When Nurses Trump Physicians

Who could question any MD’s intellectual ability to review a medical record? But physicians do not think like nurses. In hospitals, they assess medical conditions; listen to the observations of support personnel, order the care they believe is appropriate, and move on to the next patient.

If all errors arose from the wrong order or a misdiagnosis, then physicians would be excellent in the role of chart review.

When things go wrong, it touches many disciplines. Mistakes are not neatly typed and easily seen in the record – oftentimes they are found in a barely legible note on the corner of a page that does not translate into scanned text.

Physicians rightly assume their orders will be understood and executed, and that the rest of the hospital team – nurses, respiratory therapists, physical therapists, radiologists, pharmacists, wound care specialists, etc., will take care of the patient and assess the effect of what the MD has ordered.

They rely entirely upon nursing staff to report deviations, labs that are out of range, subtle changes in vital signs, breath sounds and condition, unplanned outcomes – in short, everything that the physician is not there to see with his own eyes. If a change in the patient goes unnoticed, whose fault is it? Always the nurse – follow the chain of command from CNA to bedside nurse, charge nurse, even Director of Nursing – mistakes flow uphill.

Who is responsible for charting, medicating, listening to patient and family complaints, ensuring proper nutrition, accurate IV administration and knowing when the I&O indicates fluid overload or the patient is having an adverse reaction to medications or blood, or seeing a discrepancy between a malfunctioning monitor and what the patient exhibits? Who knows when to question a physician’s order and is responsible for calling that doctor and expressing their concern? Who is responsible for knowing every section of a chart and what is missing?

This is what nurses do every day at the bedside. This is not the role of a physician, and a physician cannot see a chart from the perspective of a nurse.

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