What do I do if I think a physician is not competent? This question was posed to me recently, and I think the suggestions outlined here are worth repeating.
Most people could probably give the “correct” answer – report it – but that answer is both reactionary and premature.
What behaviors suggest a physician is not competent? Two examples were given: “The pharmacy said we haven’t done that for years” when the nurse called to clarify an unusual order; and “We always have to call the resident to get the orders fixed.” So on the face of it, this is more than a one-time event, and there is potentially a pattern.
First and foremost, focus on the patients who are in the physician’s care. If there is an immediate patient safety issue, any nurse caring for a patient should be aware of the workplace policy for resolving clinical concerns. In a hospital, policies apply to all who give care.
The purpose of a policy is to ensure that concerns about patient care are resolved quickly and accurately by the most appropriate staff. At Clarian Health, the policy includes both a nursing and medicine chain of authority. After discussing this policy with Dr. Richard Graffis, Chief Medical Officer for Clarian, he reinforced, “No one is exempt from this policy” – not the resident, attending staff physician or chief medical officer.
The most frequent reason cited by staff for not reporting concerns has to do with the perceived power of the physician involved. Known as an authority gradient, the power is either related to the status of the physician or fear that the physician will somehow punish the nurse. In either case, the code of conduct for medical staff also has no exceptions and provides a mechanism for giving physicians feedback.
Talk over your concerns with your charge nurse, shift coordinator or nurse manager. Do it in a respectful, professional manner (not in the lounge over lunch). Put your concerns in writing, and send them to your supervisor, who should be obligated to send the concerns forward for evaluation by the medical staff committee. If the concerns continue with new examples, continue to put them in writing.
Nurses are not in a position to evaluate the competence of physicians, any more than physicians are in a position to evaluate nurses. However, each is responsible for providing feedback to those who are in a position to evaluate competence.
Focus on the patient. If this were your loved one, what do you hope the nurse would do?
Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist
To join the Clarian nursing team, visit Registered Nurse Career Job Search
Most people could probably give the “correct” answer – report it – but that answer is both reactionary and premature.
What behaviors suggest a physician is not competent? Two examples were given: “The pharmacy said we haven’t done that for years” when the nurse called to clarify an unusual order; and “We always have to call the resident to get the orders fixed.” So on the face of it, this is more than a one-time event, and there is potentially a pattern.
First and foremost, focus on the patients who are in the physician’s care. If there is an immediate patient safety issue, any nurse caring for a patient should be aware of the workplace policy for resolving clinical concerns. In a hospital, policies apply to all who give care.
The purpose of a policy is to ensure that concerns about patient care are resolved quickly and accurately by the most appropriate staff. At Clarian Health, the policy includes both a nursing and medicine chain of authority. After discussing this policy with Dr. Richard Graffis, Chief Medical Officer for Clarian, he reinforced, “No one is exempt from this policy” – not the resident, attending staff physician or chief medical officer.
The most frequent reason cited by staff for not reporting concerns has to do with the perceived power of the physician involved. Known as an authority gradient, the power is either related to the status of the physician or fear that the physician will somehow punish the nurse. In either case, the code of conduct for medical staff also has no exceptions and provides a mechanism for giving physicians feedback.
Talk over your concerns with your charge nurse, shift coordinator or nurse manager. Do it in a respectful, professional manner (not in the lounge over lunch). Put your concerns in writing, and send them to your supervisor, who should be obligated to send the concerns forward for evaluation by the medical staff committee. If the concerns continue with new examples, continue to put them in writing.
Nurses are not in a position to evaluate the competence of physicians, any more than physicians are in a position to evaluate nurses. However, each is responsible for providing feedback to those who are in a position to evaluate competence.
Focus on the patient. If this were your loved one, what do you hope the nurse would do?
Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist
To join the Clarian nursing team, visit Registered Nurse Career Job Search
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