Possibly Odd Question

nurseprnRN, BSN, RN · Feb 14, 2015

One concept that a lot of people get bound up in is what one profession "can do" and what another one "can do." This very basic and primitive concept of nursing (and medicine, for that matter) assumes that tasks and hands-on actions are all that anybody does and that there is a very strict two-column list, one column for nurses and the other for physicians, and never the twain shall meet because their respective educations are so very different. This outlook also assumes that there is one hierarchy in care, and that physicians are at the top of the only ladder there is, with nurses down a few rungs, nurse aids below that, and then EMS personnel.

It is true that nurses are legally bound to implement some parts of the medical plan of care. Not all of it, of course-- we don't do physical therapy, radiology, dietary, social work, or any of a number of things that are part of the medical plan of care but not within our scope of practice. However, there's much, much more to nursing than implementing physician prescriptions for the medical plan of care.

As it turns out, nursing and medicine share a very large body of knowledge and have quite a lot of overlap in psychomotor skills (the stuff you do with your hands). Furthermore, there is a very large body of knowledge and expertise essential to patient care that nurses, and only nurses, learn and practice autonomously, that is, without direction or evaluation by physicians.

So I hope the OP hasn't decided not to come back to this thread, because this is critically important information not generally appreciated by the public.

icuRNmaggie, BSN, RN · Feb 14, 2015

It certainly is an odd question. Where did you get the idea that a nurse needs permission from a doctor to provide basic first aid?

nurseprnRN, BSN, RN · Feb 14, 2015

I'm guessing TV.

redhead_NURSE98!, ADN, BSN · Feb 14, 2015

"Not fully dedicated to it:" all I need to know. Pick something else to do.

ETA this is probably one of the trolls from that medical student forum.

MurseJJ · Feb 14, 2015

I am considering nursing, not fully dedicated to it. i find it interesting though it is only one of the paths I could choose.
With th that being said, I have a question on the philosophy of nursing in practical usage.
The scenario is; you are in the field, and someone is cut very badly, the doctor tells you to apply pressure for bleeding. It's a bleed from something vital. Do you, as the nurse:
A: ask the doctor where to apply pressure, and then know where to apply it?
B: have to know where to apply pressure, and apply it?
This question may seem out there, but I feel as though, as someone only considering nursing as a career path, it's something I feel I need to know.
thanks,
Adam

Adam, hi. From your previous posts it looks like you're in high school, right? That's great that you're considering nursing. Have you shadowed any nurses? If not, I highly suggest you check out your local hospitals and see if they have a program for pre-health students to see if you can shadow nurses there. If they don't have that, then you should definitely start volunteering at a hospital if you haven't. Hospitals usually have programs for high school and college students in the summer that you may be interested in. You could also probably start volunteering on weekends during the school year if they have that. Just Google your local hospitals and look for volunteering opportunities. This really would be the best way for you to see what nurses do in the hospital setting (noting that there are nurses in many other types of health settings and facilities).

Could I ask why you are considering nursing? What other options are you also considering?

Many people sadly do not understand what nurses do or what nurses study in nursing school to become nurses. Many people think that nurses are doctor assistants, mindlessly following the commands of doctors and putting patients on bed pans. My absolute favorite thing is watching TV shows like Grey's Anatomy, where the doctors do lots of things that nurses in real life do, and the random "nurse voice"/"nurse blur" in the background just responds, "right away, doctor!!" to a command, then scurries off. Makes me laugh every time.

The reality is that in nursing, you have to be able to think. Yes, as an RN, you do implement the "orders" of providers, such as physicians. But did you know that those "orders" can also be from another nurse, such as a nurse practitioner? Also, as the RN, you must review the order, understand what it is for, what it is supposed to do, and if it really is indicated (does the patient really need this? is it safe to give/do to the patient?). If, in your own nursing judgement, you conclude that it is not safe (based on your assessment of the patient), despite the order of the physician, you would not implement it, and would inform the provider why.

For example, if the physician (or nurse practitioner) ordered a medication, if I'm the nurse, I would think, what is this medication for? How does it work? What are the side effects? What are the contraindications (reasons why it shouldn't be given)? I may have to assess the patient's vital signs, or their blood test results, and after that assessment, I may decide it is not safe at this time to give the medication, even though yes, it is "ordered". As a nurse, you must have that knowledge to make those decisions.

The fact is, implementing orders from another provider is only part of what RNs do. In nursing school, you will study anatomy, physiology, microbiology, chemistry, pharmacology (the study of drugs), pathophysiology (the study of diseases), health assessment and physical examination, and the nursing care of patients with different diseases, disorders, and health conditions (such as in medical/surgical settings, community health, psychiatric, pediatrics, ob/gyn, etc). In nursing school you will have clinical rotations in various health care settings. You will also have labs (besides the labs for your science courses) where you practice various "skills" necessary for nursing practice, such as taking vital signs, inserting foley catheters, administering medications in various ways, etc. After nursing school, you then will have to take a licensing exam, the NCLEX-RN. Once you pass this exam, you receive your state license to practice nursing, and you are an RN!

In nursing school, you will learn that there are many interventions that are "nurse initiated", while others involve "collaborative management" involving other health care professionals, such as physicians. As the nurse, if you walk into a patient's room and see that they are bleeding, you would do what you can to stop the bleeding, then notify the provider. Often, you as the nurse will be the one to ask the provider to order an intervention that the patient needs, based on your nursing assessment of the patient. Nurses do not wait to be told what to do.

Anyway, I know that's long, but I hope it helps. Feel free to ask any questions you have about nursing. Maybe you should also check out this website:

What is Nursing?

Also, I like watching Youtube videos. Check these out:

(A Day in the Life: Nursing at Michigan-love this one. shows different types of nurses in different settings at University of Michigan Health System)

(Nurses Shatter the Stereotypes-this one shows nursing doesn't fit into what people usually think it involves)

(The Future of Nursing: Campaign for Action)

nurseprnRN, BSN, RN · Feb 15, 2015

The reality is that in nursing, you have to be able to think. Yes, as an RN, you do implement the "orders" of providers, such as physicians. But did you know that those "orders" can also be from another nurse, such as a nurse practitioner? Also, as the RN, you must review the order, understand what it is for, what it is supposed to do, and if it really is indicated (does the patient really need this? is it safe to give/do to the patient?). If, in your own nursing judgement, you conclude that it is not safe (based on your assessment of the patient), despite the order of the physician, you would not implement it, and would inform the provider why.

In my continuing crusade to get all nurses (and AllNurses) to give a more accurate vision of nursing to eliminate the word "orders" and all its connotations of superior/inferior, boss/functionary, expert/ignorant, so newbies and wannabes like Adam will completely rethink their assumptions about what nurses are and do, I offer the following rewrite of this otherwise well-meant paragraph. Think carefully about how it changes the perception of nursing.

The reality is that in nursing, you have to be able to think. Yes, as an RN, you do implement provider prescriptions, such as parts of the medical plan of care. But did you know that those prescriptions can also be written by another nurse, such as a nurse practitioner? Also, as the RN, you must review the prescription, understand what it is for, what it is supposed to do, and if it really is indicated (does the patient really need this? is it safe to give/do to the patient?). If, as a result of your own nursing judgment, you conclude that it is not safe (based on your assessment of the patient), despite coming from a physician, you would not implement it, and would inform the provider why. Furthermore, much of what you do as a nurse will not be prescribed by physicians or other providers, but will be the direct result of autonomous nursing assessment, nursing diagnosis, and decision-making. The nursing plan of care will be your responsibility.

cayenne06, MSN, CNM · Feb 23, 2015

One concept that a lot of people get bound up in is what one profession "can do" and what another one "can do." This very basic and primitive concept of nursing (and medicine, for that matter) assumes that tasks and hands-on actions are all that anybody does and that there is a very strict two-column list, one column for nurses and the other for physicians, and never the twain shall meet because their respective educations are so very different. This outlook also assumes that there is one hierarchy in care, and that physicians are at the top of the only ladder there is, with nurses down a few rungs, nurse aids below that, and then EMS personnel.

It is true that nurses are legally bound to implement some parts of the medical plan of care. Not all of it, of course-- we don't do physical therapy, radiology, dietary, social work, or any of a number of things that are part of the medical plan of care but not within our scope of practice. However, there's much, much more to nursing than implementing physician prescriptions for the medical plan of care.

As it turns out, nursing and medicine share a very large body of knowledge and have quite a lot of overlap in psychomotor skills (the stuff you do with your hands). Furthermore, there is a very large body of knowledge and expertise essential to patient care that nurses, and only nurses, learn and practice autonomously, that is, without direction or evaluation by physicians.

So I hope the OP hasn't decided not to come back to this thread, because this is critically important information not generally appreciated by the public.

This is quite possibly the best description I've ever read of the relationship between nursing and medicine.

I also agree with you about using the term "orders." It's a very misleading and one-dimensional way to conceptualize the relationship between nurses and providers. (and anyway it's kinda weird to call it an "order" when I am often the one who called, explained the situation, and requested the intervention anyway lol. )

I take direction from providers and administer their prescribed interventions, but that is actually a fairly small part of my job. I work L&D, so maybe it is different, but while I might be titrating the midwife's pitocin drip or whatever, MOST of my time is spent in nurse-initiated interventions. I don't need an "order" for the vast, vast majority of what I do on any given shift. I work closely with providers due to the nature of L&D, but our interactions are collegial and cooperative.

nurseprnRN, BSN, RN · Feb 23, 2015

I take direction from providers and administer their prescribed interventions, but that is actually a fairly small part of my job. I work L&D, so maybe it is different, but while I might be titrating the midwife's pitocin drip or whatever, MOST of my time is spent in nurse-initiated interventions. I don't need an "order" for the vast, vast majority of what I do on any given shift. I work closely with providers due to the nature of L&D, but our interactions are collegial and cooperative.

Since you can't independently prescribe medications such as Pitocin, you are working under a set of standing protocols which have been written by a physician or physician committee for use in your area. You apply your knowledge and judgment when you make decisions about increasing, decreasing, or holding these parts of the medical plan of care. However, because of the difference between nursing licensure physician licensure, you're not actually doing this "without a prescription."

cayenne06, MSN, CNM · Feb 24, 2015

Since you can't independently prescribe medications such as Pitocin, you are working under a set of standing protocols which have been written by a physician or physician committee for use in your area. You apply your knowledge and judgment when you make decisions about increasing, decreasing, or holding these parts of the medical plan of care. However, because of the difference between nursing licensure physician licensure, you're not actually doing this "without a prescription."

What I meant by that is that most of what I do is provide direct, nursing-initiated care. Labor support, assessments, education, what have you. Implementing the medical care plan is only a small part, time wise, of what I do. But I think what you said is important in helping to understand the relationship between providers and bedside nurses. Providers develop a medical plan of care, and I use my knowledge and judgment to implement that plan, working with the providers (and other professionals) to make adjustments and changes as needed.