Don't do the physicians work!

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!

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.

Reminds me of the frequent complaint of the nursing aides, the care techs, who insist that they do "all the work and the nurses just sit there at their computers doing nothing". Yes, that's exactly it, the educated and licensed nurses do nothing and the aides do it all. Breaking news!

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?

When I was ICU we had to have the the Foleys okay'd every day during rounds, similar to what you're describing but it was more of a "you must explain your rationale for why you have a Foley in your patient!" 9 times out of 10 the Foley had to be pulled - even when patients had multiple pressors. The only guarantees for Foleys were patients receiving hypothermia therapy, those that were paralyzed chemically, patients who had chronic catheters at home and stage IV decubs. Your "garden variety" sepsis, DKA and post arrest not qualifying for hypothermia protocol? Yeah no...

I understand the desire to refuse infection control, but I thought it was overkill.

Honestly, though, I was being (mostly) silly. Our CNS was obsessive about Foleys as were several intensivists.

Physicians should be directing the nurses on what to do

Since when? Nurses do not follow doctors' orders; rather, nurses *carry orders out as appropriate*.

Also, my boss has never been a physician. My boss's boss and so forth have never been physicians, either.

We're not even under the same licensing bodies.

I agree. I do not work for doctors. They have never even been employees of any facility where I have ever worked. They do not manage my nursing practice administratively, clinically, or otherwise.

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.

Obviously this is not only something that varies by specialty, but by institution as well. In Labor and Delivery, doctors absolutely give report to one another on shift change/hand off, not the nurses. As for VTE prophylaxis, that's in our order sets and the docs handle it. Same for HTN drugs. Foleys have protocol and specific parameters built into the order sets, and checkoffs built into EPIC. Follow the parameters, do your check offs and evaluations every shift (or q 2 hours or whatever the parameter states) and you're fine. Verbal orders don't bother me, again, because of the specialty I work in I guess. EPIC has cut down on a lot of that, though, because the docs have an EPIC app they can access right from their mobile device and pop in orders from wherever they are from their phone. Ta da. I still have no problem putting in verbal orders, though.

As for docs who whine and complain about using computers and drag their feet with learning how to put in orders correctly, well, we've had problems like that, and it was handled beautifully by our lovely nurse managers with rock solid backbones who took the docs to task. Our nurse managers were backed up by the administration who pretty much told the docs to suck it up and learn the technology, because it is a patient safety issue. The docs stopped whining, learned the technology, and that was that.

Sounds like you have a workplace culture problem, IMO, more than anything.

When I was ICU we had to have the the Foleys okay'd every day during rounds, similar to what you're describing but it was more of a "you must explain your rationale for why you have a Foley in your patient!" 9 times out of 10 the Foley had to be pulled - even when patients had multiple pressors. The only guarantees for Foleys were patients receiving hypothermia therapy, those that were paralyzed chemically, patients who had chronic catheters at home and stage IV decubs. Your "garden variety" sepsis, DKA and post arrest not qualifying for hypothermia protocol? Yeah no...

I understand the desire to refuse infection control, but I thought it was overkill.

Honestly, though, I was being (mostly) silly. Our CNS was obsessive about Foleys as were several intensivists.

I honestly feel they are pulled too early much if the time on my unit. We end up with retention and having to I&O cath, then anchor a new one which seems like a greater infection risk then just leaving it to begin with. I noticed the higher ups often think we like to leave them in because it's easier, but that's not the truth. I just don't feel every catheter needs to be pulled so we don't get charged with a cauti. Just my lowly opinion though.

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!

I take it you don't work in a large teaching facility. We do this all the time, we usually find the fellow and tell them to go teach.

I honestly feel they are pulled too early much if the time on my unit. We end up with retention and having to I&O cath, then anchor a new one which seems like a greater infection risk then just leaving it to begin with. I noticed the higher ups often think we like to leave them in because it's easier, but that's not the truth. I just don't feel every catheter needs to be pulled so we don't get charged with a cauti. Just my lowly opinion though.

I'm from a surgical background so I think that I's and O's are much more important than is stressed on strictly medical units, (I went from surgical to medical and my ICU was strictly medical - and not even cardiac, which would have I's and O's be super important, too - they had two different cardiac ICUs) especially in critically ill patients.

I think we had a lot more retention than thought because no one ever bladder scanned if the person was incontinent. "Oh, she's peeing so she's fine!"

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.