I'm not the doctor! - page 4

Recently my husband's grandmother was a patient in the ICU. I am frequently used as the medical translator in the family, this time wasn't any different. I had the opportunity to make a couple of... Read More

  1. by   Here.I.Stand
    5. A physician...offering to help clean up a patient? Am I seeing unicorns?
    Actually, when I was working in an LTACH the dr. asked for my help to turn the pt so he could see the pt's sacral wound. We turned him and found the pt had been incontinent of stool. The dr. offered to help me clean him up. I gratefully accepted! I did ask "are you sure, do you have time?" not b/c I considered him too educated to clean poop (hey it doesn't take an RN license to clean poop either) but b/c it was nearly 1900 and while I was getting ready to report off to the noc RN, he STILL had a list of pts to see. If you've ever worked in an LTACH, you'll understand how complex these pts' courses are and why I'd consider that he still had a list of pts to see.

    Yes, the idea of an RN referring every question to the MD is obnoxious. I've been asked by families when the multiple trauma pt's leg is going to be fixed, and I've told them that at this point it's not scheduled and that they could ask ortho in the a.m. when they round, but at this point the pt is having high ICPs and can't tolerate lying flat; and that the brain is of course a higher priority than the leg. I've been asked why a TBI pt is running a fever, "what kind of infection do they have?" I can't make a medical dx but I'll explain that we have sent blood, sputum, and urine cultures which the lab is running...right now the UA doesn't look like a UTI but the culture will tell us for sure...and then explain neurogenic fevers and that that is a possibility.

    Now if a family asks "How effective is the surgery that they want to do?" I will refer them to the surgeon. Likewise if they ask about community resources I will refer them to the SW. If they ask about having a sage burning I'll refer them to the chaplain. I am a professional, but I'm not an expert in everything.

    While I can't prescribe medical treatments, you BET we need to know that they're safe. When I interviewed for my first ICU job as a fairly new RN (a little over a year) the manager advised me, "We need someone who can critically think independently. Sometimes the RN needs to protect our pts from these residents." I have heard RNs on my unit, when their PT's ICP has been over 40 for half an hour, tell the resident "No, we're not going to turn their 2% from 30 ml/hr to 40 ml/hr and give it an hour. I'll do that, but he needs a dose of 23% also."

    One story a nursing school instructor told still sticks with me. A baby had surgery, and the surgeon prescribed a morphine infusion at whatever dose it was. Anesthesia agreed to it. The pharmacist verified it and sent it to the floor. The RN administered it. The baby became overnarcotized and died. My instructor asked, "Guess who the only one to lose their job was? Yes, the nurse who gave it. She should have known that that was too much morphine for that size infant."
  2. by   sweetdreameRN
    Quote from Here.I.Stand
    Actually, when I was working in an LTACH the dr. asked for my help to turn the pt so he could see the pt's sacral wound. We turned him and found the pt had been incontinent of stool. The dr. offered to help me clean him up. I gratefully accepted! I did ask "are you sure, do you have time?" not b/c I considered him too educated to clean poop (hey it doesn't take an RN license to clean poop either) but b/c it was nearly 1900 and while I was getting ready to report off to the noc RN, he STILL had a list of pts to see. If you've ever worked in an LTACH, you'll understand how complex these pts' courses are and why I'd consider that he still had a list of pts to see.

    Yes, the idea of an RN referring every question to the MD is obnoxious. I've been asked by families when the multiple trauma pt's leg is going to be fixed, and I've told them that at this point it's not scheduled and that they could ask ortho in the a.m. when they round, but at this point the pt is having high ICPs and can't tolerate lying flat; and that the brain is of course a higher priority than the leg. I've been asked why a TBI pt is running a fever, "what kind of infection do they have?" I can't make a medical dx but I'll explain that we have sent blood, sputum, and urine cultures which the lab is running...right now the UA doesn't look like a UTI but the culture will tell us for sure...and then explain neurogenic fevers and that that is a possibility.

    Now if a family asks "How effective is the surgery that they want to do?" I will refer them to the surgeon. Likewise if they ask about community resources I will refer them to the SW. If they ask about having a sage burning I'll refer them to the chaplain. I am a professional, but I'm not an expert in everything.

    While I can't prescribe medical treatments, you BET we need to know that they're safe. When I interviewed for my first ICU job as a fairly new RN (a little over a year) the manager advised me, "We need someone who can critically think independently. Sometimes the RN needs to protect our pts from these residents." I have heard RNs on my unit, when their PT's ICP has been over 40 for half an hour, tell the resident "No, we're not going to turn their 2% from 30 ml/hr to 40 ml/hr and give it an hour. I'll do that, but he needs a dose of 23% also."

    One story a nursing school instructor told still sticks with me. A baby had surgery, and the surgeon prescribed a morphine infusion at whatever dose it was. Anesthesia agreed to it. The pharmacist verified it and sent it to the floor. The RN administered it. The baby became overnarcotized and died. My instructor asked, "Guess who the only one to lose their job was? Yes, the nurse who gave it. She should have known that that was too much morphine for that size infant."
    Very, very well said. I really appreciate the personal examples. They really clarify and reinforce the points you made. You seem like an excellent nurse. Keep up the good work!
  3. by   systoly
    Quote from emtb2rn
    My standard reply when addressed as "doctor" is: "i'm not the doctor, i'm your nurse, i work for a living".
    noncom
  4. by   iPink
    No, I'm not a doctor. I'm much more...a nurse.

    I'm a semi-new nurse (less than 3 years experience) and started off on a unit that didn't have residents. There were a few doctors there who wanted your input about the patient's care and they valued it. That experience forced me to study when I got home so my knowledge base was expanded.
  5. by   Brekka
    While I do agree that nurses should be respected for their knowledge, and acknowledge their own achievements and abilities with a sort of professional pride, I don't necessarily agree that statements such as the one in the OP are subservient. I tend to say things along this line frequently, but I am **** proud of what I have accomplished and my role in the healthcare system. Statements such as "I don't want that much responsibility," or even "I'm just a nurse" should really be taken at face value only. What you heard may not be what was intended.

    CNAs don't have the knowledge or training that nurses have. I've heard CNAs in my facility outright state frequently that they didn't want to go on to nursing school because they didn't want the responsibility that the nurses have. That doesn't mean they aren't knowledgable, capable, competent, caring professionals, or that they are in any way lacking intelligence. They simply, "don't want the responsibility."

    The fact is, like CNAs to Nurses, Nurses do not have as much responsibility as doctors do. We do not have the training, knowledge, or experience that doctors do. We are knowledgeable and well trained in what we do, but we are not doctors, and should not be expected to be. There is increased responsibility with each step up the health care ladder, and that additional knowledge and responsibility should very well be acknowledged.

    Pharmacist, doctor, nurse, CNA, social worker, etc... We all have different roles to play, different responsibilities, and are all very important in achieving the best patient care. Lose one and everything changes, and patients are put at risk. Some have more responsibility or knowledge than the others, but that doesn't make them any less important, and it shouldn't be looked down on to acknowledge the differences.
  6. by   jae_mc
    Oh man, I've been guilty of this mindset a few times, especially when I first started working at my department over a year ago. Luckily, I've been blessed to work with doctors who don't dare to look or talk down to their nurses and we all consider ourselves "family." In the time I've been as a nurse, I've learned that my attitude also determines my capabilities.
  7. by   chillnurse
    I am glad everybody is so humble on this forum.
  8. by   Here.I.Stand
    Quote from sweetdreameRN
    Very, very well said. I really appreciate the personal examples. They really clarify and reinforce the points you made. You seem like an excellent nurse. Keep up the good work!
    Aw, thank you!!! You made my week!!
  9. by   SingingBird
    My first thoughts after reading this: I love you. Second: I completely 100% agree with you!
  10. by   chrisrn24
    I would just say "oh, no, I'm your nurse." The rest is irrelevant.
  11. by   lurn1234
    I couldn't agree with the article more. I agree that we are looked down on and we nurses are adding fuel to the fire.
  12. by   bisson
    I finally feel like someone understands how I've been feeling. We pride ourselves on being "nurses" a title that carries so much pride. But when I go to work, my voice matters to no one but myself. When the MD's round, you are nothing more than a runner, someone to carry out their orders. And this is in an ICU where I have the most autonomy I've seen in all of my experience.

    While getting my BSN, i was greatful for the knowledge of my professors who saw nursing as a professional title, and taught me that nursing is not just " butt wiping" but a professional role. But in order for us to be seen as such, we have to present ourselves as professionals. We are already there, we follow evidence based practice versus doing things the way they have been done. We are far from being seen as an equal to an MD, even as an NP, but I refuse to be proud of my profession if we are seen nothing more than maids.
  13. by   MsRNAqueelah
    As a new graduate nurse and reading some of these responses to this thread are quite saddening!!! To suggest that the "reason" why one is a nurse and not an MD is due to the fact that you don't want the responsibility, is hard for me to swollow!!!! It's Quite ironic how this question is asked so rapantly throughout interviews. You can guarantee that my reasonings are far beyond just responsibilities!!! GodSpeed!

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