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.
Specializes in Cardiac, Transplant, Intermediate Care.
I work in a teaching hospital. We once had an event, where clopidogrel wasn't ordered for a stent patient. I see both sides of this issue. I also admit patients during non-business hours and have to go through a total medication reconciliation after they have been in the ED with a physician and an in-house pharmacy available. I don't mind having to perhaps be the last safety net in the chain of care-givers-- but on the other side of it, I will then ask management to hire support staff who are not very young, inexperienced, self-centered know-it-alls who refuse to do anything on the floor but get vital signs and blood sugars and then be hiding out somewhere on their cellphones when the nursing staff need them.
Specializes in Hospice, corrections, psychiatry, rehab, LTC.
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.
Physicians may be rounding after a full day of surgery, office appointments and who knows what else. They get tired. If I have to occasionally remind a physician of something, so be it. It is part of caring for my patient, and also of supporting the physician and his/her plan of care.
In my facility nurses are given a max of 5 patients and usually have around 4 patients. The hospitalist on the other hand will have all the med surg patients on average twenty or so, usually 5 ICU patients, and all the incoming admissions from the ER going to Med Surg. I don't think it is realistic to expect them to do head to toe assessments on them all as the OP has stated. Can you imagine doing over 25 head to toe assessments, progress notes, writing orders etc.. We are the last line of defense for our patient. Yes they do miss stuff but wouldn't you with that kind of workload? We are more familiar with our patients than they are. We spend more time with our patients because we have fewer of them to care for. So if we have to remind them about a beta blocker or dvt prophalaxis its not the end of the world
That's ********! I'm accountable for my job and so should they! If they can't keep up then there is a problem with the hospitals trying to make too much money with too little staff!! It is completely against the law for them to not fully assess their patients or someone alike such as a NP,PA,Resident, or fellow. They do not do a complete assessment.. Do u see them check their backside?? Ha right!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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
If you are unwilling or unable to advocate for your patient, you are not a damned good nurse or even a competent one.
Have actually been a member for several years, and a lurker for several years before that, but was unable to remember my user name because I posted so infrequently. Having said that and re-registered, just wanted to say that the above comment is one reason why I DON'T post messages here. Probably won't again. Do not like to read damning, blanket statements like this one, and do not want to send, receive or read any of its kind anymore.
That's ********! I'm accountable for my job and so should they! If they can't keep up then there is a problem with the hospitals trying to make too much money with too little staff!! It is completely against the law for them to not fully assess their patients or someone alike such as a NP,PA,Resident, or fellow. They do not do a complete assessment.. Do u see them check their backside?? Ha right!
If your hospital follows core measures, then it is your responsibility to ensure that those measures are met. When the C.N.A comes to me and says that my patient is in pain or has redness to the buttocks I know that assessing isnt technically theit job but I am sure glad they tell me. This is us all working together, cna, lvn, rn, doctor for one common goal- A better outcome for the patient.
Have actually been a member for several years, and a lurker for several years before that, but was unable to remember my user name because I posted so infrequently. Having said that and re-registered, just wanted to say that the above comment is one reason why I DON'T post messages here. Probably won't again. Do not like to read damning, blanket statements like this one, and do not want to send, receive or read any of its kind anymore.
Tempers flare when hot spots get touched. There are so many interesting topics and great discussions on here though. Hope you stick around. I am a relatively new user and love the variety of opinions but have seen the kettle get hot hot hot!
Horseshoe, tell me what a nurse does that is so life threatening besides carry out a physicians order?? lets think..hmmmm...give a med wrong? I take full responsibility what I give a pt and that's a complete nursing function. What else? Identify and notify a md of abnormal assessment findings? That's a complete nursing function and u should be held responsible if u miss something u are suppose to check and report..what else???? Help a pt oob and not have any falls? Yep all nursing too...can u think of anything? Oh I'll add label a specimen wrong? That's your fault too lol...failing to report a lab or test finding that is abnormal also is nursing...the nursing scope of practice cuts off there.. We can help and be "good nurses" all day long like asking for a diet or an activity order or telling the doctor what we think is going on with the pt or what we think they need but the physician is the deciding factor, the one legally responsible for all medication orders. A RN has no prescribing authority! We can recommend but that's it.. In court u cannot be sued because u didn't recommend something to a physician.. If so please give example and help me understand...
In a situation in which there is an established standard of practice that is not met, YES, a nurse can be sued and held liable for not advocating for the patient. That doesn't mean the physician won't be held to account as well, but you are absolutely wrong that nurses can say "hey, I can't prescribe meds, this isn't my problem."
Whenever there is a lawsuit because a negative outcome occurred due to negligence of omission or outright malpractice, everyone involved is sued. Sometimes, as the lawsuit proceeds, various personnel are dropped from the suit, and it comes down to the doctor and often a few of the patient's nurses who are pursued. You better believe that nurses are held accountable when a situation occurs and nurses do not speak up and advocate.
Before I became a nurse, I worked for a personal injury lawyer. I am not a lawyer and am no expert, but I can say absolutely that nurses have been sued and found liable for failure to act. Sure, if you catch a mistake and lobby for a certain medication or intervention and the doc fails to respond or even overtly refuses to act, you document, document, document, get supervisors involved, etc. and you are going to be okay in most cases. But ranting that it's not your job, you're not there to babysit the docs, etc., in a situation where there is an established standard not being met-you are toast.
Don't kill the messenger, these are the facts. The scope of a RN includes the responsibility to recognize mistakes made by others and take action to intervene in the patient's best interest. Don't do that in a manner that any "reasonable" RN would and you can very well find yourself in a very bad place.
Yes, we are supposed to nag the physicians ... I mean remind them of SCIP protocols. I get the sense that it comes back on us if beta-blockers and other things aren't ordered. And yes, it gets tiring. I'm really busy on my Med Surg floor and don't really have extra time.
Maybe nurses are the real doctors. How about that for a thought. If you have 20 patients and 2 doctors without nurses, or 20 patients wit 2 Nurses and no doctor. Who has the better outcome? I'd say the nurses.
Beatlefan, BSN
63 Posts
I work in a teaching hospital. We once had an event, where clopidogrel wasn't ordered for a stent patient. I see both sides of this issue. I also admit patients during non-business hours and have to go through a total medication reconciliation after they have been in the ED with a physician and an in-house pharmacy available. I don't mind having to perhaps be the last safety net in the chain of care-givers-- but on the other side of it, I will then ask management to hire support staff who are not very young, inexperienced, self-centered know-it-alls who refuse to do anything on the floor but get vital signs and blood sugars and then be hiding out somewhere on their cellphones when the nursing staff need them.