If you are the patient's advocate, can you sue the MD?

[CaLLaCoDe]

I am curious to find the answer to this question. I know that most anyone at anytime can sue another individual in America. But if you see outlandish medicine practiced at your facility, can you sue the MD for malpractice as the nurse representing this client at the bedside? Anyone know of any historic events that mirror this concern?

Or for that matter visa versa, can an MD sue you the nurse for not providing the best of care to a patient???!

[leslymill]

You might be able to address your concerns to the AMA, but I don't know if that would be the best route. I suppose it would depend on how gross the misconduct. Sueing is not an option though.

[ceecel.dee, MSN, RN]

This is thought provoking. I guess that I have considered myself my patient's advocate. Not in a legal sense (I hadn't thought of it that way), but in that I attempt to see to it that they are treated in the manner that they want to be treated, regarding safety and proper medical treatment, understanding their options, and comfort.

[jjjoy, LPN]

The thing that bugs me about the way nurses are taught that "nurses are patient advocates" is that it tends to sound like this is unique to nurses and that other health aren't going to be as concerned with the patients overall well-being. It sounds a little adversarial... suggesting that other health care personnel AREN'T looking out for the patient's best interest. Each profession has it's own angle and nurses have a unique view that should be heard along with the others.

Some physicians don't SEEM all that concerned. Maybe they need more education on a certain topic. Maybe they are overworked or burned out. Maybe they are just jerks. But I think we should start with the assumption that other health providers ARE looking out for the best interest of the patient and as nurses, we need to be active participants in assuring patients get the best care.

So if we see something that isn't being addressed or seems to be wrong, we need to approach our colleagues with our assessment of the situation and suggestions for how to address it (if we have a good idea). In our system, MDs usually have the last say in clinical decision making, but RNs should be expected to participate. Participate, collaborate all in the patients' best interest. Advocate? I'm not sure if that's the best word for it, but the main point, as I see it, is that nurses' shouldn't shy away from influencing health care decisions about their patients.

[James Huffman]

The thing that bugs me about the way nurses are taught that "nurses are patient advocates" is that it tends to sound like this is unique to nurses and that other health aren't going to be as concerned with the patients overall well-being. It sounds a little adversarial... suggesting that other health care personnel AREN'T looking out for the patient's best interest. Each profession has it's own angle and nurses have a unique view that should be heard along with the others.

Some physicians don't SEEM all that concerned. Maybe they need more education on a certain topic. Maybe they are overworked or burned out. Maybe they are just jerks. But I think we should start with the assumption that other health providers ARE looking out for the best interest of the patient and as nurses, we need to be active participants in assuring patients get the best care.

So if we see something that isn't being addressed or seems to be wrong, we need to approach our colleagues with our assessment of the situation and suggestions for how to address it (if we have a good idea). In our system, MDs usually have the last say in clinical decision making, but RNs should be expected to participate. Participate, collaborate all in the patients' best interest. Advocate? I'm not sure if that's the best word for it, but the main point, as I see it, is that nurses' shouldn't shy away from influencing health care decisions about their patients.

I think you're right. The "advocacy" folks make adversaries out of people with whom we're supposed to be in collegial relationships.

My bigger issue with nurses-as-advocates is that it makes our patients (clients, whatever) into helpless figures in need of our going to bat for them. I go on the assumption that folks I'm dealing with are strong in their own way, and I am there to assist them with professional services. People (or their families, or whomever they choose) can "advocate" for them, but that's not my role. Oh, there'll be times when we correctly advocate, but it's definitely a sideline for nurses: I'm thinking about calling a doc when a med order is incorrect, or stopping a lab tech from doing a routine blood when a patient has just gone to sleep and desperately needs to rest.

My other beef with the "advocacy" theory of nursing is that the patient has hired the doctor, but -- in 99% of cases -- the patient has not directly hired the nurse. If I'm working in a hospital setting, the patient has come under my care incidentally, because of the patient's relationship with the doctor. I think it's presumptive for me to interfere with a doctor-patient relationship by assuming that I have to somehow come between the 2 as the patient's advocate. There are nurses who don't like this, but it's the reality, and as I've mentioned before, if a nurse wants to serve as a nurse-advocate, they are welcome to do so, but they should enter this relationship with patients as independent contractors or in a private nurse practice setting, and the relationship should be explicitly defined with the patient.

It's a part of what I call the "implied contract" that nurses and patients enter into in a hospital or other inpatient setting. 99% of people there have a certain expectation of what nurses are and do. We can and should educate folks as we are able, and explaining what we are doing is part of that. But patients expect that their doctor will direct their care. And as long as they expect that, it is professionally inappropriate for nurses to interfere with that relationship.

[leslymill]

We are also the Doctor's advocate.

Or

So I was taught.

[James Huffman]

We are also the Doctor's advocate.

Or

So I was taught.

I've never heard this before, but that may be because I didn't listen well.

But like I said earlier, if we were the doctor's advocate, does the doctor know about this? If not, how can we do something as a professional responsibility if the other party isn't aware of it?

[leslymill]

He is aware we are to instruct the patient on his DX, TX, prognosis. He knows we are not to hinder but promote the Doctor Patient relationship.

We are the middle man. Usually there is no big conflict here.

[Altra, BSN, RN]

I think you're right. The "advocacy" folks make adversaries out of people with whom we're supposed to be in collegial relationships.

Very true.

[cmo421]

Ok, as with everything else, we take things to the extreme. We do advocate for doc's as well as pt's. We are not all hired as advocates, but in some way,shape or form, most of us serve in this way at some point in our practice. If we put everything under a microscope, if become way to complicated.

[James Huffman]

He is aware we are to instruct the patient on his DX, TX, prognosis. He knows we are not to hinder but promote the Doctor Patient relationship.

We are the middle man. Usually there is no big conflict here.

Thanks for explaining what you meant. I think you're right -- there's no conflict in that area.

[Neveranurseagain, RN]

If you see "outlandish medicine practiced," report it to your state board of medical examiners. When you file a complaint, the state medical board will keep it anonymous. It may prevent a pt's death or harm, and keep you from getting involved in a med mal case--the behind you save may not only be the pt's but your own.

[RN BSN 2009]

Was there any damage involved to you?

If not, then no case.