Don't do the physicians work!

BSN16 · Apr 2, 2017

I don't entirely agree with all of this. Let me say first i am an ICU nurse. Our intensivist rounds with a multidisciplinary team daily. He assess the patient and puts in new orders for therapies or medications he thinks would benefit the patient. That being said, i am always present in the room when each doctor on the case comes in. I will take the verbal orders without a second thought, especially when i go to them about an issue.

Ex. Me: Doctor room #32's BP is 170/90 and has no PRN's. I will receive and input any verbal order at this point.

That being said sometimes doctors have no IDEA how to order certain medications. At our facility ordering blood and etc can be difficult. They usually ask me nicely to do this and i have no issues helping them out. In fact, most of our physicians works at many different hospitals in town and i'm sure its difficult to manage different charting systems.

Lastly, if physicians do not report off to each other i have no problem filling them in. In fact when i need to call whoever is on call over night i usually start of by giving them background info on the patient. example "Hi doctor, i'm calling about pt jane doe in room 32. She was a hemorrhagic stroke brought in on 3/31. She is intubated and sedated. I am calling about a critical potassium...etc. really not that hard.

I understand that your facility may be different than mine but i work VERY closely with all my doctors and would never refuse to put in a verbal order unless i believed it could potentially harm the patient.

Apples&Oranges · Apr 2, 2017

I work in a teaching hospital, and honestly feel that myself, the docs, resp therapists, speech, PT, OT, etc are part of a team.

If I know that my patient needs something that they are not getting, I will call the resident and say, "Shannon in 525 needs more for pain. I'm going to put in for x increase in the PCA basal rate, increase the demand dose to x, and a 1 time of Toradol under your name, k? Her kidney and liver fx is fine, and VS are also."

If a pt's BP is too high, I call and say, "Shannon's BP is 210 over 99, her HR is 107, I'm going to give 5 of Labetalol and see how it goes. If that doesn't work, do you want me to call you back, or give another 10?"

If I have a stroke pt who doesn't have SCDs ordered, I check for s/s of DVT, if none, I just do it and put in the order.

The residents usually tell us, "If speech has a recommendation, that's great, just go ahead and tell them to put it in under my name."

Maybe I'm naive, and asking for a trip under the bus, but that's just how we roll.

Should docs make comments about nurses not doing their jobs and write nasty passive aggressive nursing orders when we miss a "nursing responsibility" or should they just say during rounds, "hey, Oranges, I noticed the pt didn't get x lab this morning that was part of protocol" or should they just be a team player and add it on?

Maybe I'm being too sensitive about this, but I've started to hear the incredibly inappropriate "Uh, oh, July 1st is right around the corner, hahah!" jokes already, from brandy new nurses, and it pisses me off. Nurses are not superior in knowledge or care. Docs should not be expected to be superhuman. In an ideal world, we are a TEAM, and part of being a team is that we not only catch each others' mistakes and omissions, but supplement each other when it comes to, well, everything.

Whew! Sorry for the rant! Thanks for reading. Be kind to each other. That said, I don't always follow my own advice.

---Oranges,who is learning daily to be more patient.

ModernRN · Apr 2, 2017

I don't entirely agree with all of this. Let me say first i am an ICU nurse. Our intensivist rounds with a multidisciplinary team daily. He assess the patient and puts in new orders for therapies or medications he thinks would benefit the patient. That being said, i am always present in the room when each doctor on the case comes in. I will take the verbal orders without a second thought, especially when i go to them about an issue.
Ex. Me: Doctor room #32's BP is 170/90 and has no PRN's. I will receive and input any verbal order at this point.
That being said sometimes doctors have no IDEA how to order certain medications. At our facility ordering blood and etc can be difficult. They usually ask me nicely to do this and i have no issues helping them out. In fact, most of our physicians works at many different hospitals in town and i'm sure its difficult to manage different charting systems.
Lastly, if physicians do not report off to each other i have no problem filling them in. In fact when i need to call whoever is on call over night i usually start of by giving them background info on the patient. example "Hi doctor, i'm calling about pt jane doe in room 32. She was a hemorrhagic stroke brought in on 3/31. She is intubated and sedated. I am calling about a critical potassium...etc. really not that hard.
I understand that your facility may be different than mine but i work VERY closely with all my doctors and would never refuse to put in a verbal order unless i believed it could potentially harm the patient.

Just because YOU are ok putting in the verbal orders, YOU are putting the patients safety at risk! Plus you are enabling the physicians to continue to exercise bad habits in healthcare!

ModernRN · Apr 2, 2017

I work in a teaching hospital, and honestly feel that myself, the docs, resp therapists, speech, PT, OT, etc are part of a team.
If I know that my patient needs something that they are not getting, I will call the resident and say, "Shannon in 525 needs more for pain. I'm going to put in for x increase in the PCA basal rate, increase the demand dose to x, and a 1 time of Toradol under your name, k? Her kidney and liver fx is fine, and VS are also."
If a pt's BP is too high, I call and say, "Shannon's BP is 210 over 99, her HR is 107, I'm going to give 5 of Labetalol and see how it goes. If that doesn't work, do you want me to call you back, or give another 10?"
If I have a stroke pt who doesn't have SCDs ordered, I check for s/s of DVT, if none, I just do it and put in the order.
The residents usually tell us, "If speech has a recommendation, that's great, just go ahead and tell them to put it in under my name."
Maybe I'm naive, and asking for a trip under the bus, but that's just how we roll.
Should docs make comments about nurses not doing their jobs and write nasty passive aggressive nursing orders when we miss a "nursing responsibility" or should they just say during rounds, "hey, Oranges, I noticed the pt didn't get x lab this morning that was part of protocol" or should they just be a team player and add it on?
Maybe I'm being too sensitive about this, but I've started to hear the incredibly inappropriate "Uh, oh, July 1st is right around the corner, hahah!" jokes already, from brandy new nurses, and it pisses me off. Nurses are not superior in knowledge or care. Docs should not be expected to be superhuman. In an ideal world, we are a TEAM, and part of being a team is that we not only catch each others' mistakes and omissions, but supplement each other when it comes to, well, everything.
Whew! Sorry for the rant! Thanks for reading. Be kind to each other. That said, I don't always follow my own advice.
---Oranges,who is learning daily to be more patient.

Your practicing outside of the scope of nursing and risking the pt's safety and your license. When a nurse catches a physicians error the docs just say oh ok thanks and keep on rolling. But if a physician catches a nursing error he or she is liable to write you up or tell your manager and the nurse is scolded. Id like to see physician scolded for their errors as well. Just my opinion and frustration I suppose..

With todays age and time, I feel it is important to define the boundaries between nurses and physicians as I am the only one looking out for my license. Healthcare is a team effort but I promise when your in court it you WILL be examined on a individual basis.

ModernRN · Apr 2, 2017

1. Physicians still giving verbal orders - this has been noted as a national patient safety issue. So why can't the physicians protect patients safety? Are doctors truly concerned with pt's safety? If they are ignoring pt safety goals then I'd say no they aren't.
This will need a culture change within your organization. I work as an NP in a university hospital and no nurse will ever enter a verbal order anymore and I don't blame them. In this age of EMR's, any provider can enter an order himself or herself in any location of the hospital that has access to a workstation (even call rooms for providers). Older providers who trained before the age of EMR will have to keep up and learn or quit.
2. Why are nurses now responsible to make sure certain medications or therapies ordered such as Metoprolol or VTE prophylaxis? Nurses are getting burned because physicians aren't capable of being thorough enough to make sure they have ordered what is appropriate for their patient. This is just lousy of physicians in my opinion.
Again, this is an institutional variation. Non APN's are not providers and their scope does not cover writing orders for VTE prophylaxis and beta blockers for whatever indication. You facility is taking a short cut to keep up with regulatory standards by making nurses take care of these issues instead of making providers accountable for this particular part of their role. This is not something nurses decide on where I work.
3. Nurses having to get physicians to renew 24 hour restraint orders and foley cath orders. If your physician does not know the pt is in restraints or has a foley catheter that requires a new order then they are not fully aware of the pt they are managing care for and is not professional.
You as the bedside nurses know more of the hour to hour the changes that happen to a patient. I wouldn't know if you're still concerned about patient safety, hence, the need for restraint. I don't feel restraints should be treated in an "auto pilot" way and nurses and providers should collaborate on their use. For that reason, I prefer being told that I need to renew restraint orders. Same with Foleys, I actually have had conversations with nurses who prefer their input prior to DCing indwelling catheters.
4. Physicians are not giving report of their patients when another physician is taking over call. Calling a physician for help with a pt issue and the MD has no clue who you are talking about is poor physician management in my opinion and is a safety issue.
It's hard to comment on this. Providers do give hand-offs to each other when they switch. I know we do as NP's in the ICU. However, I don't necessarily respond well to a call from a nurse saying "Mr. S PCO2 is 68". Give me a little bit of background so I can get a perspective of why you're calling me.
Also realize that in some situations, a provider is carrying the pager for a large number of patients some of whom they only got a one liner about in terms of patient info. During hand off, a lot of the times we get sign out on what to expect as problems that may arise but I'm sure other issues will pop up unexpectedly. That's where SBAR or whatever system you use help.

Thank you for this response. I must say that I am a travel nurse working in a hospital full of travel nurses because they can't keep any full time staff..I have worked at much better facilities where workflow is awesome! After being a nurse for 17 years its very difficult not to let these things get to me. Everyone of us nurses know that if something can be pinned on the nurse it will be done and we will take the heat...On the other hand I see physicians make errors and its like "oh well"...Just doesn't seem fair but hey Life isn't fair right? I think I am looking for boundaries between the nurses and physicians so I will feel more confident and not always be made to feel like we are the bad guys. I love what I do and have no clue how to do any other job...just wish I could better process these things that bother me. Thanks again!

amzyRN · Apr 2, 2017

I hear you. It sucks to have to double check physicians duties. However, physicians work their tails off too. Most physicians work way longer hours than RNs do (at least during their residency). They decided to take on more responsibility by becoming MDs. They take on more debt, work longer hours, carry more of the legal responsibility, etc. This doesn't mean that they have the right to be disrespectful or lazy, but obviously, need a helping hand to make sure patients are kept safe. Does that make it our job? Not necessarily in my opinion.

One ER physician I worked with once complained that he was the only doc that night for an ED with 80 patients in it. He said "I don't have staffing ratios like RNs do". He said please don't interrupt me with anything that isn't life threatening right now. Well, maybe physicians should start to organize or something so that their load is a little lighter so they can provide safer care.

I think that we as health care providers need to empathize

with each other more. We are on the same team, just slightly different roles. We are in it to help, even if that's not your primary motivator, that's what we do. We help people together and need to support each other.

chacha82, ADN, BSN · Apr 2, 2017

I have taken verbal orders from doctors. I repeat them and confirm this is what the doctor wants. Usually the order appears in the chart a few minutes later once the MD gets to a computer. Then I make a note this is a verbal order per MD.

BSN16 · Apr 3, 2017

Just because YOU are ok putting in the verbal orders, YOU are putting the patients safety at risk! Plus you are enabling the physicians to continue to exercise bad habits in healthcare!

By taking a verbal order and confirming it with a read back I am not putting a patient's safety at risk nor am i exercising bad habits in health care. In fact this is in my job description.

For example throwing a fit because a physician gave you a verbal order for stat levophed is putting a patient at risk.

This is part of the job of an RN. Stop crying because you have to do your job.

3ringnursing, BSN · Apr 3, 2017

I take orders via Tiger Text - a secure text messaging system for cellphones and computers. I copy & paste those into my note. My job in telephone triage depends on it, but at no time are we ever communicating verbally (thankfully).

ModernRN · Apr 3, 2017

Yes you are BSN16! The goal is to eliminate ALL verbal order entry by nurses! ALL!! The doc can put in the Levophed order himself when he takes his ass to a computer or chart. Stop kissing ass and keeping us from getting physicians on board with the system and technology where they should be sweet cheeks!

BSN16 · Apr 3, 2017

I take orders via Tiger Text - a secure text messaging system for cellphones and computers. I copy & paste those into my note. My job in telephone triage depends on it, but at no time are we ever communicating verbally (thankfully).

That sounds amazing. We use Doc Halo which is also a secure text message system however we are not able to receive orders this way...so basically pointless lol

SmilingBluEyes · Apr 3, 2017

Quoting ModernRN: "Yes you are BSN16! The goal is to eliminate ALL verbal order entry by nurses! ALL!! The doc can put in the Levophed order himself when he takes his ass to a computer or chart. Stop kissing ass and keeping us from getting physicians on board with the system and technology where they should be sweet cheeks!"

Totally inappropriate post. Disagree all you want, but this is just plain rude and I see now where you might just have a communication problem with colleagues and physicians alike. Quit whining; change what you can and accept what you can't and move on. But don't attack other posters; it's immature. Your anger is out of proportion to the problems. Fix them; be part of the solution instead of whining how physicians have it better. They don't.