Nurses in clinical setting: physicians servant or patients caregiver?

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After 14 years clinical experiences, this question rush my nerve. What is your opinion?

Specializes in Family Practice, Mental Health.

I smell homework.......

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We're not blindly following doctors' orders. In fact, we could lose our licenses for doing so. A huge part of our job is using our nursing judgment. Another huge part is advocating for the patients. Yes, doctors often make the final decisions on things like medication, but they do so in conjunction with what we nurses tell them about a patient. Very often doctors prescribe medications because nurses ask them to. "This patient is in 7/10 pain, but there's nothing ordered and he takes X at home. What can we give him?" And then the doctor writes the order.

And we nurses make decisions every day about whether or not to give a particular medication. Just today, I had a patient with orders for two nicotine patches. I was able to pull them from the med room, and scan them through the computer. I could have placed them both on the patient. Who would then have had a massive dose of nicotine in his system. Basically, one resident increased the nicotine patch dose and never discontinued the other order. Pharmacy didn't catch it. I did. And the patient only had one patch placed because I used my nursing judgment after a resident messed up.

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Specializes in Family Practice, Mental Health.

With the advent of more managed care medicine, HCAPS scores, Press Ganey, Patient Satisfaction, CMS, etc., everyone is practicing less and less of their craft, and more and more of whatever it takes to get higher reimbursements. Nurses are being put in the position to tell the docs what needs to be done to follow a pathway” to satisfy best practice. If you present with a stroke, everyone knows what is supposed to be done. Got an MI? That's covered too. Diabetes - start checking off boxes. The lines are becoming more and more blurred.

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Nurse;8797289]I smell homework.......

I smell my nerves rushing.

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Specializes in Pediatric Hematology/Oncology.

Who hurt you?

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Specializes in Pediatric Hematology/Oncology.
I smell my nerves rushing.

Nerves rushing, jimmies rustling....

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I smell homework.......

I would agree, but I can't imagine a school of nursing actually using the term "physician's servant" (or, for that matter, "caregiver" in referring to a licensed nurse).

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The moment I stop using my good judgment and just blindly follow the physicians is the moment they hunt me down and shove my stethoscope (oh excuse me, a doctor's scope) up my rear. My attendings rely on me to both be their intelligent eyes and ears and to run interference on the interns before a pt is killed in the learning process.

I've had attendings get angry if I don't think and do for myself.

If all I had to do was follow orders, I wouldn't have had to do all that damned work in college, nor pay out the nose for the privilege.

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Specializes in Psych, Addictions, SOL (Student of Life).

I have a very playful sense of humor - especially at work - Most of the doctors I work with are very "Old School" and like to be "Attended" when they do rounds. I have know most of them for well over 15 years. We like and respect each other. We have a policy in our facility that all physicians be greeted by name and title when they enter the Unit ie........"Good morning Dr. X" one in particular once joking walked into the nurse station and said "What ever happed to the good old days when Nurses stood when a physician entered the Nurses station. We planned it our perfectly and the next time he showed up we all stood in unison and gave a polite Japanese style bow. Still for the most part we treat each other as a collaborative team. Since I am the only nurse on the unit who has any psych experience Dr's ask me "What do you think?" I offer suggestions of what I think and we go from there. I find it's so much easier when you make the physician your enemy. Besides the physicians are the ones sending us patients which generates revenue which in turn keeps us working........

Hppy

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I smell homework.......

I was guessing a med student or resident..

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I was guessing a med student or resident..

With a nurse "thing".

Physician's servant, lol.

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Specializes in Critical care (coronary care).

I thank you for the detailed answer. For several years I am working as a nurse in Iran. Now, I am teaching nursing students in undergraduate and postgraduate. ِ

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