questions about dealing with docs...

[jnette, ASN, EMT-I]

I'm a new nurse... although have spent my past 30 yrs. around the nursing profession and in the medical field.. have seen a lot, done a lot...now I need some clarification. Perhaps this comes as a result of having served in the military where the docs carried the rank, and therefore we all submitted to their say... but somehow, I still carry around this "outdated" concept of feeling that I must "obey" the docs.

It was a real eyeopener in school to learn about nursing autonomy and the nursing profession's view on this. But somehow, this past concept still lingers and I need some help in shaking it. I still find myself being intimidated by the docs (or at least FEELING like I SHOULD be) and like who am I to question them in ANY regard, or on ANY subject when it comes to patient care. I still allow them to make me feel like it's THEIR patient more than MY patient, and I struggle with knowing where I stand, where the line is, when do I question them, when do I make judgement calls on my own, do I have the right, and WHEN to do so, etc., etc.

Guess it's the old-school thing where the doc makes the decisions and the nurses implement his "orders" without question.

WHEN is it appropriate do do otherwise, how do I know, how do I stand up to it when it DOES occur.. are they "my boss" or not, can "they" have you fired.. etc. etc......... really need some help on this, some real clarification. I want to be a competent and responsible nurse, but I need further guidelines in working out

this issue to enable me to perform to my best abilities and know what I MAY and/or may NOT do concerning the docs. Thanx everyone, in advance. :)

[Weenurse]

I suppose alot of it is to do with having confidence in your self. I felt the same way when I had just qualified, but I soon learnt that I knew just as much as some of the doctors if not more. I find that when the junior Doctors start they ask the nurses for advice. And at the end of the day, you're the one that spends more time with the patient. Don't be afraid to question something you're not sure of, believe me you'll be respected alot more if you show that you're a 'thinker' and not a 'do-er'. You are there for the patients not the Drs!

[Vsummer1]

my instructor summed it up this way:

don't do something because someone told you to do it, do it because it is the right thing to do for your patient.

she included herself in that, saying don't do it because your instructor tells you to, don't do it because the doctor tells you to. do it because you understand how it will help your patient. if you don't understand it and think it is funky -- look it up, ask another nurse. you may be right, it is funky! you are the patient advocate.

and if you do something because someone else tells you to, and it harms your patient, you are liable.

[frankie]

jnette, frankie here. I think just about everyone feels this way out of nursing school and/or when changing into a new field of nursing. This is where a good mentor (preferably one who works on you nsg unit) can help. Or, if you have a good relationship with a past nsg. instructor, that is a good resource too. The longer you work in the hospital, the more people you will learn to trust. Also, this is where keeping up to date with nursing becomes paramount. You have to know how/where to find resources quikly - I use the internet at work and the hospital librarian. She does great medlline searches and orders the articles for me. So, all that nursing school stuff about keeping abreast of new info is true. When you are speaking from a knowledgable base, talking with a physician about anything medical, even his patient, will become a positive experience (most of the time). Sometimes, no matter what you do/say/know certain MDs will be jerks - and there is nothing you can do about that. But if you know the correct med/procedure/dose/whatever about what you are doing, you can provide the jerk MDs with information - sort of like a computer voice on a telephone. Remember there are no stupid questions, and NEVER try to educate an idiot. frankie

[jnette, ASN, EMT-I]

So far so good, Guys ! Keep 'em coming !

Yes, I remember well all I was taught in school, I have the "headknowledge" of how to addresse this issue, I now must find a way to apply it and "personalise" it. I believe, as Weenurse said, that it will come with experience and selfconfidence... as a new nurse, that in itself will take some time. As it happens, I suppose I'll know it, and with that experience and confidence will also come the ability to stand up for what I KNOW is right for my patient....... right? :)

[frankie]

Jnette - frankie here - you go girl - you are on track. Find a mentor or two on your unit, and you will be set to run with the best of nurses. frankie

[Nurse Ratched, RN]

Jnette - a phrase I love that you can use with docs when something seems weird in an order is, "Do you have a minute to educate me on this?" It protects their fragile egos, keeps the working relationship friction-free and opens them up to give us valuable information (or backtrack and admit a mistake - I've seen it happen!)

[jnette, ASN, EMT-I]

That's GREAT, Ratched !!! I REALLY LIKE that.. a LOT !!! What a wonderful way of putting it! I'll keep that one in mind...thanx so much ! :)

[SmilingBluEyes]

Imagine for one minute that patient is YOUR sister/brother, mom/dad, grannie/gramps or FRIEND. Would you feel absolutely good about what you are doing for him/her? IF not, time to examine WHY and take ACTION. This takes courage and conviction and willingness to risk the wrath of some, but how can you do less?

I remember, I was a 1st year graduate nurse and a doctor was making all manner of unreasonable and DANGEROUS decisions on the floor. It was night shift and the House Supervisor and other doctor on the floor saw all that was going on but failed to back me up when I needed the help. Welp, Being charge nurse (yep in my 1st year in a rural hospital), I took exception and challenged him (in a professional manner) about it. HE told me he would have my job when I refused an order that I considered dangerous. I replied if he got away w/all this, HE COULD HAVE MY job cause NO way was I working under such needlessly dangerous conditions, which were all unwarranted.

Then, being the type to CYA, I wrote up a long memo about each event, including times, specifics and patient names involved. I also met w/my nurse manager for a breakfast conference about what occured after my shift was over at 7:30. By the time I was thru talking w/her, I was in tears. That I managed to keep my cool on the floor was a fortunate thing.

Anyhow, that memo (thank Heaven I wrote it), was asked for at an OB committee meeting....guess what; the Chief of Staff stood behind NURSING, based on the details presented there. Now of course, I was not at that meeting, but the fact that I stood my ground (trembling, oh yes) made me feel good and made me stronger in my convictions to do the right thing.

It is remembering *why* we are there and WHO we PLEDGE to advocate for, that keeps me on the right road most of the time. Sure, I mistakes. Sure, sometimes I have great trepidation about upsetting physicians and patients. I did not say it is easy to do, but when you look at it this way, a lot comes into focus that matters, and it makes decision-making a bit clearer. Good luck, hang in there and keep your convictions!:kiss

[jnette, ASN, EMT-I]

Thanx, Blu Eyes !

That made me feel stronger just reading it. A good way to approach it.."my sister, my mom" etc. Guess I'm just not yet confident enough in my own knowlege base, but I believe when I AM, I'll have no trouble doing as you suggest.. no trouble at ALL. I can be pretty feisty when I KNOW that I KNOW that I KNOW. And I don't back down, either...if I'm right and KNOW that I'm right..I stand up for what I believe.. .. This will take time, continued learning and experience, until I feel confident enough in my knowlege.. but when I do.. watch out!

And the CYA... oh yes!... one of the first things ya learn in the service, right? Carried that little tradition with me from then on. That will come naturally. Thanx again ! Appreciate the input! I guess when you're this new, you're convinced you're still pretty darn stupid... that will take some time...

[MollyMo]

I told a family member once that I wasn't there for the family. I was there for the patient. My job is to protect my patient and keep my patient safe. And if I have to P*** off the family to keep my patient safe, I'll do it. The same thing goes for a doctor. I don't apologize for calling a doc in the middle of the night. I'll apologize only if I don't have all the info that I KNOW he'll need before I make the call. If he throws something at me out of left field he'll have to wait until I find out or find out for himself. No they aren't your boss. They don't sign your check. No they can't have you fired. They can have you written up. But you can do the same to them. Just remember you are there for the patient.

[OBNURSEHEATHER]

Originally posted by Nurse Ratched

Jnette - a phrase I love that you can use with docs when something seems weird in an order is, "Do you have a minute to educate me on this?" It protects their fragile egos, keeps the working relationship friction-free and opens them up to give us valuable information (or backtrack and admit a mistake - I've seen it happen!)

Oh, I just love this!

Heather