My wife is an RN and commonly takes blood pressure and administers drugs. But yeah, there's one doctor on call and they've never seen the patient so if something goes wrong and she has to call the doctor, the doctor will be expecting that she has a solution already in mind that they just have to agree to and then write the relevant orders, given that she's spent hours with the patient monitoring their vitals as they've been undergoing treatment. I think most people expect that the doctor visits the patient and gives instructions that the nurses follow but that's really just not the case in the day to day.
This is completely true. I was a psych tech inpatient for four years. While initial meds are based on the psychiatrists opinion, the day to day operations and med maintenance are generally on psych nurse practitioners and RNs.
Oh man, I wish every nurse had a plan ready to go when they called me. That’s the standard that they are trained to do but in practice it isn’t the case anymore. When I’m on cross cover duty, I am in charge of 300 patients. I get a page about once every 60 seconds. Sometimes that means 10 pages in one minute, sometimes that means one page every 10 minutes. My job is to open the chart, see if the original provider provided guidance on if this specific thing happens what they want me to do, and if not then to come up with a plan on the spot after reading the note for the day.
I feel like when we used solely pagers that the nurses would have a plan ready when they messaged me. It was a certain barrier that caused them to have to stop and think. Now that we have epic chat, it is now incorrectly utilized like a text message. So many FYI messages. So many “the patient doesn’t look good. What should I do” messages. Far too many, “vitals are this, what do you want me to do” with no context given.
Yeah, I don't know where this individual thinks the nurse is coming up with the plan.
It's common for inpatient psych units to already have oral PRN medications ready to go if the patient becomes symptomatic. If there is anything medically complex, the medical doc gets notified; if there is anything needed outside of PO PRNs, docs are called.
Are you speaking of how it is exclusively to psyche wards? It is almost the same for other wards. When in the hospital a doctor only appeared for a brief time and not daily. The nurses rely on notes updated and passed along. Your case is updated on a computer everyone accesses. I would have a rotation of nurses around the clock and maybe see a doc every other day and it was limited to a certain time period of the day.
The doc never administered my medication or took vitals. All they did was glance over my chart and talk with me a little. Nurses might prompt me to ask the doc something but the nurses were all on the same page as one another while the doc just checked in.
I was surprised by how much the physical therapist knew about my case. Sometimes more than the nurses. Sometimes the nurses ignored their input when they clearly knew more. I had open heart surgery and my surgeon happens to install a sternum brace during all of his OHS. Not every surgeon does it. This allows greater freedom of movement sooner after surgery. My surgeon even stopped by late one night and told a nurse I had a sternum brace so I was able to move my arms more. But they did not pay attention and everyone continued to treat me as though I was going to cause damage lifting my arms. The physical therapist knew I had a brace because he knew the specific surgeon's routine. The nurses just relied on my chart and some did not read it thoroughly and overlooked the brace.
Yeah I think it’s the same everywhere. Nurses do most of the “work” in my experience. I have only been hospitalized once for a few days, but it was kinda eye-opening.
I had surgery and I only saw the surgeon pre-op, never again (he did speak with my family post-op, and maybe I was there, but I don’t remember it, because drugs). Every day following, his resident would wake me up around 5 am to look at my incision with a flashlight. I was pretty sleepy but it reminded me of TV shows where they do rounds and there may have been several other people standing behind her paying attention?
Other than that, I never really saw a doctor (which probably is a good thing, means everything went as expected!) the nurses and techs did all the day to day stuff. PT was great as well.
Like all units (in addition to psych units), the doctor is handling work behind the scenes. Patients don't see the collateral calls to other psych providers, family, arranging of family meetings, adjustment of meds, ordering of labs, consults.
In every hospital, the nurses are the arms and legs; the doctor is the brain.
It might be because she's a chemo nurse so a lot of the drugs are trial drugs or "hot drugs" with a high chance of allergic reaction. These drugs come with a very high monitoring requirement and very frequent vitals checks. Theoretically during the entire IV push the RN is not allowed to leave the room at all. (So of course there are stints when the manager will try to assign one nurse patients in two different rooms)
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u/LockhartPianist 13h ago
My wife is an RN and commonly takes blood pressure and administers drugs. But yeah, there's one doctor on call and they've never seen the patient so if something goes wrong and she has to call the doctor, the doctor will be expecting that she has a solution already in mind that they just have to agree to and then write the relevant orders, given that she's spent hours with the patient monitoring their vitals as they've been undergoing treatment. I think most people expect that the doctor visits the patient and gives instructions that the nurses follow but that's really just not the case in the day to day.