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

[pinkdoves]

Does anyone else wonder why the RN has to double check other people's work? The MD puts in discharge instructions, yet I have to analyze every section and write back what they did wrong???? Isn't that...THEIR JOB???? Can't they check it themselves or have another MD look? why do I have to double check them? Another case is with respiratory therapists. At my work we have to double check they are placing the patient on a different mask when ordered...isn't that THEIR job???? I get that the patient is the center of everything, but thats the MDs and RT's patient too. I just don't get why it seems I have to do everyone's job and if I don't it's my fault???????

[kbrn2002, ADN, RN]

2 hours ago, CommunityRNBSN said:

I work outpatient but a HUGE part of my day— maybe a third— each day is devoted to fixing the mistakes of our providers. As an example: We have one that constantly sends prescriptions that say things like “Take one tablet BID three times a day half a tab with meals once at bedtime.” The pharmacy calls, I have to deal with it (meaning I have to go track down the doctor in another part of the building, ask her what it means, then re-send the prescription to the pharmacy.) It is particularly bad because this is an inner-city clinic, the doctors are paid very little, and there is zero accountability for their work. I agree that is is irritating because, why is she allowed to be totally incompetent at executing the details of her job? For the record, she is extremely knowledgeable and highly intelligent. If I had a mystery disease, I would want her diagnosing me. But that doesn't make up for a don't-give-a-*** attitude about her work.

That's awesome! Well unless you are the nurse or pharmacist trying to figure that out. Best I can decipher that RX would be 1 whole tablet two times a day plus 1/2 tablet three times a day with meals and at bedtime for a total of 4 tablets a day. Was I even close?

[FolksBtrippin, BSN, RN]

On 4/25/2020 at 12:45 PM, KatieMI said:

Many of docs in fact are too. But there are two things:

- when they see "the whole pucture", they see a very different one."Thinking as a doc" and "thinking as a nurse" at times looks like communicating on foreign languages.

- to see whatever big picture, one needs time and chance to do concentrated, uninterripted thinking. Physicians hardly ever have chance to do it because of insane loads, limited time, need to solve too many problems at once and, yes, those very multiple calls.

I disagree. The MD's training is not big picture training. The medical model is to find the source of disease and eliminate it. The nursing model is to look at all the different systems and support healing, growth, recovery in each one.

This is why nurses are the last person the patient sees before discharge. The doc is saying, we fixed your problem so you can go home. The nurse's job is to look at every other thing besides just the original problem. Does the patient know what to do with his drain, how to administer his insulin, where to go for follow up care? Can the patient get to the bathroom? And on and on.

If the nurse can't do that job because she doesn't have enough time, authority and/or respect then patients will and do have poor outcomes and repeat hospitalizations that drain the system.

[Serhilda, ADN, RN]

Interesting how some of these responses are "it's our job because it's our job" instead of realizing we do have the option to hold people exclusively accountable for their actions. While double checks should be encouraged or made into policies, I do not agree with making it a reportable offense to the BON. I'm well aware I'm going against the culture of nursing that prides itself on being the jack of all trades, but we need limitations on how far we're spreading out accountability. As it currently stands, it can be quite overreaching at times.

Accountability seems to be an issue not only between hospital staff, but between hospitals and patients honestly. Falls are the big one that disturbs me. The culture as it stands is that if a fall can be foreseen, responsibility for its prevention should and will be on the nurse. Regardless of the patient's orientation or intelligence here. I'm sorry, but if you're a&o x 4 and know you've fallen in the past, it should be your responsibility to accept your limitations and ours to educate you. What you do with that information is on you. Instead, we've absolved patients of the expectation of common sense here and caved into a litigious culture.

So yeah, I'm with you OP.

[Kooky Korky, BSN, RN]

On 4/23/2020 at 7:25 PM, 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. 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.

It works both ways. If she had NOT reported the INR off, she would have been in trouble for not reporting it.

[Mind spirit body heal the triad]

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 becausenurses 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

I hope that you are also doing all this for the health and well being of your patient, may or may not and probably does not know any better and put full Trust and their doctors and nurses, and not just to cover your own ***. It is good to cover your *** but you should also care for the people you're taking care of who are not able or knowledgeable enough to do it themselves.

[beachbabe86]

On 4/26/2020 at 12:50 PM, kbrn2002 said:

Absolutely correct. Nurses actually have very little leeway here. We are required by policy and procedure to report things we know don't really require follow up all the time. Most providers are pretty understanding, especially when you start by saying "I'm sorry to bother you but policy requires I report xyz."

I definitely know this territory. My DH and both of our daughters are MDs. They all three know the ropes of the way it works. While they are not happy about certain calls, it is just the way life in the field of medicine works these days.

They calmly and politely answer calls. They all three want the best for their patients.