Nurses expecting to do too much!

[CosmoRN77]

Hello there,

I have been a RN for 15 years now and there is something's that just gets under my skin and would like to know if anyone can relate.. As nurses at the bedside we have tons of responsibility and many tasks which I'm sure u guys are already aware of... Now here is my beef... More frequently I see where the hospital administration is pushing nurses to make sure the doctors are doing their responsibility such as making sure a post MI patient is prescribed a beta locker.. Now I'm all about nursing but I'll be damned if I'm gonna sit there and tell a doctor what he needs to be prescribing to his patients as he is the ultimate one responsible for medication reconciliation and proper medication ordering.. Another example is DVT prophylaxis... They are wanting us to make sure this has been done for patients.. Another no no for me.. I strongly feel this is overstepping our obligations as a nurse.. And I don't want to hear ANYONE mention well a "good nurse" would do this for the physician and patient.. Because I'm a damn good nurse but do not tolerate doing the physicians job.

Hope to hear some feedback!

Thank

[KatieMI, BSN, MSN, RN]

I was one time in a place which took several nurses (which, to tell the truth, were with long experiences but still without enough critical thinking to safely manage more and more critical patients... I hope everyone here knows what I am talking about) and promoted them to "bedside quality control" and charged them witn implementing the said core measures and more of it.

The result was utter disaster. I do not know if all and every one of those nurses was such an ardent policies' kisser and what they did before, but I saw one of them literally throwing hysterics when seeing CBG of 69 with no any other signs/symptoms and patient being given a planned meal instead of policy-prescribed OJ. Another one made an RN to call a doc in the middle of the night for b-blocker order because patient had CHF, with third degree block, atropine and pacer at bedside at all times. it was trouble of poorly imaginable proportions, for everyone involved.

IMH (umble) O, if someone can prove, with numbers in hand, that such quality control is beneficial, then the people charged with these responsibilities must be at the very least mid-levels with related experience. They, at least, will not mindlessly make marks just because some policy paper. They will, hopefully, think before putting a human being on four anticoagulants at once (ASA for CAD per core measures, coumadine for afib per the same and no insurance coverage for anything else, Plavix and pentoxyphilline for peripheral stents by surgeon, and heparin sq because of hospital policy).

[Jules A, MSN]

I understand the frustration as it is just one more thing that really the MD's should be doing without nurses holding there hands to get it done. Missing an order here and there is one thing but now it's our responsibility to make sure the MD's aren't missing these things so we get payment from Medicare, etc. because hospitals are losing out on money reimbursements for MD fall-outs. Yes, it's in the best interests for the Pt but I don't see why there's such a backlash for a nurse venting and calling out the BS of the situation honestly.

I haven't read the entire thread yet but didn't want to lose my train of thought, lol. I agree and as a provider while I much appreciate my nurses politely questioning my rationale if I seemed or did miss something there is no way I'd tolerate the hospital telling them to monitor my prescribing.

To me it smacks of them being afraid to piss of the Docs but shoving the nurses in front of the firing squad. It isn't your responsibility and if there are so many instances that the hospital would take this stance they need to address it with the providers. A no brainer would be to put in automatic flags on the computer. Our system stops us if we don't address certain issues such as DVT preventative.

[Jules A, MSN]

The OP had me until the Doc bashing started. After reading the rest of the thread it sure seems like a large portion of this is once again nurses being willing to do whatever is requested and just taking on more tasks while whining about it but doing nothing to address it or setting boundaries with their employers.

Then comes the Doc bashing, not cool, they should be videoed? their schools are dumbed down like what...perhaps the many fabulous nursing schools out there accepting anyone who can write a check for tuition? Patients are dying because Doctors are so careless? and I guess I can surmise that nurses are single handedly saving lives and stamping out diseases? Wow.

The bottom line imo is if nurses had the stones Doctors had they wouldn't tolerate this type of silliness or feel so put upon or perhaps as this thread seems to indicate being a martyr part of the appeal?

[Julius Seizure]

The bottom line imo is if nurses had the stones Doctors had they wouldn't tolerate this type of silliness or feel so put upon or perhaps as this thread seems to indicate being a martyr part of the appeal?

oh snap!

[emmy27]

The OP had me until the Doc bashing started. After reading the rest of the thread it sure seems like a large portion of this is once again nurses being willing to do whatever is requested and just taking on more tasks while whining about it but doing nothing to address it or setting boundaries with their employers.

Then comes the Doc bashing, not cool, they should be videoed? their schools are dumbed down like what...perhaps the many fabulous nursing schools out there accepting anyone who can write a check for tuition? Patients are dying because Doctors are so careless? and I guess I can surmise that nurses are single handedly saving lives and stamping out diseases? Wow.

The bottom line imo is if nurses had the stones Doctors had they wouldn't tolerate this type of silliness or feel so put upon or perhaps as this thread seems to indicate being a martyr part of the appeal?

Yes, differing management treatment between medicine and nursing has nothing to do with power differential between the two roles within organizations, the relative supply and demand of those types of workers, the perception that medicine is a profit center while nursing is a cost center, the historical or legal roles of nurses and doctors, or even the tiniest hint of classism or sexism. It's all right down to docs having "stones" and nurses enjoying being martyred for sure.

Trenchantly observed.

[icuRNmaggie, BSN, RN]

I am truly over having to babysit people who avoid all responsibility for the most basic functions of the job that they were hired to do, especially pharmacy, imaging and respiratory.

If someone whose job it is to monitor CMS core measures called me instead of the physician, I would put her on hold and transfer that call to the attending.

If that isn't an option I would get her name and number and send it to the MD via the encrypted text paging system, as in "Sally RN x 4444 has questions about Mr Smith's core measures."

[NurseFifty]

I am curious, does the hospital penalize you in any way if you remind the doctor but he/he still fails to prescribe the DVT prophylaxis? Can anyone please provide a link to some lawsuits on nurses not successful in convincing doctors to do their MD jobs?

I think: your job at that hospital includes reminding the doctor. Advocating for your patients is a guiding principle of your practice. But, in the end, I don't believe you can be held responsible for another clinician's decisions or actions. You can only be responsible for work that is within your scope of practice where scope of practice is defined by law. I don't think we RNs can be held liable in a lawsuit because the doctor did not listen to us. But of course, your hospital can fire you for not carrying out a hospital policy on what they expect their RNs to do in their hospital. Your circumstances is different from mine and so I might not be able understand all your considerations for continuing to be in your current job given your complaint...but if it were me, if the "reminding the doctor" part of my job overwhelms the rest of my work then something is really wrong with the hospital. Reminders are supposed to be on a limited number of instances when the doctors forgets, and not a regular occurrence. If the doctors are not able to fulfill their responsibilities, then the hospital administration should try something else to "help" them be more responsible. First, I would bring the issue to my Nursing manager's attention. If the hospital administration continues to not take action directly with the people directly involved(the doctors) and instead passes the buck to some other people (the nurses), then that sort of process risks safety. I would not want to be involved in that kind of hospital. There are other places to work.

[icuRNmaggie, BSN, RN]

It is ridiculous that there is a nurse in charge of compliance with CMS core measures, using her position to create more work for bedside nurses.

Just to be clear, I will follow through on ensuring that core measures are addressed, but I do not take commands from another nurse or anybody else.

[hawaiicarl, BSN, RN]

I have mixed feelings on this. I understand the OPs point of view that a lot of extra administrative type stuff seems to get dumped on the bedside nurse. Personally I am permanent charge in an ICU, who gets a full patient assignment, and is also the code nurse, and the RRT nurse, then gets charge nurse projects, etc etc ... so I feel their pain. On the other hand if the hospital wants to get paid by insurers, and get decent hcaps scores, and have decent patient outcomes, all those little boxes need to get checked off by someone, someone doing direct care on the patient. Then after all the boxes get checked, someone in QC can audit them to fill out the compliance rate. I guess in the end I feel sort of like it is a necessary evil.

Cheers

[Nurse3000]

That's a valid point. Docs are only human and forget things/make mistakes too. At the end of the day we are all part of the same team working for the patient.

[Nurse3000]

we are working in a multidisciplinary team in th pts and other parties' interest.

[CrazierThanYou]

I agree. I'm tired of being expected to do the doctors' jobs for them. If they want us to babysit the docs, then perhaps our salaries should align more closely to ours.

Where I currently work, we have a real problem with day shift hospitalists dropping by and telling a nurse they are going to order this or order that. It gets passed on to us on night shift, but we never see an order because while the doc SAID he was going to order it, he never did. If I am only told heresay in report and never see an order, I'm not going to follow that order. It's ridiculous.