responsibilty

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I'm currently about to start my clinicals so the I know that its not unusual for the instructors to warn us to always be extra precautious. That I understand. What I don't understand is how it seems that as a RN, I would be responsible for looking over EVERYONE else's job. She basically said that RN's are responsible for the pt., the people under them (LPNs aids), the pharmacist to dispense the right drug, the doctors to prescribe the right drug and to alert them of any unsual finding in lab results. If any of these people make errors, it is my legal responsiblity to detect it since at the end of the day, I'm the one administering the medicine or signing my name at the bottom of the chart.

She said that you are legally responsible to TRIPLE check the above so that everything is right. If the doctor prescribe the wrong medicine or the wrong dosage, it is my responsibilty to know better. But isn't that why HE is the doctor making the big bucks? My question is, is there anybody looking over us? I know that it is the real world out there, but this really scares me. I know nursing is rewarding and what not, but it seems like it is also such a taxing job (physically, mentally, emotionally, legally).

Its just frustrating to know that since I am only human, I will make mistakes. Now I have to worry about other people's mistakes too.

Is this worth it?

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Specializes in High Risk In Patient OB/GYN.

Yes, it's worth it, or no one in their right mind would be doing it.

Most of those things are very much common sense.

Pharmacy--why wouldn't you check to make sure that they did indeed send up Ampicillin 1g IVPB and not Gentamycin or Clindamycin or PO amoxicillin? And check that it's the right patient? I'd want to do that even if it weren't my legal obligation to do so. NOW-if pharmacy sent you up with a bag Labled "Magnesium Sulfate 20 grams in 500mL Steril H2O" and you run it at the rate prescribed--let's say 50 cc/hr which is 2 grams per hour, and the patient developes magnesium toxicity because the bag actually contained 500grams in 500mLs (very unlikely, but let's just use it for number's sake)-THAT is not your fault. Although, hopefully you were assessing the Pt as per protocol, picked up on the s/s of Mag Tox and intervened in time. ;)

LPNsCNAs--If the CNA is supposed to do a finger stick at 10pm, then you need to make sure that not only was it done, but that it was within normal limits for that patient. Again, forget about legalities here. Wouldn't you want to know that your patient's blood sugar is 450 BEFORE the resident notices it at 6am rounds? I sure would. (FTR-for the most part, the CNAs I've worked with were great as far as notifying the RN or LPN about results, etc)

Doctors--If a doctor ordered Tylenol 975mg q4h PRN, yes, you should know that that's too much. If he orders Amoxicillin 500mg PO when the Pt. is severely allergic to PCN, yes, you should know that there's an error there. In the begining especially (but also the seasoned nurse)-look things up in the PDR. If a dosage seems weird, ask the doctor. Sometimes there's a real reason-ie with Cytotec. Usually it's a once daily PO med (when used for preventing ulcers). In inducing labor or abortion, it can be inserted lady partslly or rectally, sometimes a few pills at a time. Either way, you stand to learn a lot.

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I can not remember when I found out that I was responsible to insure that the MD had written a correct prescription, and that it was more than just administering what the doctor ordered. If you think you are scared now, wait until you hear the words that you are being sued. Nothing will bring home the gravity of a nurse's "responsibility" and "accountability" like getting that news.

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Specializes in Trauma, Teaching.

Its not so much that you are responsible for them, as it is that you are responsible for knowing what you are doing is right. Doesn't matter if the doc wrote for 200 mg of Morphine, if you give it somebody dies. 2 mg is normal! Or even 20 for some cancer patients. Since we (as nurses) are 24/7 in the hospital, we are the patient's safety net or safeguard. Its comforting to know somebody is looking out for you when you are on the receiving end.

So, if it doesn't seem right, stop and check out what you're doing first, don't just assume that because someone else is a professional with a lot more experience that they can't make a mistake.

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Yes, it's worth it, or no one in their right mind would be doing it.

Who said we're in our right minds?

Everyone said it quite well. You aren't exactly responsible for every little thing the others do, but you ARE responsible for what YOU do, and that includes knowing what's right and what's wrong.

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Specializes in High Risk In Patient OB/GYN.
Who said we're in our right minds?

:p

Relatively speaking, or course. ;)

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Is the OP totally freaked out about nursing now, or willing to come along for the ride anyway? ;)

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Specializes in Critical Care, Pediatrics, Geriatrics.

It's worth it to me. Those who shy away from responsibility might not agree that its worth it though. LOL.

The healthcare system is full of checks and balances. That's one reason you check behind everyone. It promotes pt safety.

You are operating under an independent license and have a certain degree of autonomy. You are being paid for your ability to assess the pt's status and implement interventions accordingly, or prevent them (as in holding medication/questioning an order). If you simply were following written orders blindly, your autonomy would be nil, and your pay would match as well.

Registered Nurse is a leadership role, even as a floor nurse. You direct patient care. The LPNs and CNAs follow your lead in the plan of care for that pt. It is your job to ensure they can appropriately carry out the tasks delegated to them without causing pt harm.

You have to become comfortable with these responsibilities. It is the nature of the job description. Sure the MD treats the disease, the Pharmacist sends the medications, the CNA assists with vitals and hygeine, PT sees the pt for ROM/Rehab, Dietary is seeing the pt for their nutritional needs...BUT the RN is coordinating pt care...you are the centerpoint ensuring that all the pieces of the puzzle match up...you are like a mini-manager for that pt...you ensure safety and quality. That is an awesome responsibility and a very honorable job!

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Specializes in Med-Surg.

Yes, it's worth it. Rarely does anyone loose their license for a mistake someone else has made.

That said, I had a coworker go before the BON because she gave a med the patient was allergic too. The patient coded, but is o.k. The doctor ordered it, the pharmacist dispensed it, and she gave it. The BON was not interested in hearing one word about the MD or the Pharmacist, but her own mistake as a nurse. It was a devastating experience. This was quite a while ago and I'm not sure what ever happened to her, but she didn't loose her license and the rules around here changed, especially in the pharmacy.

We can never ever let our guards down. We must always follow our checks and balances and never cut corners.

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I was intimidated too, at first. Then I realized that its not so scary as it sounds. I check the meds--right med, right pt, right dose, right route etc etc. I look up every med I am not familiar with in the Lexi-comp, and then if I still have questions I call the pharmacist and often talk to other nurses as well. Just to make sure. You will find that there are certain meds you will use far more often and you will become familiar with those.

Be cautious and be alert. But don't be frightened.

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