Looking for help with a new policy

nurseabc123 · Sep 19, 2008

I don't think it can be that cut and dry. A policy like that will do a disservice to your patients and nurses. Nurses should be able to determine whether or not patient's change in status is significant enough to warrent notifying a physician. Maybe more education is necessary, not a policy change.

ukstudent · Sep 19, 2008

Is the problem that the Doc's are upset that nurses are NOT calling them about such things? Are nurses wanting this policy change in order to cover their ***?

If so then you are never going to be able to write policy/pre-approved orders to cover every incident. I would suggest going in the other direction. Have the nurses call for every change in pt status day and night. The docs will soon back off and decide that they would like your nurses to use their brains and critical thinking skills again.

Good luck

SuesquatchRN, BSN, RN · Sep 19, 2008

I'm betting the docs don't want to be bothered.

Write a policy that says, in essenvce, too bad.

belmont99 · Sep 24, 2008

I appreciate the feedback!! I, personally, am of the opinion that if an ICU nurse cannot use his/her nsg judgement and critical thinking skills...then they need not be in my Unit. However, the docs don't like it if they are called over little things and they also get their drawers in a wad if we don't call over some little things. There is no happy medium and we may have to suck it up and deal with it. Goodness knows we cannot please them all! However, these same docs, have a SERIOUS God complex and seem to have the most pull with upper administration. I suppose we will see what happens... :banghead: :rolleyes:

SuesquatchRN, BSN, RN · Sep 24, 2008

Document ALL of the "little things." Present the policy. Have them sign off or not. If not, rewrite it until they do.

Seriously, write a procedure for every. stinking. reason you might call.

deeDawntee, RN · Sep 24, 2008

Oh my, you have been put in an extremely difficult position.... I could see that litigation issues could stem from a 'policy' that, let's face it, is being asked for so that MDs don't get bothered at night. Phew, I wouldn't do it.

Have you ever had that 'gut feeling' when you just knew a patient was going bad? How do you put that in a policy?

Are your nurses collaberating with each other? At times, your more experienced nurses can help with the decision making. I guess I would be more apt to write a policy encouraging collaberation, and an ultimate commitment to the patient's well-being and to the MD's role as being the person who ultimately must make the treatment decisions.

I would bet that the real policy you should write will not make your docs happy, but so be it...support your nurses!!!! And of course ultimately the patients. The Docs will need to see where your commitment is and be a little more flexible. I mean really.....that is what being a Doctor means, being on-call at night. deal with it.....

allnurses Guide · Sep 24, 2008

I would put the onus back on your physicians. If they have issues with what they are called about, they should specify when they want to be called, or not. Then they can't complain later and your nurses are covered. Maybe just a standard order sheet like:

Call for:

BP <..... or> .....

HR <.... or> ......

etc, and a space at the bottom for particular things they want to know about that patient.