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.
Considering the consequences to the patient if they do not receive DVT prophylaxis or beta blockers, bringing the missing medication to the physician's attention is the only safe and legal thing to do.
As a student, part of studying for the NCLEX is dealing with questions that list a bunch of doc orders for some kind of procedure prep and then ask, "What order would the nurse question?" or, "What order is missing?" So, I'm guessing if a pt needs their DVT prophylaxis or beta blocker and the doc didn't order it and I know it should have been ordered, I guess I'm going to go ahead and ask about that instead of waiting for the doc to suddenly remember to do it. I'll take being safe and within the law over being passive aggressive toward the doc any day. Now, if the doc was telling you to just put in the orders yourself, that's a bit of a different story........because then, you're actually doing the physician's job.
But, I can see it being aggravating that orders that are part of standard care and should basically be rote memory are being forgotten.
I totally agree that I have an ethical, moral and legal obligation to ensure that core measures are addressed.
But I can also see the irony in having a QI "team member" demanding that the nurse get this done. I would have a hard time with that and refraining from
saying:
"So your job, is to tell me, to tell the physician, to do his job?"
The job descriptions of most RN QI Specialist shows they work with all disciplines, not just Nursing. So, they should be directly talking to the doctors.
I totally agree that I have an ethical, moral and legal obligation to ensure that core measures are addressed.
But I can also see the irony in having a QI "team member" demanding that the nurse get this done. I would have a hard time with that and refraining from
saying:
"So your job, is to tell me, to tell the physician, to do his job?"
Yes, I agree with this. If someone is monitoring the core measures, that person should be calling the HCW who has neglected to address them; physicians should not be given a pass here. If the nurse notices an omission first, yes, she can take action by calling the doc. But if someone has been hired with the sole job of monitoring and obtaining compliance with these measures, it's absurd for her to call the nurse over an omitted physician order.
Medication reconcilliation takes teamwork, it's not not just the physician's and nurse's responsibility but is the pharmacist's responsibility as well, I have frquently seen pharmacists alert physicians of medication ommisions.
Oh, I did leave. I gritted my teeth & did a year of med/surg and then went to hospice, what I truly wanted to do. And I love it.
For me, hospital/bedside nursing was not fulfilling. They kept adding checklists to do, chart the same thing in 5 different places, chart audits, fall precaution checklists, and on & on.
I had a pt fall and at the RCA I told them all the signs, bracelets & checklists weren't going to help..,the only thing that stops it, is being able to check on the patient! But with 7:1 ratios & all the checklists & charting...
I guess I'm anal, but because I HATE to be forced to get on the telephone and chase docs for order clarification once they have escaped the unit, I've been known to grab the chart right out of their hands to check for completeness and legibility, at the same time saying, 'Don't you take a single step until I make sure these are right!' You would not believe some of the reactions I get but all have been positive. Most chuckle. I totally horrified a new oriented I was precepting but like I told her: It's 95% about the patient and 5% CYA!
I guess I'm anal, but because I HATE to be forced to get on the telephone and chase docs for order clarification once they have escaped the unit, I've been known to grab the chart right out of their hands to check for completeness and legibility, at the same time saying, 'Don't you take a single step until I make sure these are right!' You would not believe some of the reactions I get but all have been positive. Most chuckle. I totally horrified a new oriented I was precepting but like I told her: It's 95% about the patient and 5% CYA!
They are probably relieved because it reduces the chance of them getting called during dinner with their families to clarify orders they know deep down they should have written. I was like that too with docs, and they sometimes would sigh as though I was making their lives hard, but we both knew that the opposite was true.
When you gain the respect of the docs with whom you work, AND you establish a good rapport with them, they will often just say "Nurse Jones, what do you want for this patient? Ask and ye shall receive!" It's often said as though in jest, but it's actually the reality. When they know that you are smart, know what you're doing, and care about their patients as much as they do, they are all too happy to comply with your demands, er, requests.
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spitcher2
5 Posts
Same here. Make sure it get's ordered and file an incident report on the MD. Next....