RN's accountable for MD's? What do you think?

  1. As an RN on a med surg unit your manager tells you that according to the plan of care for stroke te patient is to get test A, B, C on day 2, and get started on meds A, B. You are to see that the docs either order these tests or write in the progress notes the reason why not. The charts will be audited for compliance by the MD's and if they do not meet standards the RN(s) that cared for the patient will have to account for why not.

    I argue that RN's are not responsible for MD's practice, and if there is a problem the docs should be doing their own program and auditing. Sure, if I notice the pt is at immediate risk I will mention it to the MD, and expect a response. I have also gone up the MD chain of command when necessary, but don't think the proposed plan should be left on nursing shoulders, or that nurses should be counselled when the doc does something wrong.

    Am I out of line?
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    About canoehead, BSN

    Joined: Oct '00; Posts: 8,729; Likes: 8,411


  3. by   ?burntout
    You are not out of line-We are in no way or SHOULD we be held accountable for MDs.
    This is CRAZY-who dreams this crap up???!!!!
  4. by   2ndCareerRN
    I agree, we are not, nor should be, held accountable for MD's.

    If you have a protocol for certain pt's, why not get a preprinted order sheet that can be signed by the admitting doc? That way the orders are in.

    Otherwise the nurse is not responsible for making sure the doc does his job. This had to be dreamed up by a bunch of Docs who were figuring out how to do even less.

  5. by   frankie
    Canoehead - Frankie here. If there is a program for a medical condition that includes labs, meds, and other tasks that requires a physician order to execute, this should have been reviewed and approved by an administrator in nursing, and the medical director (physician) associated with this program. If indeed, someone is pressing you to talk with the docs, that is probably OK - if you have time. This is NOT high on patient care priority issues. The administrative nurse, and/or the medical director should be addressing the problems of physicians not following pathways. On the other hand, if your supervisor has dreamed up this plan on her/his own, then you and your coworkers should discuss this with him/her. This is not a valid reason to disciplin a nurse. Until you could talk with the supervisor, I would say - document, document, document all issues and conversations related to this issue. - frankie
  6. by   canoehead
    This is a hospital wide policy and new conversations suggest that the idea has caught on with admin. I will have to email the BON for their take.
  7. by   mattsmom81
    I agree with Bob...if it's an expectation for nursing to carry out orders automatically, there needs to be a standing order/protocol sheet on the chart and signed by the doc.

    I ran into this when I was new at a facility. I got reamed by my manager because a cardiologist was pizzed I didn't do a CBC and platelets and call him stat post cathlab. I asked...where is the order/protocol /written policy for this...? I was never informed this expectation existed and am new here, blah blah.....They snapped back 'just do it...write the verbal order for the doc to sign later.' (((sigh))

    Why won't they do a protocol/standing order sheet...who knows... but I agree it's a problem of nurses doing doctors' work for them.
  8. by   KP RN
    For crying out loud, Canoe!! Now, I've heard everything!
    Next thing is that you'll be following the MDs to the bathroom to make sure they wipe themselves OK and wash their hands!
  9. by   renerian
    Canoehead that seems crazy to me. You cannot make a doc write an order. Some would be downright angry about that. I agree with you.

  10. by   canoehead
    Actually washing their hands between patients is one of the things we are supposed to make sure they do. But since this is not part of our documentation it cannot be audited and no one has been "spoken to" about not reminding them.
    Except me when I said it was the doc's responsibility and I would not be their babysitter. (True story)
  11. by   rebelwaclause
    This burns me up. Where in any nurses (LVN, RN) Scope of Practice does it say we are to dictate to the MD's what their orders should be? Granted we are responsible for anticipating orders, being well versed in standard treatments, reporting abnormals, having a "sixth sense" about wacky MD orders, etc. But "responsible" if MD's do not initiate and direct care... As they should?


    Outside of putting a sticky by a telephone or verbal order that says "Please Sign Here" and reminding them to wash their hands between patient care, it's outside of my scope of practice.

    When we share MD's salaries, maybe I'll take more initiative.
  12. by   sanakruz
    Dont EVER write a verbal order and expect some doc to cover your ass and sign it later. Standing orders are ok. And I think that as a nurse you should ask the PATIENTS to remind the doctors to wash there hands prior to touching them... Then leave a pile of customer satisfaction surveys where patients and family members have acsess, with questions like "DO YOU BELIEVE YOUR MD WASHED HIS/HER HANDS PRIOR TO CARE a)SOMETIMES b)SELDOM c)NEVER...Etc. And then canoehead tell me this a joke,please
  13. by   rebelwaclause
    Good point, I rarely go back to see if an MD signs off or not.

    Verbal/Telephone Orders at our facility; We have a big neon green, pre-printed "sticky" that allows us to take verbal and telephone orders, name the MD who authorized the order, time, date, etc, and sign our name. It is up to the MD's to sign it during their rounds. Whether they sign it or not is a chart audit issue, but now that my antenna's are up, if the patient and chart is still there the following day - I'll follow up on the order.
  14. by   deespoohbear
    outside of putting a sticky by a telephone or verbal order that says "please sign here" and reminding them to wash their hands between patient care, it's outside of my scope of practice.

    when we share md's salaries, maybe i'll take more initiative. [/b]
    my sentiments exactly....

    i am not a doctor, i am a nurse...i make nursing decisions.

    want to know what m.d. stands for?

    make decisons!!