Nurses are by NO means physicians. The roles are very different, and yet they tend to overlap consistently in modern healthcare. Relationships are becoming strained and tired as demands grow. Small seeds of mistrust have been planted and are festering. Health care needs to SLOW DOWN and see the bigger picture. Without a pause, danger sets in.
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It's 0730 and bedside rounds with the night staff and day nurses have completed. Morning labs have been reviewed and the rush has begun. A new physician has strolled onto the scene with his coffee and nonchalant smile. "Good morning" he pleasantly addresses to the passers-by. We smile awkwardly as we rush to meet morning needs (of which are always so great). Orders start popping up as I read through each one. My brows furrow together as I see some oddities that make me uncomfortable. I head to the Doc box (where our physicians reside) and inquire on some of the new tasks I've been encouraged to complete via CPOE (online orders). "Are you sure that the patient with the COPD should truly be on beta blockers? It's typically contraindicated," or "I understand that you just ordered that fluid bolus on the patient with the low blood pressure, but they do have heart failure with renal failure, I think it may be in their best interest to decrease their Lisinopril." He looked at me with bugged out eyes and waved his hand dismissively. 'I'll look at it later."
Later came a lot faster than usual. I paged the hospitalist again to request orders for physical therapy, case management for skilled nursing placement, medication corrections, medication reconciliations from the night before and writing scripts for discharges. Text page after phone page and back again, I am back at ground zero with empty hands. So, I page again and again. None of these are returned. At this time I am allowed to STAT page. So I do. A monotone voice answers, "Doctor?" 'Yes?' Then I progress to mention what I've been paging about for the last five hours. 'I was already there this morning, I am leaving at three, so the night physician can take care of that.' I press and press. He hangs up.
My blood is starting to boil. Families have questions, patients want answers and yet I cannot bridge the gap. My charge is notified and she does what's in her jurisdiction. Still no response, no meds corrected, patients are growing more frustrated and families are now angry. I page and page, the end of shift comes. I explain my dilemma to the night nurse who gives me a talking to, seeing as I "sat on these issues" all day long and "didn't do anything about it". Needless to say, I'm speechless and defeated from the hard work I attempted, and was yet spat on for trying.
Unfortunately, the next day was the same. I was told to fix things myself by this doctor, or to page someone else to take care of the orders because he was 'just too busy'. Despite his busyness, despite his idea of workload and time management, I was trying to explain that a lack of treatment for these patients would increase their hospital stay as well as (in the end) screw us with reimbursement services if we did not provide. Another blank stare, 'I have to go' was all I got.
I watched those white coat tails billow behind his short frame as I felt my trust wither and flilt away with him. I did the only thing I knew, I contacted the chief of medicine. Seeing as my charge nurse was aware, at the time was without management, the next best thing was the Chief of Medicine. He showed up in person not even thirty minutes later. He corrected what was missing, adjusted the meds that fell short, or overtreated in dangerous ways and then thanked me for my diligence.
I was pleased for the action that had been encouraged from my so-called 'tattle-taling' but I still felt as though I had accomplished nothing. It shouldn't be the nurse to correct your dangerous orders. Yes, we are a checks and balances group. It is often a good thing to have more hands in the pot in order that things can get done. But when issues arise and your choice is to act to sit quietly, sit quietly should not be the option you choose.
For nurses, this is a frequent occurrence. I know that we are all imperfect and things often need fixing, titrating, or medications are given because of a 'greater good' outcome. But it's a lack of action that will continue to endanger our licenses, our ability to assist patients in their ultimate care and to act as an advocate.
If we speak up and suggest and are incorrect, teach us. Otherwise, we look to you as doctors to act and please address concerns and issues as they arise.
