Implement a RADICAL IDEA! "Medical plan of care."

[nurseprnRN, BSN, RN]

i am really, really tired of the old-fashioned, dates-back-to-the-military-of-clara-barton-and-florence thing that "doctors give orders and nurses follow them." i call for an immediate end to the use of the word "orders" in all collegial relationships, including this one.

in this day and age, every patient has a medical plan of care, some parts of which may require nursing implementation, and every patient has a nursing plan of care.

we already know that the ana scope of practice requires rns to be responsible for patient care to the extent that we must refuse to implement any dangerous component of a medical plan of care-- blind "order-followers" wouldn't have that kind of autonomy and power-- or responsibility.

does anyone out there, besides maybe students or wannabe nurses, think that you could get away with saying, "i just followed the doctor's orders" when something bad happens? nope, didn't think so.

therefore, i call upon all my colleague an'rs to immediately modify their language in this regard, when discussing patient care with the press and other media, physicians, students, other professionals, patients and families, and ... other nurses. imagine how we could change the face of nursing for all those people by engaging them with just those simple words.

"dr smith, what's your plan to manage mr. jones' pain?" instead of, "we need pain medication orders."

"the nursing plan is to assess what else is going on here to see what other means can help mr. jones prevent and manage his pain."

"what's your plan for diagnosing this presentation?" rather than, "write lab and radiology orders." "the primary nurse's plan is to have nursing look at the role his home situation and health education has in his repeated admissions."

"your wife's physician plans to manage her pulmonary edema so she will be able to breathe better, and involve social work and the visiting nurse to help monitor her at home. the vna will plan how much help and what kind she needs," rather than, "dr. smith wrote an order for lasix, the vna and social work."

i dare ya. give it a shot for a week. go to the forms committee at your hospital and have the paperwork changed to reflect this. how does it work for you? i can tell you it makes lawyers sit right up in their chairs!

[mcleanl]

Hahaha.....this made me laugh. I usually refer to doctors orders as "suggestions".........since some of them really aren't all that wise to follow!

[xtxrn, ASN, RN]

I don't need to change the language to have felt a part of the team..... we know what we do, who cares about the way it's said???? :) I've been lucky to work with mostly easy docs to work with- there was no condescending comments from them, and the patients know who does what for the most part.

Sorry- not picking this battle :)

[LegzRN]

When I hear orders, I think more of someone ringing up some product in exchange for a monetary currency, not so much as "I order you to do this now!" It's like when you're at Wal-Mart and you're buying light bulbs, but instead of light bulbs, you're ringing up a complete blood count. I mean, isn't that what healthcare's all about? Dollar bills and Press Ganey scores?

[SharonH, RN]

It'll never work, nurses on this board are vehemently opposed to creating their own plan and following through, they only want to follow doctor's orders. Sorry.........

[That Guy, BSN, RN, EMT-B]

Im sorry, but I just dont care.

[No Stars In My Eyes]

I think it'd be cool, but my brain and tongue would get all tangled up trying NOT to say what has been sort of automatic all these years. Though once I called a doc and told him what was going on with a patient and the doc responded with the do-this-give-that orders (suggestions?!) Without even thinking how it might be received, I said, "Ooooh, you're good; that's exactly what I was going to tell you we needed to do." And I didn't know this guy from Adam! Fortunately he must've had his "laid-back" meds, because he just chuckled....warmly!...and said he was glad we concurred.

[Flo., BSN, RN]

I think we have bigger fish to fry.

[SneakySnake]

I think it'd be cool, but my brain and tongue would get all tangled up trying NOT to say what has been sort of automatic all these years. Though once I called a doc and told him what was going on with a patient and the doc responded with the do-this-give-that orders (suggestions?!) Without even thinking how it might be received, I said, "Ooooh, you're good; that's exactly what I was going to tell you we needed to do." And I didn't know this guy from Adam! Fortunately he must've had his "laid-back" meds, because he just chuckled....warmly!...and said he was glad we concurred.

:yeah:

[xtxrn, ASN, RN]

I think it'd be cool, but my brain and tongue would get all tangled up trying NOT to say what has been sort of automatic all these years. Though once I called a doc and told him what was going on with a patient and the doc responded with the do-this-give-that orders (suggestions?!) Without even thinking how it might be received, I said, "Ooooh, you're good; that's exactly what I was going to tell you we needed to do." And I didn't know this guy from Adam! Fortunately he must've had his "laid-back" meds, because he just chuckled....warmly!...and said he was glad we concurred.

:lol2::lol2:

[xtxrn, ASN, RN]

It'll never work, nurses on this board are vehemently opposed to creating their own plan and following through, they only want to follow doctor's orders. Sorry.........

Yikes:eek: So we're all just puppets? :) No other areas where we think and react autonomously? No psychosocial interactions that nobody could write an order for? No nursing measures that we can do?

Are you in med school ? (if so, congrats) Or don't like being a nurse? I'm sorry if that's so... Just nurses on this board? There's another board where the nurses want to practice medicine? :)

:)

[Anna Flaxis, BSN, RN]

I don't think of doctors' orders as commands to be followed, but rather, as placing an order for a product or service. If a doctor orders 0.5mg of Dilaudid, the doctor is placing an order for the medication. I just happen to be the one who administers it.

I always speak with the physician in terms of what the plan is, rather than what they want me to do. If I'm not sure what direction we're going with Mr. A, I'll ask the doctor "What is the plan for Mr. A?". If I think Mrs. Z needs something that is not within my scope of practice to do without a doctor's order, I'll say "I think Mrs. Z would benefit from ___________."