In reality RN facade of management is calling the doctor or paging code "insert color of what your facility uses" and waiting for their response.
If the patient goes in to cardiac arrest on your floor is RN allowed to initiate CPR? By that I mean prompt initiation of chest compression on your own accord? Because that is what this patient currently needs. Or you call the doctor? Or page/broadcast/announce/call response team?
If the IABP malfunctions, there is a timing error or patient sustains an arrhythmia is RN adjusting the IABP control and controlling the arrhythmia or the correct answer is one again call the doctor?
Any nursing exam if there is a choice “call the doctor” it’s usually the correct answer.
Well, I think we have gone to the heart of the matter hear. Frankly, you are operating under either some completely incorrect assumptions, or your perspective has been limited to an unusually restrictive facility and you are extrapolating it to the rest of the world.
First I'll admit my perspective is limited to my first hand experience as an EMT, a nursing student, an ICU nurse, and to what my colleagues have related to me in other states and hospitals. I hope that I can share some perspective with you:
Yes, the ICU nurse is going to IABP controls (at many facilities at least, I know of one where it could be RT flying the IABP). I'm guess you also think RNs have to ask mother may I before giving O2.
Yes, the nurse is going to initiate CPR without being told to do so, but not before hitting the code blue button and/or yelling "Bring the Code Cart NOW!!!" That is expected of a CNA, EMT, Paramedic, RN, or MD. At my facility, the RN is expected to have CPR in effect, the lifepack pads on and, if appropriate, to initiate the first shock all before the code team arrives. In the ICU, we will push atropine for symptomatic bradycardia if it is appropriate, and there are plenty of other RN practice policy privileges (something akin to protocols). When we run codes, we use a pilot/copilot model with the resident as the pilot and an ICU RN as the co-pilot.
Next, I'll share with you some information. Let's start with nursing exams: the answer is not always "call the doctor." Nursing is expected to assess, investigate, and problem solve as appropriate. In fact, turning off your brain and calling the doc for everything will get your reamed and fired. When you do call the physician, you are expected to be able to explain the situation, give the background and unnecessary findings, your assessment of the situation, and your recommendations on what should be done. SBAR (or ISBARR if you prefer).
For example: I see PVCs in my patient who was otherwise in ST and the MAP is starting to drop. I adjust some vasoactive drips, assess, and elected to send scheduled coag and CBC labs early, and tacked on an ABG and lytes panel. I receive the results, THEN I called the resident, which went something like this:
Me: "Hey Doc, this is Summit taking care of MICU bed X. There is some new ectopy and hemodynamics are requiring more aggressive use of pressors apparently from worsened coagulation and worsened hemorrhage with a continued acidosis. I saw some new polymorphic PVCs and so I sent the labs early, the H&H has now dropped to 6.5/20 and the PT/PTT/INR is now 70/85/8.9 and fibrinogen is less than 60. The iCa is 1.09 and Mg is 1.4. Also, we the profound acidosis continues and changing vent settings further is unlikely to help an uncompensated metabolic acidosis of 7.14, 20, 114, and 8.5. Can we please start a bicarb drip? It will help my pressors work too... and do some FFP, cryo, platelets, and PRBCs, and replete the Ca and Mg?"
Dr. So and So: "Crap. Yea. I'll order the blood products. Go ahead and push a gram of Ca and I'll write for the Mg. I like the bicarb idea, but I want to check with pulm first."
Me: "Sweet. I will push 1 gram of Ca, I'll look for the Mag bag, and I'll call blood bank to let them know the paperwork is forthcoming."
(and later there was a bicarb drip)
Even though the Intensivist allowed you to come, but the charge admin RN’s think it’s highly inappropriate for a Medic to do an ICU rotation with the MD.
That is ridiculous. I am sorry that happened to you. It sounds like that facility was not very pro-education.
RNs who’s employer paid them to attend and they complain how early they had to wake up. Getting dirty stares from all the nurses when I am the only medic in the room after we do the introductions
I don’t expect RN’s to change their minds about ambulance drivers even though there are outliers and I don’t expect Paramedics to change their minds about nurses even though there are outliers. Will see if my outlook will change when I am in the medical student role, although honestly I think it will be worse.
It really sounds like you have an axe to grind here... I hope you can gain some perspective and peace on this issue. Perhaps you should try setting the example. If you go through medical school with disdain for nurses, it will not be to your advantage. Our chief of medicine never walks out of a patient room without asking for nursing input and constantly reminds residents to listen to and respect nurses.
Nursing isn't always right, but we are all on the same team, just with different jobs.
One thing I've learned as I've gone on is how much more there is to know and be an expert at than virtually any person can master, even within their own subfield. You realize that when dealing with complex problems in complex systems, the human element can muddy the waters. It is readily apparent when you see renowned cardiologists disagreeing among themselves, or the cardiothoracic surgeons going at it with the cardiologists, or the pulm/cc fellow ranting that if the medical attending would only listen to them then things would right.
ETA: While I was typing all that, Tigger posted.
