Genuine question that I know is going to make me sound like a TERRIBLE nurse...

Sour Lemon · Apr 23, 2020

We are the "coordinators of care", so they say. I'm okay double checking many things, and I appreciate that RT, pharmacy, nursing assistants, and charge nurses double check on me.

It can be taken too far, though. I don't want to critique MD discharge instructions, or even worse ...call them and tell them they're "required" to order A, B, and C.

KatieMI, BSN, MSN, RN · Apr 23, 2020

In american medicine, everybody providing direct patient care checks everybody else providing direct patient care.

We are all people. Mistakes, conscious or not, are inherently human. By providing another set of eyes and hands, we may avoid some of them. I am a provider and my work is checked by pharmacists, nurses and everybody else all the time, and this is okay.

Re. "having another M.D. look", leaving alone HIPAA and insane workloads already there, things just do not work this way. To "just take a look", one needs to know too many details - which you, as a nurse, are supposed to know already.

RRTs are specialists with their own area of clinical knowledge and power of making clinical decisions within their scope of practice. If they use different mask or different oxygen concentration or source, then they might consider it as more appropriate for the patient at the particular moment.

BTW, if M.D. or another provider does discharge summary not exactly the way you want to see it, this alone doesn't mean anything is "wrong". Please get into a habit of actually reading all providers' notes and asking questions during rounds. It will save you a lot of time hanging on the phone.

Davey Do · Apr 23, 2020

As Cain RN said, "Am I my constituent's keeper?"

pinkdoves, BSN · Apr 23, 2020

3 minutes ago, KatieMI said:
BTW, if M.D. or another provider does discharge summary not exactly the way you want to see it, this alone doesn't mean anything is "wrong". Please get into a habit of actually reading all providers' notes and asking questions during rounds. It will save you a lot of time hanging on the phone.

No...when I mean "wrong", I literally mean wrong. Like they ordered the wrong dose of medication or missed an important order...it has nothing to do with my preferences if that makes sense. And aren't there multiple providers involved with the same patient? I don't mean just any random MD or NP double-checking

KatieMI, BSN, MSN, RN · Apr 24, 2020

1 minute ago, pinkdoves said:
No...when I mean "wrong", I literally mean wrong. Like they ordered the wrong dose of medication or missed an important order...it has nothing to do with my preferences if that makes sense. And aren't there multiple providers involved with the same patient? I don't mean just any random MD or NP double-checking

For "wrong dose", there is a pharmacy, not you.

For "missing an important order" - quite frequently patients do not need everything they had ordered at hospital to be reordered at discharge.

Specialists do not check each other' orders. This is the law.

Providers who are not assigned to the patient at any particular day MUST NOT do anything about the patient that day unless there are some special circumstances, and a nurse's call is not one of them. This is another law. We providers can pay with our career for caving for your "concerned" call only ONCE.

Sorry but I am going to be very blunt here. I feel you are the one of forever "concerned" nurses who spend their days calling and "updating" everybody about everything. Please return to your patien's rooms and learn your patients inside out instead of doing that. This way, you might better understand what is going on and why providers order or do not order something.

pinkdoves, BSN · Apr 24, 2020

2 minutes ago, KatieMI said:
For "wrong dose", there is a pharmacy, not you.
For "missing an important order" - quite frequently patients do not need everything they had ordered at hospital to be reordered at discharge.
Specialists do not check each other' orders. This is the law.
Providers who are not assigned to the patient at any particular day MUST NOT do anything about the patient that day unless there are some special circumstances, and a nurse's call is not one of them. This is another law. We providers can pay with our career for caving for your "concerned" call only ONCE.
Sorry but I am going to be very blunt here. I feel you are the one of forever "concerned" nurses who spend their days calling and "updating" everybody about everything. Please return to your patien's rooms and learn your patients inside out instead of doing that. This way, you might better understand what is going on and why providers order or do not order something.

I think you are gravely misunderstanding what I mean. I mean, I literally tell the MDs "you put this instruction in wrong" or "you put in the wrong dose" and they say "yeah, you're right I did" and then change the paperwork. Those "concerned" nurses update you for a reason. It's because nurses can be blamed and sued for every little thing, so as long as we tell you what's going on we are protecting ourselves. There is no need for personal attacks

buckchaser10 · Apr 24, 2020

I can't wait for the nurse versus practitioner pee fight that is about to ensue

pinkdoves, BSN · Apr 24, 2020

1 minute ago, buckchaser10 said:
I can't wait for the nurse versus practitioner pee fight that is about to ensue

LOL no fight is about to ensue!! she seems very angry I am no longer pursuing her in convo

KatieMI, BSN, MSN, RN · Apr 24, 2020

19 minutes ago, pinkdoves said:
I think you are gravely misunderstanding what I mean. I mean, I literally tell the MDs "you put this instruction in wrong" or "you put in the wrong dose" and they say "yeah, you're right I did" and then change the paperwork. Those "concerned" nurses update you for a reason. It's because nurses can be blamed and sued for every little thing, so as long as we tell you what's going on we are protecting ourselves. There is no need for personal attacks

Just letting you know: nurses are not sued for every little thing. In fact, they are not sued even for quite a big things.

About 70% of nursing calls are, unfortunately, done without much reason. It takes incredible amount of time and leads to quite a lot of clinical mistakes. Those incessant calls for "something for nausea" demanding Zofran routinely end up with prolonged QT, and those insisting on "something for anxiety and agitation" end up with delirium, falls and respiratory arrests, among other things. Those calls of "you forgot to reconcile A, B and C" lead to unnecessary polypharmacy. Nurses do not get sued for all that; we do.

I will never in my life forget a nurse who was calling for an hour to get "some orders" for INR 5.3 (calculated target was 5.2 upper). She spread her nursing wings "protecting patient and herself" and got some orders and happily implemented them. It took patient 3 hours after that to die a horrendous death from DIC.

This is not personal attack. It is the fact of life, fact of the side of medicine you simply do not know about.

Have a blessed day.

buckchaser10 · Apr 24, 2020

1 minute ago, KatieMI said:
Just letting you know: nurses are not sued for every little thing. In fact, they are not sued even for quite a big things.
About 70% of nursing calls are, unfortunately, done without much reason. It takes incredible amount of time and leads to quite a lot of clinical mistakes. Those incessant calls for "something for nausea" demanding Zofran routinely end up with prolonged QT, and those insisting on "something for anxiety and agitation" end up with delirium, falls and respiratory arrests, among other things. Those calls of "you forgot to reconcile A, B and C" lead to unnecessary polypharmacy.
I will never in my life forget a nurse who was calling for an hour to get "some orders" for INR 5.3 (calculated target was 5.2 upper). She spread her nursing wings "protecting patient and herself" and got some orders and happily implemented them. It took patient 3 hours after that to die a horrendous death from DIC.
This is not personal attack. It is the fact of life, fact of the side of medicine you simply do not know about.
Have a blessed day.

These adverse effects are from practitioner orders though. Just because someone annoys you doesn't mean you have to order it. Stop pinning these issues on nurses. Ultimately the practitioner ordered it..

LibraNurse27, BSN, RN · Apr 24, 2020

Nurses have to review all MD orders anyway since we are the ones implementing them, so it's not extra work to look at the orders. If I see something that doesn't look right I'll ask the doctor for clarification, and I have caught a few mistakes. The doctors were grateful that I caught them. Pharmacy has also caught MD mistakes and I have caught pharmacy mistakes. Other nurses have helped prevent me from making mistakes, and so have CNAs.

I think it's good as long as the person receiving feedback is receptive and not defensive. The gray area for me is if a doctor puts in an incorrect/unsafe order and the nurse follows it, do we get in trouble or does the doctor? Or both? For an extreme example, an MD at the clinic I worked at wanted pt to get 10 units insulin and in a rush wrote 100 units. The MA gave 100 units. (pt survived btw). So who would get in trouble if the pt sued? Orders are doctors' responsibility but nurses should be able to recognize things that look wrong, in my opinion, not just blindly follow orders. Open to opinions!