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.
These are not already parts of order sets or protocol for MI patients it patients at risk for DVT?
Yeah at one place I work its a 5 step time suck that is mandatory for every single admission. I'd guess the providers in peds and NICU are probably burdened with it also. The pendulum has swung way too far in the other direction.
The pt always comes first so that means we hold all members of the team to the highest level. Md,nurse, hospital admin and all responsible for their care!! Why are nurses vilified if they demand others do their jobs. It feels to be a good nurse we quietly do others work for the good of the pt. The doctor is eating his free lunch in the cafeteria while we quietly go 12 hours without voiding our bladder.if you want to give all the pts the best care take care of the nurse.Decrease htn,DM, burnout .I love nursing but being a martyr goes too far. After 32years I'm a team player but martyrs aren't on my team. WE ALL DO OUR JOBS.The hospital admin will have you doing the mds job as well as engineering,pharmacy pickup, and since you only have 3 pts in icu... Empty the trash
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.
But should nurses be held liable if the physician isn't reminded to order these things?
What is our (nurses) job description? X*!@) Bleep, bleep, bleep!!! Bc it pretty sures seems like anything else no one else wants to do, make it the nurses responsibility (without any raises, extra pay, or a decrease in other duties to offset the SATURATED WORKLOAD!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)
Who's to say the doctor isn't disciplined? If you have concerns about a specific MD repeatedly making the same errors, then you need to talk to his/her superior, or fill in incident reports, to make it clear there's an ongoing problem.
As to the nurse getting in trouble, unfortunately, that's part of being the last line as the bedside nurse; if we don't catch a mistake or omission, there's nobody between us and the patient to flag it up.
We are NURSES! Why is it our responsibility to manage doctors and perform write ups? Medicine is a different discipline than nursing. There should be a management team member performing those write ups, audits and reporting. Many nurses don't even get lunch breaks...So where is the additional time going to come from in order to keep doing consistent multiple write ups every day?
You can just say to the doc "Do you want to add a beta blocker". Simple.
If you can find the doctor. If the doctor will return a page or answer the phone. I am busy trying to make sure this elderly lady doesnt get up and fall out of bed bc of the refusal for an order restraint and sitter.
Everything is simple until you add on another simple thing, and add on another simple thing and on another simple task and another simple procedure and add on another admit, then its just one discharge and then its just one more checklist, then its only one extra quadruple documentation requirement but needs to be placed in another spot, and another simple sign off sheet, and its a simple screening question, and only one more iv to start, only one foley to insert, and only one more time to replace the telemetry batteries in the monitor, and simple task of following up with one family member, its only one transfer from icu, its only one more board u have to update and one more careplan, and one more incident report, its only a simple one page report to fill out b4 the patient leaves the floor, a simple check on a lab b4 u give this med that was ordered by the doctor, a simple call to let doc know the patient refused, a simple crashcart check, a simple order reconcilation form, a simple order clarification, a simple restraint documentation form , a simple order requisition for supplies, a simple placement of this sign to go on the door that's located a mile from the nursing station, a simple task to place the 300+ pound patient back in the bed after Physical therapy left them out, a simple page to remind Resp therapy about the scheduled breathing tx on the MAR, .....etc.
None of these things are complex individually but add it all up together.
I need this profession to simply get it together. Can we stick together and have each other backs and make our work environments just a little more tolerant by at least asking other disciplines to not just DUMP tasks on us because it's just one simple thing to do????
I worked in a fairly small hospital in the past and they had standing orders for so many things. The Doctor would have to sign them, and a few orders on the page would have a box for check off but it was done ahead of time. Would that work in bigger places? It's been a few years since I have worked in a hospital but how that do?
Of course, nothing is simple. This is Nursing. The question was whether it is the nurse's duty to bring this to the doctor's attention. The facility says it is, and is there another way to get an order from a doctor other than contacting the doc? My point is that we can maintain professional demeanor with the doc by just asking.
I agree that it is part of the role of nurses to advocate to the best of our ability for our patients, including making sure physicians fulfil all their obligations to the patient. However, over the years several employers in my experience have turned a blind eye to physicians practicing while cognitively or chemically impaired, leaving the RN holding the bag. That I resent very much, because those same administrators that do not want to bruise a physician's ego by holding them accountable, would never be that accommodating to a nurse in that situation.
We are NURSES! Why is it our responsibility to manage doctors and perform write ups? Medicine is a different discipline than nursing. There should be a management team member performing those write ups, audits and reporting. Many nurses don't even get lunch breaks...So where is the additional time going to come from in order to keep doing consistent multiple write ups every day?
I didn't say to write up the doctor. As staff nurses, we don't have the authority to do that. I said fill in incident reports, or do whatever else your facility does to highlight adverse events or breaches of policy that could or do have a negative effect on patient care/outcomes. If you have a steady stream of paperwork coming in saying that Dr. Z repeatedly forgets this one thing, his/her superiors won't be able to sweep it under the rug, and it will also help CYA.
QI should tell doctor to put the order in! I thought computerized charting was so doctors can put their own orders in and to cut down on the verbal orders. Crazy contradictions in management.
CosmoRN77
51 Posts
Coming from someone who obviously doesn't pay attention to legalities.