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Nurses acting like physicians


Robin Hood

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If we want to throw anecdotes in the mix then let's talk about a night shift were the resident kept writing the wrong orders, ex. IV when he meant PO. Not entirely sure what his deal was but the aftermath of these orders could have been potentially been fatal. Every time the nurses at triage would probe him for rationales he would say "you know what I mean". So yes, the role of a nurse is to protect patients from inept physicians, which do exist whether or not you would like to admit. It really goes both ways. One of the primary tenants of nursing is patient advocacy, so I stand by my statement.

 

That bad residents/physicians exist does not mean that your statement was anything other than inflammatory BS. The role of a nurse is to apply best practices in medication administration, hygiene, documentation, wound care, and a myriad of other non-medical or quasi-medical interventions ranging from patient positioning to keeping the bed angled at 30 degrees in the ICU. Good nursing care saves lives and, yes, that includes checking on orders, though most of the time the po vs. iv thing merits a call from pharmacy not nursing. And 99% of the time we're on the same page.

 

On a related subject, sometimes I don't care about the route (e.g. Gravol) and just write po/iv. Narcotics aside, it usually doesn't matter that much. (Well po Mg won't exactly replace it, but it will cause some exceptional diarrhea... and po Vanco will do nothing for systemic infections while iv Vanco will do nothing for C diff. So it matters.)

 

I'm sure you made that comment of out self interest which is completely logical as you fear encroachment, but it's simply false. Nurse practitioners have been taking over GP role all over Ontario and Alberta (from what I know), and surprise! It's working. Also, NPs are taught to practice under a biopsychosocial model rather than a strictly medical model, so they shouldn't really be compared at all.

 

There is no "medical model". This is just something people pontificate about in "theory" classes, as if it makes some sort of difference in practice. A biopsychosocial model doesn't make up for the obvious and glaring deficiencies in training and knowledge I've observed among NPs. The reason they are able to work in primary care - often with something of a specialty bent with well women, well baby exams, screening visits, etc. - is because it's not necessarily that complicated. They are bad at acute management (BRBPR in a stable patient? STAT CT abdo! No DRE! :rolleyes:), but then it's not something a lot of family docs who work mainly in the community are great at either.

 

Anyway, NPs are working in a few settings but their numbers are hardly significant compared to the number of family physicians in practice, let alone the 1500-odd that finish residency every year. It's a niche profession which functions in several niche roles, but the training is adequate only within those niches and for certain areas in primary care. Perhaps when NPs start thinking that can supplant internists, I'll start fearing "encroachment", but that day has yet to come (in Canada at least).

 

Anyways, it seems like this could go on forever so I suppose we should just agree to disagree. Oh and if you have an issue with "arbitrary policies" then perhaps you should go into policy making. As much as we nurses despise them, they are policies we have no control over so it seems silly to fault us for them.

 

No, it's not silly at all because usually these are simply fake policies that get quoted without any kind of reference, and also usually have the odd effect of obstructing our ability to get things done, i.e. to manage patient care effectively. The NG thing is a classic example because (1) it's totally ****ing false and (2) the patient needed NG decompression emergently. And they still did it anyway. The idea that floor nurses are uniquely aware of special hospital policies that somehow go unmentioned in our exhaustive, picayune, and tedious orientations that every single hospital staff member goes through is just silly. It's also not "patient advocacy" to claim that they can't perform interventions that are absolutely in their scope of practice for patients that have absolute indications for said interventions.

 

I only mention that example because it occurred recently. Perhaps while on call Sunday something similar might happen again, but more likely is that I'll have another busy and sometimes interesting 24+2 hours. And when I get the inevitable call for a Tylenol or Gravol order, I won't be mad at the RN calling me, but the resident who didn't bother to write the PRN on the admission orders.

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There is no "medical model". This is just something people pontificate about in "theory" classes, as if it makes some sort of difference in practice. A biopsychosocial model doesn't make up for the obvious and glaring deficiencies in training and knowledge I've observed among NPs. The reason they are able to work in primary care - often with something of a specialty bent with well women, well baby exams, screening visits, etc. - is because it's not necessarily that complicated. They are bad at acute management (BRBPR in a stable patient? STAT CT abdo! No DRE! :rolleyes:), but then it's not something a lot of family docs who work mainly in the community are great at either.

 

 

This is very true.

I don't know what this so called ''medical model'' is, but I've never heard of it during med school. And if such a model existed, it would certainly include the biopsychosocial theories, otherwise we wouldn't have canmeds etc.

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There are many arbitrary policies... So many that it makes it difficult to the job

 

I'm gonna keep my nose out of it mostly, bit I'd like to add that what makes it difficult is that at my center, certain people make up policy in order to avoid doing a task they want to avoid.

 

Example: claiming that policy is that nobody but Urology is allowed to insert a coude tip catheter so we need to page Uro at 2 am to get them to drive in to put one in a patient in retention. (Note: at my center anyone authorized to put a foley in can put a coude tip in, and this floor had done it a dozen times before when I was there)

 

If I'm getting BS made up policy I know is an excuse to not work, I ask whoever is BSing me to produce the documentation. That usually calls their bluff and they do the work.

 

Fake policy is rampant in certain locations in the hospitals I work at. I've seen it busted out by nurses, docs, admin staff, techs, social work etc.

 

All the fake policy and lies make it hard to tell when there actually is policy issues.

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