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.
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.
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.
You would just have a bunch of patients with no orders. What good would that do?
Were you a paralegal? I am curious what sort of charges were brought against the nurse and for what situation. Any example you have would be very helpful information.
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.
This is absolute.
The very reason doctors "get away with it" is because they want to. From social, economic, and political realms they have worked to put themselves in the positions they are in. Because nurses are more than willing to "take it," get ticked off, and deal with it isn't because they only worry about caring for the patient or any other liberal, codependent mantra. It's because in the grand scheme of things nurses took a backseat and said, "hey, take the handlebars, drive this bike, and I'm gonna ride itch."
Nurses aren't trained to treat the patient. I get that. I also get that because nurses are, for good or bad, more invested in patients that they feel more ownership and responsibility, i.e. "I send 12 hours 'caring' for this patient, and you walk in for 3 minutes, hurt my feelings, and make my job harder." Unfortunately, there is a lot of crap that has occurred over the years that allows doctors to do what they wish while nurses come to this forum and merely sulk about it. If you've read Duhigg's The Power of Habit you can read about various truces and workplace habits such as Rhode Island Hospital. Nurses can do their jobs, take treatment orders, and otherwise function independently and maintain dignity. Instead, history, via social, economic, and political constructs, has led nurses do be the whipping boy of the healthcare system. It won't change fast. It can't change fast, but it can indeed change.
Competing with the docs' stones isn't a game of rock, paper, scissors. You can't cover it with paper forever. Eventually nurses are going to have to grow their own rocks, as a collective body. Although it's true, you're a cost and physicians are revenue, there are a lot more nurses out there than physicians.
I totally concur. Nurses are constantly given more and more tasks to complete which can cause anxiety in a nurse which can cause he or she to be in a hurry which also puts a patient at risk due to potential mistakes.. Seems like the focus has been on fixing or manipulating everything but workload which in fact poses a risk to patients well being.
The hospitals don't want to add more workers so you can have a more manageable workload. They want more money for themselves - the decision makers - the execs and the managers (who receive incentive compensation). Of course, if the hospital is non-profit, their books don't have to be made public, so we can never really know. They just tell us they are having a hard time making ends meet and yet they continue to exist.
I'm not sure why you believe the doctor wouldn't be held responsible as well. I'd imagine he would be.
In my facility, MD not held responsible. Treated like God (yes, happens at most facilities in my neck of the woods), but let a nurse miss one thing like that and it becomes a federal case, often with the nurse being left to feel very stomped on. I've seen it often here lately, both in my FT job and PT job...sad because we should all be treated as professionals
The very reason doctors "get away with it" is because they want to. From social, economic, and political realms they have worked to put themselves in the positions they are in. Because nurses are more than willing to "take it," get ticked off, and deal with it isn't because they only worry about caring for the patient or any other liberal, codependent mantra. It's because in the grand scheme of things nurses took a backseat and said, "hey, take the handlebars, drive this bike, and I'm gonna ride itch."
Nurses aren't trained to treat the patient. I get that. I also get that because nurses are, for good or bad, more invested in patients that they feel more ownership and responsibility, i.e. "I send 12 hours 'caring' for this patient, and you walk in for 3 minutes, hurt my feelings, and make my job harder." Unfortunately, there is a lot of crap that has occurred over the years that allows doctors to do what they wish while nurses come to this forum and merely sulk about it. If you've read Duhigg's The Power of Habit you can read about various truces and workplace habits such as Rhode Island Hospital. Nurses can do their jobs, take treatment orders, and otherwise function independently and maintain dignity. Instead, history, via social, economic, and political constructs, has led nurses do be the whipping boy of the healthcare system. It won't change fast. It can't change fast, but it can indeed change.
Competing with the docs' stones isn't a game of rock, paper, scissors. You can't cover it with paper forever. Eventually nurses are going to have to grow their own rocks, as a collective body. Although it's true, you're a cost and physicians are revenue, there are a lot more nurses out there than physicians.
This! Thank you, for eloquently adding what I was aiming for. :)
I can remember back when prior authorizations first started. Someone had the bright idea that the providers would be responsible for filling in these long annoying forms to justify the medication we ordered. A medical staff meeting was called within the week. We had a very brief discussion and unanimous decision that none of us had even the slightest interest in doing this task. Our medical director went to the ED's office and told him the physicians, NPs and PA will be doing no more than signing the completed forms and they needed to find someone to fill them in. You guessed it, before they eventually brought in admin staff to take it over, the poor nurses got stuck doing it.
My last 10 years in nursing were spent at a university hospital. Especially in July, if we didn't advocate for our patients the results could be tragic. And not just things NOT done for the patient!
To identify shortfalls in a patient's plan of care IS a sign of a good nurse. Where I see the potential problem is in the expectation of making us responsible for it. I am not a physician, it is illegal for me to prescribe medications. I have no problems discussing my patient's plan of care with the MD, but where do we draw the line of discussing care versus insisting on a prescription! And how do I chart this? Also, my nursing practice, as reflected by my charting, gets audited extensively. I am sure the same practice could be used to enhance the physicians' compliance with a standard of care and can be done by somebody other than the bedside nurse. Another solution would be to have protocols in place which include DVT prophylaxis or beta blockade in the face of an MI.
To identify shortfalls in a patient's plan of care IS a sign of a good nurse. Where I see the potential problem is in the expectation of making us responsible for it. I am not a physician, it is illegal for me to prescribe medications. I have no problems discussing my patient's plan of care with the MD, but where do we draw the line of discussing care versus insisting on a prescription! And how do I chart this? Also, my nursing practice, as reflected by my charting, gets audited extensively. I am sure the same practice could be used to enhance the physicians' compliance with a standard of care and can be done by somebody other than the bedside nurse. Another solution would be to have protocols in place which include DVT prophylaxis or beta blockade in the face of an MI.
Every time I called a physician with a concern that was not addressed, I documented it. "Patient's blood pressure has decreased from 120's/70's to 80/60. Patient complains of light headedness, dizziness, and nausea. HR is now 120 bpm after a trend of 60-70. Patient diaphoretic. Notified Dr. Jones of patient status and all vitals signs and objective and subjective signs and symptoms. No orders received. Paged Dr. Jones' attending physician."
ambr46
220 Posts
What?