Question about total patient care.

LouisVRN, RN · Apr 16, 2010

Hi everyone, I'm a student nurse set to graduate this June, yay! :) Anyways, I'm doing a case study on total patient care and I have a couple of questions. We have to use something called the four organizing principles and one of them is who is responsible for making what decisions. With regards to TPC, is the RN or the physician responsbible for actually making the desicions? Another organizing principle is who is overseeing the process? Would this be the RN, physician, or nursing director? Thanks for any help!

What do you mean by total patient care? We have whats called primary nursing on our floor, which from what I can find seems to be similar, basically the RN is responsible for ensuring any consults have been made, that those doctors have seen the patient, that dietary, RT, CM, SS whoever is seeing the patient IS seeing the patient, aware of changes in the patient status and aware of the patients anticipated discharge date and any barriers to discharge. The physician is of course responsible for the final orders, but it is the RN who will try to advocate for the needs of the patient and keep everything organized and everyone on the same page. As far as who oversees the process, at our facility its the charge nurses.

brownbook · Apr 16, 2010

Seems like all the answers would fall under "the chain of command." The nurse is responsible for the patient she is assigned to. Depending on the insitutions protocols or policies the nurse is allowed to (and in some cases must) do nursing interventions on her own "make the decision." She then might (depending on the intervention) notify the doctor of what she had to do. Who oversees the process? The doctor is responsible but a doctor might be in the hospital 1/2 hour out of 24 hours to see that patient. He can't oversee what he doesn't know about. The nurse would be responsible to notify the doctor so he can "make decisions." The nursing director can only assist with (or hinder) what the floor nurse informs her about as she would be part of the chain of command. "Dr. S notified and no new orders noted," is acceptable documentation. But for a serious medical issue that won't hold up in a court of law. KNOW YOUR CHAIN OF COMMAND!