Too many hats

[TonyaM73, ASN, RN]

Just to warn you, I had a hard day yesterday. It is impossible to wear as many hats as a med/surg nurse has to wear today. We need to be RN of course, but there is also MD, case manager, aid, secretary and Lord knows what all else in one day. For example, yesterday I had a MD dc ativan for a seizure pt that was currently actively seizing. I asked said MD about this and they stated "Wellll, they are extemely lethargic, so of course I dc the ativan." Of course they said this in a really derogatory way, like I was stupid or something. HUH???? But MD, the pt is actively seizing and has been all morning. "Oh they are? Oh, is that what the ativan was for?" HUH??????

I have enough on my plate with everything else, but to have to tell the doctor that we needed ativan and to please don't dc it, just topped it for me yesterday! YIKES! Where do they get these people?

[gcupid]

I would think the only reason behind the dc of Ativan is bc wrong report was given to him; however, he should know the diagnosis behind the patients stay and he should also be able to prompt questions from the person giving report to him so that he can make prudent decisions.

[gcupid]

Yes indeed!! Lol! I am just now really fully understanding your post.

I am too a med surg nurse and we do wear too many hats.... Is there anything that can be done about it besides venting?

Please.... If anyone knows, reply so that we can make some things happen.

I find myself being responsible for my work as well as over seeing others who are not only subordinates but are often times team players, supervisors, and individuals with licenses as well as carriers of credentials that exceed mine.

[TonyaM73, ASN, RN]

I have a friend of mine that I work with and we vent together. I really don't know what is to be done. I have gone to my manager about some of it and keep being told to keep a log of events and then email her with it. THERE ARE TOO MANY for me to go into specifics about everything. I have tried to relay the general feel for everything, but without stopping and writing down the details of everything, I don't think anything will be done. We have anything from the MDs ordering too many narcotics, including Dilaudid, like it was candy, to pharmacy not getting orders correct and the RNs having to back track and fix everything, to aids just plain being lazy and if you tell them to do anything....you are not a team player because that is something that the RN is qualified to do. So frustrating.

[Bubwa]

California has a nurses union. Perhaps other states should consider this?

[TonyaM73, ASN, RN]

That would be lovely. I don't think it will happen anytime soon with the job market the way it is.

[Altra, BSN, RN]

Your manager needs to have specifics. If pharmacy is sending incorrect meds ... without knowing the specific meds and the patient(s) they were sent for, there is no way to pinpoint the source of the error. If there is a particular MD or physician group whose pain med prescribing practices are out of step with others, perhaps this can be addressed IF those particular patients are tracked for increased LOS, instances of respiratory depression, difficulty transitioning to oral pain meds, etc.

Solutions don't just happen ... there needs to be a methodical approach to investigating the problem.

[natthomas]

I have had both rewarding and exhausting days, but today I almost quit. I had 6 patients, 4 were totals, DM, and the same were having acute issues that not been address for days. One pt left AMA today due the discharge process taking so long. I was told in the future by management when med profile is not done correctly, for me to correct myself without call a doctor for clafication because thats common sense. I was blow away about what I was being told. I guess if orders needed to be claifiy, I need to use common sense because apparently I don't have any, and correct orders without consulting a physician.

[Been there,done that, ASN, RN]

"I am not a doctor but I play one on TV".

Or.. most of the time when I am at work.

Yes, we have many duties that administration and corporate greed has added to our list.

The role of doctor is the most profound. We have much less education.. but have the responsibility to tell the doctors when their orders are incorrect.(in this case, the so-called doctor cannot recognize a post-dictal patient).

A conundrum that will NEVER be resolved. Your manager and the hospital administrators know that this "doctor" is inadequate.

However..doctors brings in revenue and nurses are viewed as a negative cost factor in the ultimate goal of ...

PROFITS!!!

[natthomas]

"I am not a doctor but I play one on TV".Or.. most of the time when I am at work.Yes, we have many duties that administration and corporate greed has added to our list.The role of doctor is the most profound. We have much less education.. but have the responsibility to tell the doctors when their orders are incorrect.(in this case, the so-called doctor cannot recognize a post-dictal patient).A conundrum that will NEVER be resolved. Your manager and the hospital administrators know that this "doctor" is inadequate.However..doctors brings in revenue and nurses are viewed as a negative cost factor in the ultimate goal of ...PROFITS!!!

You are so right, wow

[TonyaM73, ASN, RN]

"I am not a doctor but I play one on TV".

Or.. most of the time when I am at work.

Yes, we have many duties that administration and corporate greed has added to our list.

The role of doctor is the most profound. We have much less education.. but have the responsibility to tell the doctors when their orders are incorrect.(in this case, the so-called doctor cannot recognize a post-dictal patient).

A conundrum that will NEVER be resolved. Your manager and the hospital administrators know that this "doctor" is inadequate.

However..doctors brings in revenue and nurses are viewed as a negative cost factor in the ultimate goal of ...

PROFITS!!!

Thank you for putting it so well. I have always been stumpted by this.