Nursing – Is the doctor allowed to?
Nursing: Is the doctor allowed to ask the nurse to make the bed?
Nursing – may the physician? – Care Love Magazine
"Nurse please make the bed".
About 15 years ago, a statement of this kind by a head physician in a clinic was still to be interpreted as almost official instructions.
That means, if physician had given an appropriate instruction to the care personnel, the bed was made as a matter of course.
However, the increasing emancipation of the nursing professions and the resulting clear delineation of professional competencies, both for the nursing area and for the medical area, are also increasingly revealing the respective responsibilities with regard to the right of direction.
This means that a clear medical order in the sense of a medically necessary therapy must be carried out by the nursing staff, but not an activity that falls within the exclusive competence of nursing (for example, making the bed).
The nursing staff would therefore not be obliged to implement the doctor's order with regard to the immediate "making of the bed.
This simple example documents that activities clearly falling within the scope of nursing care are not subject to the physician's right of direction.
Nursing and the nursing documentation
Similarly, the physician's order "Please write in the documentation that the patient has actively participated in basic care this morning".
If the physician has observed the patient at the base, and has made this observation, then the nurse may still contradict the order.
The nursing report is used exclusively for observation by the nursing staff.
The doctor would therefore have to record his observation on the documentation sheet reserved for the doctor.
Here, too, the nurse could contradict the doctor's order without any legal problems.
Nursing – May the doctor order the shaving of the leg?
If a doctor orders a patient's leg to be shaved for an examination, then, strictly speaking, shaving is a nursing activity.
However, since the shave serves as a preparation for a medical examination, the nurse must follow the doctor's orders in this case.
The attending physician is not allowed to report a notifiable disease
Another example (which is admittedly very extreme, but which happened to the author in exactly the same way from his own experience) is the problem of the so-called occupancy beds.
Doctors in private practice in particular sometimes earn an additional fee on top of their regular salary by occupying beds in clinics.
If a patient is admitted to the regular ward and is suspected of having a notifiable disease according to the Infection Protection Act, but the attending physician is afraid that his beds might not be filled and therefore orders that the notifiable disease not be reported, the nurse may object to this order?
Basically, this is an obligation to report, which is to be assigned to the medical area in the clinic.
The physician acts here however contrary to the valid legal hygiene regulations and the hospital.
Since the nurse has knowledge of this case, she may report this, both in terms of the health of the other employees, but of course and especially in terms of the patients of the nursing management and in this respect at least transfer their own responsibility to the superior body.
The fact that the nurse has fulfilled her duty to report and has indicated that there is a reportable case on the ward, but the doctor refuses to report it and forbids the nursing staff to pass this on, means that the nurse also avoids a possible criminal prosecution of her own, conceivable here would be, for example, the criminal offense of negligent bodily injury (for information: in the case that actually took place, the head of nursing stood behind the nursing staff, informed the head physician and the illness was reported to the public health department).
Conclusion: Physicians may order, but not always
The examples given show very clearly that certain orders of the physician are to be obeyed absolutely, other orders may be contradicted however by the care personnel.
Basically, however, it can be said that in more and more clinics the doctors know what work the nursing staff does for the overall well-being of the patients.
Conversely, the same applies to nursing staff in relation to the medical profession.
Nursing – Practical tip for those responsible in the clinic
In order to avoid a dispute over competencies, the head of nursing should work with the medical director to draw up a clearly defined list of competencies, including both clearly defined individual competencies and joint competencies.
This will promote efficient working.
Nursing – What experience have you had with the doctor's right of direction? – We are very much looking forward to your letters per eMail to [email protected]