Im a nurse! Not a doctor!!!

ktrapp2006 · Feb 8, 2009

If she is expected to know everything to do and do it, is that without an MD order? Is that do it even if MD explicitly says not to? Is she supposed to get consults without orders from MD to get them?
Where does the RN's responsibility end and the MD's begin these days, since there is, apparently, no captain of the ship any more? I am going to PM you to please get a copy. Thanks!

I agree with Vito, Where does the line cross for the RN's responsibility and the physicians? Especially if the physician doesn't agree with your assessment that you are looking at right then and he is sitting at home disagreeing!

allnurses Guide · Feb 8, 2009

A root cause analysis is not a "blame" situation. All you needed to do is what you did - document, and explain what happened. The purpose of RCA is to avoid such events in the future.

mcknis · Feb 17, 2009

I think you covered your butt by charting that the MD was there and gave no new orders. You are right by looking, checking, and calling pharmacy!

feliz3 · Feb 17, 2009

I am so sick of my facility expecting me to be a nurse doing total care of critical patients AND expecting me to be a doctor. I did not go to medical school. I went to NURSING school. yeah sure I need to question crazy orders and get orders for crazy things that happen. I am okay with that. That is my job. I am NOT okay being held resposible for a MD's decisions. I had an IV infiltrate.. okay my job to deal with this. fine. I call pharmacy and ask if this drug needs any kind of extra attention ( an antidote or what-not) Pharmacy says well, there could be some damage but it is not likely and is not common practice to treat. I didn't go to medical school so I call the person who did and is responsibe for making these types of desicions. Pt IV infiltrated, such andsuch drug was running pharmacy said this and this, area is swollen but pt states is not painful at all , didn't even know it was infiltrated, ice pack applied per pharmacy suggstion. MD in to see pt...no new orders. will continue to monitor. 2nd Iv site infitrate area slightly swollen, pt states area is not painful ice pack applied. Md notified. No new orders.will continue to monitor. end of shift and I go home.
2 wks later.
call from upper management for root cause analysis. pt infiltrate site got necrotic and had to be debrided. then a wound vac. where do I stand here? Did I not do what I was supposed to? I notified the doc and called pharmcy about it. I caught it from assessing the site properly. but for some reason I feel responsible. Pt has now passed after a surgery on the legs, an unrelated incident I HOPE. Manager says it was not related. I stil feel responsible though. IV infiltrates happen. you can check it and maybe even the moment you leave the room the patient moves wrong and its 2 hours before you get back in there. It sucks but I am not negliegent in this as we assess patency Q2. WHY do I feel responsible. Why do I feel like the worst nurse in the world like I should somehow magically aquire the judgement skills of a medical dr in 1 year of nursing. like I shoud have insisted the MD do something differently based on some knowledge of pharmacology and pathophysiology one aquires in medical school. Yes I know that I need to know quite a bit, but come on! If I knew everything why do we even need doctors???????
Okay. Its out now and I feel better. Thanks for reading the VENT!

If everything goes south who do you think will administration points out as the "fall guy" with all kinds of accusations about malpractice, negligence, etc., etc.? Document everything you did, who did you call at what time and what were the responses to your calls for support and above all the status of the patient that was the reason for all your interventions. TRUST NO ONE. feliz3