Nurses have to know so much - partly play the role of doctor and pharmacist!

Posted
by Nunurse0821 Nunurse0821 (New) New Pre-Student

I feel like we have to play the role of pharmacist somewhat (knowing side effects and contraindications) and doctor somewhat (if they prescribed the correct drug, route or dose and if they considered the allergies ) and we are responsible for knowing if they have made a mistake. When I become a new nurse I feel like this gives me so much to be responsible for and it scares and overwhelms thinking that I might not catch a mistake they made. I just feel like this is a lot to put on nurses, especially new nurses. Can anybody make me feel less stressed out or put things in a different perspective? I feel like we have to know a little bit about everything and that's kinda overwhelming to me. Thanks! 

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN

Specializes in Med/Surg, LTACH, LTC, Home Health. Has 35 years experience.

Here’s my 2 cents worth: we’re not responsible for knowing if the doctors or pharmacists have made mistakes. They are responsible for their own due diligence to safeguard their license and protect patients’s lives. It is the expectation of nurses to speak up if we see or feel something that we’re unsure of and ask for clarification before administering a medication in question since we are typically the last line of defense before an error reaches the patient.
 
****If you sense or know something is off and don’t stop to question it, then you may be culpable.**** 


Again, that’s just my take on it. In my new role in primary care, I refused to accept a document that was meant for the provider. Basically it was a list of notes they had not signed off. I explained that it is not my job to make sure the doctor signs his notes. It is the responsibility of providers’ supervisor to check behind the doctors and NPs. I said I was not going to check behind subordinates, myself, and higher-ups, too. Let’s share in the accountability thing. 
 

As a result, they’ve begun to give that list to the responsible persons (no matter the title).  If we continue to accept these tasks that are not ours, they’ll continue to hand them to us. We canNOT own EVERYTHING. But we are ALL responsible for patient safety.

But I do try to be in the know as much as possible. If you know what they’re supposed to be doing, then you’ll also know what they can’t hold you responsible for. I’m just nosey like that.😁😁

verene, MSN

Specializes in mental health / psychiatic nursing.

Yes, RNs do have to know a lot of information. However, the most critical thing is to know where to find information.  Memorizing every medication and every side effect isn't necessary. Knowing  your medication classes and common side effects and rare/life threatening by class is important (and a lot easier to learn than trying to memorize for every single medication you may see).  

You'll also find that in practice certain medications will be commonly prescribed in your practice setting and you'll want to have a good handle on those, for ones you see less commonly - it's more about the ability to look up the information.  Do you know where the drug guide is on your unit and how to quickly look information up? Do you know how to run a medication interaction report in your e-mar? 

You are not responsible for the Attending making a mistake, or the pharmacist making a mistake, you are responsible for knowing enough to be able to identify obviously life threatening or weird issues and to take  a pause and ask questions before it hits the patient.  (E.g. when taking meds out of the omnicell if the drawer is stocked with the wrong med this isn't your fault, what would be your fault is if you don't look at the medication package and realize what you are holding doesn't match what is ordered in the MAR).  

If a patient is asking for more information on a medication it's okay to say "I don't know a lot about this medication, but let me print out one of our information sheets for you" or "Let's look up this information together".  (which I've totally done numerous times with patients, and most are totally okay with you not knowing the answer to a specific question so long as you can find it for them. I've found that fact that I'm willing to pull out a drug guide to verify information and show them the page, or print off a patient education hand out, or get a pharmacist on the phone or to come to the unit to walk us both through it actually tends to bolster patient confidence). 

Yes, it does feel terrifying and overwhelming at times, but in practice you typically get into a good flow and get to know your specialty area well, and as long as your are following the 7 patient rights of medication administration, you are unlikely to get into serious issues. 

Even as an NP I don't know everything. It's totally normal for me to stop and look up a medication, side effects, dosing rates, run drug-interactions etc particularly for medications I don't prescribe as often. If I have concerns I'll also chat with a pharmacist and have them help me review interactions and/or literature about the medication.   If I don't know the answer when a patient is asking me - I'll tell them I need time to research it and will get back to them. So long as I do get back to them, patients are typically able to be patient and recognize I that I'm taking the time to make sure I'm giving them accurate information. No one is expected to know everything, but you are expected to recognize when  you don't know something and to know what your resources are for finding our information when you need it. 

 

 

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

This concept extends out of the hospital realm as well. As a legal nurse consultant I can't testify on physician (or pharmacy) standard of care but I can sure as heck recognize it when I seet it, good or bad, and look them uip to verify. That's when I point out my concerns (or lack of them) to the retaining attorney, and offer to find a testifying expert of that specialty to give an opinion under oath.

It’s not about you being responsible for their mistakes, it’s about you preventing harm to the patient by recognizing and pointing out mistakes..

 

Tegridy

Specializes in Former NP now Internal medicine PGY-2.

I think as a nursing student it would be more prudent to look out for your own mistakes prior to presenting the premise as your going to prevent mistakes of those more experienced. It may happen occasionally but honestly you probably don’t know the dose or indication or contradictions to most medicines we use. 

Edited by Tegridy