RN's accountable for MD's? What do you think?

Nurses General Nursing

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As an RN on a med surg unit your manager tells you that according to the plan of care for stroke te patient is to get test A, B, C on day 2, and get started on meds A, B. You are to see that the docs either order these tests or write in the progress notes the reason why not. The charts will be audited for compliance by the MD's and if they do not meet standards the RN(s) that cared for the patient will have to account for why not.

I argue that RN's are not responsible for MD's practice, and if there is a problem the docs should be doing their own program and auditing. Sure, if I notice the pt is at immediate risk I will mention it to the MD, and expect a response. I have also gone up the MD chain of command when necessary, but don't think the proposed plan should be left on nursing shoulders, or that nurses should be counselled when the doc does something wrong.

Am I out of line?

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outside of putting a sticky by a telephone or verbal order that says "please sign here" and reminding them to wash their hands between patient care, it's outside of my scope of practice.

when we share md's salaries, maybe i'll take more initiative. [/b]

my sentiments exactly....

i am not a doctor, i am a nurse...i make nursing decisions.

want to know what m.d. stands for?

make decisons!!

pretty much always been that way around here. somebody needs to baby sit them i guess it might as well be a nurse:)

Nursing management needs to sit down with the doctors and work this out.

You are not responsible for a Doctor's practice.

We do reminde Docs to wash hands politely but if he doesn't then it needs to be addressed by management. If a Doc is chronically violating rules then again management needs to address this. If they are not signing orders etc. They can loose privileges. Management is passing the buck. Probably because they do not know how to aproach this with the Docs. Bottom line is the Doc's are out of line and they need to be disaplined not you. If they want to practice there they need to follow the rules. Doctors do not want to loose privileges they will comply if forced to. You do not have the power to force them management does.

Canoehead, ? were the verbal orders from the Unit Manager backed up by any written documentation from management and was it signed off by management.

Where ever I have worked always edicts ,protocols ect have had to be signed off.

The only time I have ever seen standing orders like you are describing they were developed as a clinical pathway that the nursing staff and attending physians/surgeons had developed together and were set out dealing with specific for each procedure

just another job for the already underpaid and overworked nurse to perform.:rolleyes: i agree with the previous posts....a standing order or caremap should be signed by the doctor. most docs don't appreciate your suggestions...can't wait to see their response when you tell them they have to do something, let alone chart on why they are not. one of our docs is infamous for throwing away nurse's documentaion/charting when he unsatisfied with how the nurse portrayed him...eventho it is usually right on...the guys is a meanie (for lack of better word!):eek:

Specializes in cardiac ICU.

So basically, nurses at this facility are going to be the targets of hostility from MDs who don't want to be told what to do? THIS IS THE JOB OF ADMINISTRATION. If they want to dictate to the physicians, it's cowardly of them to stick the NURSE with this job. Administration is afraid of pizzing off the docs, because they admit patients and hence make money for the hospital. HOWEVER, if there are no nurses to care for patients docs want to admit, where does that leave them? I mean, duh.

What, exactly, are your docs getting paid the big bucks for? Sheesh!

Following signed written standard orders is one thing. However, you are not the doctor's keeper -- it is up to him/her to do his/her job. Get a written copy of your job description -- I'm quite sure "being accountable for MD to write orders" is not listed. As if you don't have enough to do.....

Shoving responsibility and liability for OTHER PEOPLE'S PERFORMANCE onto RNs is an unrealistic and abusive stress on already overworked nurses.

The day the RN is accountable ONLY for his/her performance, not any underneath or above, will be a big step forward in the respect nursing deserves.

More "babysitting or ELSE" duties like this shucked onto breaking nursing backs will just add to the retreat from the bedside.

Soon the average length of time a new graduate RN works as an RN before pursuing another field:

3 months.

Specializes in ER.

We have preprinted orders that they just check off and sign, but are expected to follow up with the doc if he/she didn't check off what the pathway dictates.

I for one think that one group auditing another group just makes for friction between them, and leads to worsened patient care in the long run. I would certainly be upset if the housekeeping staff watched my practice and reminded me to document correctly on patient care that was given.

Originally posted by KP RN

For crying out loud, Canoe!! Now, I've heard everything!

Next thing is that you'll be following the MDs to the bathroom to make sure they wipe themselves OK and wash their hands!

At my last facility nurses were told to observe and report docs who didn't wash their hands between patients. We were also told to reprimand them in person (yeah right they love that) :rolleyes:

Is it any wonder some nurses get to the point they just nod their heads at administration, ignore them and and simply carry on... :rolleyes:

Know the difference between God and a doctor? God doesn't think he's a doctor!!!!

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