How to survive nursing?

xxdiscoxxheaven · May 21, 2015

I don't know about this whole "stay in your place...don't play doctor" thing. If you give a bad med order, it's on your ass and your license. Doctors make mistakes or over look things. They are humans like all of us. I think I would continue to double check order that look fishy to me.

%63theend · May 21, 2015

That's not at all what I was trying to say. Thank you for giving me an opportunity to clarify my intention since I wouldn't want it to be misinterpreted.

I said within reason we should double check. But we shouldn't think that we are supposed to know as much or more than the physician. Many new nurses I know stress themselves out because they feel inadequately prepared for the job. You will never know all there is to know in nursing. At some point you have to learn to trust your team you're working with. Yes, I've advocated for a patient that needed testing and the dr said she didn't. Yes I continued to pursue it until the test was done and my suspicions confirmed. Yes doctors are not always correct. But second guessing every order on every patient is not possible and you will burn out that way. Double check your meds, do your rights of med admin, always verify your patient before a procedure with 2 patient identifiers, etc. but don't walk around thinking the physician is going to order some procedure that will kill your patient. Don't carry that paranoia around. It will suffocate you. Most nurses I know left the field because of concern over liability.

LadyFree28, BSN, LPN, RN · May 22, 2015

I have so many responses to your post:

That's not at all what I was trying to say. Thank you for giving me an opportunity to clarify my intention since I wouldn't want it to be misinterpreted.
I said within reason we should double check. But we shouldn't think that we are supposed to know as much or more than the physician.

Say WHAT??? :confused:

I disagree with that point... :no:

Most of the time we know MORE than the physician, and in mmay instances, we work alongside physicians to figure things out...what your post articulates is that if a hierarchical nature, and that is NOT conductive to today's healthcare environment.

[QUTOE]

Many new nurses I know stress themselves out because they feel inadequately prepared for the job.

And many new nurses are NOT; meaning, due to competition with other schools and hospital liabilities; many new nurses are faced with only the minimal requirements in order to learn to be a beginner nurses; they are novices, and can't always hit the ground running. :no:

You will never know all there is to know in nursing. At some point you have to learn to trust your team you're working with. Yes, I've advocated for a patient that needed testing and the dr said she didn't. Yes I continued to pursue it until the test was done and my suspicions confirmed. Yes doctors are not always correct. But second guessing every order on every patient is not possible and you will burn out that way.

True nursing and healthcare is always ever evolving; however, sometimes you will need to second guess or even question orders; omit once and it could be a sure fire way of my worrying about burnout, but possibly being not able to have a license; and that's not being over worried; being vigilant in the name of pt safety is a PRIORITY as a nurse.

Double check your meds, do your rights of med admin, always verify your patient before a procedure with 2 patient identifiers, etc. but don't walk around thinking the physician is going to order some procedure that will kill your patient. Don't carry that paranoia around. It will suffocate you. Most nurses I know left the field because of concern over liability.

If a percentage of nurses are leaving because they underestimated the liability issue, then so be it-I beg to differ in it being "paranoia"; I work in a specialty where double checking is absolutely necessary because I am, as all nurses are, the last line of defense when giving medications and treatments, these is no way around it; being comfortable in the role is something that nurses will continue to have to hone-not fear.

%63theend · May 22, 2015

I'm not sure if I'm just not explaining myself clearly or if you're just picking a fight. But it's a mighty tall soapbox to stand on saying you're smarter than the doctors you work with. Or maybe I've just been lucky to work with very capable doctors the majority of the time.

LadyFree28, BSN, LPN, RN · May 22, 2015

I'm not sure if I'm just not explaining myself clearly or if you're just picking a fight.
But it's a mighty tall soapbox to stand on saying you're smarter than the doctors you work with. Or maybe I've just been lucky to work with very capable doctors the majority of the time.

To be clear, it may be that you are not explaining yourself clearly.

Based on your posting, like I stated before, it seems as though you are discouraging the use of our knowledge to assist with the plan of care; if not, clarify.

Yes, I do know MORE than the physicians, meaning, the expectation is to know more than them in order to assist in planning care; my holistic assessment is VERY helpful in assisting with the POC for my patients, and has been in the ten years that I have been a nurse my process and knowledge is significant and valuable that providers seek it out; I have made suggestions to the POC to help my patients; to advocate based on my knowledge has always been beneficial; whether the provider is excellent mediocre or poor didn't matter; the focus has been-and always has been-the pt.

Being a nurse is an empowering thing; to fear the responsibility is one thing, but understanding that empowerment and focusing on being the 3 C's:Consistent (remain constant in nursing practice), Competent (knowledgable in current and best practice) and Confident (meaning be confident in asking questions for clarity and safety, confident in ones assessment, confident in ones nursing practice to better advocate for patients) are the key to being the best nurse and not merely to "survive" in nursing, but to thrive in nursing.

You think I'm "picking a fight"; why?

Because I disagree with what your posting?

That's not a fight-it's called a difference of opinion.

HouTx, BSN, MSN, EdD · May 26, 2015

Well, that escalated quickly.

I understand where the OP is coming from. Nurses need to accept that patient care is a "team thing"... in which every clinician does his/her part. No one individual is responsible for EVERYTHING. I think that is a mature and accurate frame of reference. It's not a case of who knows the most.

There are many occasions in which the bedside nurse, who has spent many hours in close contact with a patient, has acquired information that the physician doesn't have - unless the nurse provides it. It's just as important for the nurse to understand the physician's plan of treatment - and the "why" for all medications and interventions that are ordered. That's how teams work to achieve their common goal.

My advice to the new nurse? Don't be afraid to communicate with the physician. Ask 'why' if you don't understand & make sure that you know exactly what parameters &/or patient information are most relevant to the current plan of care.