RN rounding for Doctors?

[traumasurgRN]

In the hospital I am currently working at, I have noticed that many of the general surgeons, neuro surgeons, and even the pulmonologist have experienced icu Rn's who round for them, write orders, and take first call for them. Is this a common practice in other hospitals? The Md comes behind the RN and signs off the orders they write as a VO.

[traumaRUs, MSN, APRN]

They aren't APNs?

[meandragonbrett]

Yes, it is fairly common to have Rounding RNs who pre-round on their patients and write their notes and write orders.

[traumasurgRN]

No, they are not APNs, just RNs. Several have actually came from my trauma icu.

[jadelpn, LPN, EMT-B]

Experienced or not, that is taking a huge risk. Especially because they are not APN's. Because they are employees of the hospital, and not of the individual MD (and MD's who privately employ RN's can have leeway as they can direct under their own license and take responsibility--but I am quite sure that the MD's can't direct their office RN's to round for them) I would think that quality assurance/utilization review would be all over this--unless there's a policy in place that allows this, but that would be an interesting ethical debate. Opens up to a ton of malpractice issues. Never underestimate the power of the patient who is on to the fact that the MD doesn't and hasn't rounded, but the RN has. And as far as I had learned Jhaco and the like are discouraging the use of the verbal order. It perhaps will only take one time of an RN writing an order that the MD will not sign as he/she is not in agreement, then all heck will break loose with this practice. Whether you believe you know what is best for a patient or not is non withstanding. Seems like a cushy gig for the MD's. They are not obligated to sign off on an RN's orders she makes up herself, however, give a malpractice situation, the axe falls on the RN who illegally is practicing medicine. And lets call it what it is.

[traumaRUs, MSN, APRN]

Yes indeed. This opens this RN up to a whole lot of legal trouble. Just one wrong move and voila, no more RN license as she/he is practicing medicine without a license.

[cp1024]

I'm not a nurse yet, so please forgive my ignorance. But how is having an RN doing what is described by the OP any different from an RN doing an assessment, and requesting orders from the MD? Would it not be considered the same thing since the MD is still the one approving the order?

[jadelpn, LPN, EMT-B]

I'm not a nurse yet, so please forgive my ignorance. But how is having an RN doing what is described by the OP any different from an RN doing an assessment, and requesting orders from the MD? Would it not be considered the same thing since the MD is still the one approving the order?

The key is that the nurse requests, then MD approves the order. The nurse doesn't write her own orders then has the doctor sign off on them after.That is for Advanced Practice Nurses or MDs.

[traumaRUs, MSN, APRN]

This is what I have issues with:

"experienced icu Rn's who round for them, write orders, and take first call for them. Is this a common practice in other hospitals? The Md comes behind the RN and signs off the orders they write as a VO."

Sorry but if the RN is writing orders after making rounds, making decisions on their own, yep that IS practicing medicine w/o a license.

Not something I'd want to base my RN licensure on for sure.

[Sun0408, ASN, RN]

They are very common at my facility. The RN is not a staff RN, they work with the MD and round on all their pts before the MD does.. The PCP still rounds on their pts. All complex issues the RN is made aware but really does nothing more than gather the info for the MD. As far as orders, many are for transfers, PT, OT, advance diet or leave in foley. Medication adjustments, increase or decrease pain medication etc... I have not seen any of them write such things.

The RN knows very well what she/he can and can not do and the RN is in constant contract with the PCP.

[meandragonbrett]

I have worked in facilities across the country and this is common practice.

It is VERY common for specialties to have rounding nurses that round and write out the beginning of the daily progress notes....such as labs, vitals, I/O's, etc. As well as writing basic orders for the AM labs for the next day, electrolyte replacements, transfer orders, etc. The rounding RN isn't making these decisions on their own. They are in contact with the practice physician that they work for.

It's a way to streamline the provider's daily workload as they then come in behind the rounding nurse....add to the progress note their assessment, write any additional orders they want, and then move on to the next patient on their list.

[traumaRUs, MSN, APRN]

That's what APNs are for!