fentanyl, ketamine, propofol and the like - from the Pyxis and draw them up. At that same time, there was no record being made of what drugs were given during the procedure, or when; the physician providing the anaesthesia would write orders to the effect that "x mcgs fentanyl, y mg ketamine, whatever rocuronium and fluids given for procedure" in the chart after the fact. Many of us were very uncomfortable with that practice and one of our now-assistant head nurses took the issue to our regulatory body. The upshot of that is nurses are NOT to pull controlled drugs from the Pyxis for physicians to administer - the physician must get the drugs themselves, fill out a proper anaesthesia record and waste whatever wasn't used appropriately. But there are still physicians who want the nurse to do it for them. Yesterday, I was asked (by our intensivist-anaesthesiologist, no less) to get the narcs and I said no. The physician then responded in a loud voice, audible throughout our open unit, "Well, THAT'S something we have to standardize, because some nurses will do it." Not this one. I'm happy to waste the remainder with whomever, that's not a problem. There's another related issue that I also refuse to be part of and that's having intubation drugs "drawn up at the bedside". No one in their right mind should have syringes of ketamine and fentanyl drawn up and sitting on the bedside cart for God knows how long. No one.
The verbal orders thing is a touchy subject. I don't have a problem taking a verbal order, especially if it's something I've asked for. But I do have an issue with a physician standing the doorway of the room, issuing a verbal order and then walking away. Write it down! You're right there!! (We're not quite there with CPOE but we've been promised it's coming... as soon as our physicians learn how to write orders properly on paper.)
Why should I be expected to have the patient sign their OR consent form - when I haven't been involved in the converstion between the doctor and the patient regarding the procedure?
I'm a CRNA, I get my own anesthesia consent. I'll even get the blood transfusion consent, because I'm the one giving the blood to the patient. But I think the surgeon is just being lazy if they do not obtain their own surgical consent!
In my facility and many others Foley's need to be documented q24hr to prevent them from being forgotten and causing a CAUTI. CAUTIs are an HCAPS measure and a hospital that accepts Medicare and Medicaid can have reimbursements withheld based on HCAPS scores. In my faciility the RNs have to document the reason for the Foley q24hr but not reorder. If there is no good reason we contact the MD to get a remove order. The longer the Foley is in the greater chance of UTI. Hope that helps.
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.
More money for whom?
I take it you haven't been watching this situation evolve for very long!
These physicians of whom you speak - are they employed, or in private practice?
Man, it is depressing to hear a nurse comment about this situation using the same verbiage as a completely uninformed lay person.
Modern RN, I feel your pain. That sounds exactly like the last hospital I worked! They should take more responsibility in the care of their patients, no doubt!
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Really? It is what it is? Abstract knowledge is hardly worth anything if it is not correctly utilized.
Yes. Really. It is what it is.
Physicians are the money-makers of hospitals and other healthcare facilities because they refer patients and get profitable heads in each bed. This is the main reason administration and many nurse managers side with physicians even if they might behave badly or be flagrantly wrong.
Abstract knowledge pays off in our society via prestige. It is apparent by observing the manner in which those who are assumed to possess it (e.g., doctors, tenured professors, etc.) are treated.
A lack of assumed abstract knowledge results in less compensation for one's time. There's a reason physicians earn six-figure salaries while home health aides often earn less than $30,000 per annum. One person is paid for his/her presumed body of knowledge, whereas the other is paid for the busy tasks (s)he completes.
So even if a doctor is not correctly utilizing his/her fund of abstract knowledge, it is still worth something. In fact, it can be worth millions over the course of a lucrative career.
Nurses have been policing physicians since the professions started. However, with the regulations that are in force now (that seem to cover almost everything---HCAPS, etc.), repercussions are worse than they used to be. The one thing I find to be a double-edged sword is that if a doc forgets something or screws up, it goes overlooked. If a nurse messes up or forgets something, they get written up & reported to the board of nursing for incompetence. And nurses will get in trouble for not "reminding" a physician to do something. Give me a break---how hard is it to renew restraint orders or other orders? Those things should be automatic before anything else for a physician. It matters not whether that patient is their or they are covering. Just look at the record and you'll see what's going on with the patient, what needs renew orders & whatever else.
I refuse to police physicians. It is not my job & I have enough work to do. For all the posters that say to be "understanding" because doctors have to take care of so many patients & they're working so hard, I say that they knew exactly what they were in for when they decided to go into medicine in the first place. If you can't take the heat, get out of the kitchen. I am not going to fix orders, complete documents that they left unfinished, "remind" them of things they should be well aware of, draw up medications for them, fetch things for them. I don't care that they are "taking care of" 20 patients. They're getting paid a hell of a lot more than I am, and therefore have more responsibility. I am not getting paid to follow them to make sure they do their job. They certainly don't make sure nurses are doing their jobs, that's for sure.
I wholeheartedly disagree with the poster that said a 1st year resident has more knowledge & critical thinking ability than a nurse with 20 years of experience. BULLS***!!! I can't even count how many 1st year residents (and 2nd year and 3rd year) I have saved in my years as a nurse. There is no way on God's green earth that a 1st year resident has better critical thinking skills than an RN that has working in ICU or ED for 20 years. After that much work experience, a nurse is usually just as good as a physician at diagnosing most things based on symptoms. 1st year residents are running specimens to the lab, for God's sake. They can't do anything without the approval of the chief resident or attending. I am sure many nurses will attest to the fact that they've had many residents ask them for help when they didn't know what they were doing. I think working as a team is the best way to do things---if everybody works together to get things done, it usually works out okay. The problem is, hospitals are running on skeleton staffs of as few nurses as possible & the rapport that used to be developed between residents & nurses has been worn away. Communication goes a long way. Having said that, I still won't do their job or police them. That is not part of MY job. If a resident or attending physician can't keep up with what they're supposed to do, then they shouldn't be doing it. Go find another job. That's what a nurse would do if they couldn't keep up with the demands of the job. Expecting nurses to bail them out is unprofessional.
I am not going to fix orders, complete documents that they left unfinished, "remind" them of things they should be well aware of, draw up medications for them, fetch things for them. I am not getting paid to follow them to make sure they do their job.
What are you getting paid for and what exactly do you feel is your most important role?
In my opinion, bedside nurses have one of the most important roles on the healthcare team as the only member that is in near constant contact with and has an evolving assessment of the patient and their response, the "last line of defense". Catching errors, fixing orders, are the service to the patient, not the provider.
Don't get me wrong, RNs are not the personal secretaries of providers, but if there is truly a team mentality it takes work from both sides: it should be a two-way street, and I am not sure it always is. I just don't think that the patient should be the one suffering in the middle of a blame-war.
Verbal orders are dangerous, I think we all agree about that, for the RN, for the patient, and for the provider.
After that much work experience, a nurse is usually just as good as a physician at diagnosing most things based on symptoms.
To be honest, this is a gross overstatement.
That's what a nurse would do if they couldn't keep up with the demands of the job.
The average hospital based nurse has no idea how busy a physician really is. Most (not all, there are exceptions to every rule) put in 1.5-2 times as many hours per week as a nurse. Hospital nurses just don't see them because the majority of the time isn't with their patient, or even on their unit. Physicians also have about 5 times as many patient they deal with every day. Imagine have 25 patients on your floor that you are responsible for! You couldn't do it! It's the same. Do your job like it's supposed to be done. Want that "easy life" you think the doc has? Go to Med school. Otherwise, quit complaining.
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.
Many people do not have a problem with putting in verbal orders, but we are not supposed to be doing that. If a physician has privileges at the hospital, he has computer access wherever he is (unless on a south pacific island). The idea of physicians entering orders directly come from government mandates regarding patient safety. It is not a preference issue. There are some hospitals where the physicians absolutely do not want you entering their orders because these are tracked and the physicians are reprimanded. We have to move away from the idea that putting in verbal orders demonstrates team work.
BostonFNP, APRN
2 Articles; 5,584 Posts
When I cover call for my group I am on-call for 19 providers and normally it's pretty calm, I would think 50 would be feasible overnight if doing just call full-time.