MD refuses to sign a telephone order. - page 3

by modernhippie_

11,029 Views | 35 Comments

I'm a new grad working on my own for almost a month now, starting in ICU at a hospital where the acuity of the patients is rather low, so I consider it a SICU. I had a pt with a history of cvs with right sided weakness. She was... Read More


  1. 4
    Quote from Seasoned
    "I told her to check the phone records and see if that particular MD called on the date and time tht I charted her telephone order. She said she can check to see who was on call tht day. I JUST got my license a few months ago, and I'm shaking at the thought of loosing it over a matter of her word against mine. When r they going to start recording every phone call so ths doesn't happen. I am so angry and I wanted to know what I could do to prevent this from happening again, if anything."

    It has happened to all nurses at least once. But to smart nurses only once!

    It is really important that you have CYA game plans to protect your license. So it is very good you are reaching out to collect suggestions! For MD orders at places that do not have electronic records your back-up is your colleague, charge nurse, or nurse supervisor as a witness. For every MD verbal order? YES!

    The practice of verbal orders are outdated, keeping nurses at the mercy of physician negative politics. Only the progressive electronic record systems will save a nurse from a verbal order dispute.

    Get in the habit to TELL ANOTHER NURSE for every verbal order and put her name in your progress note, e.g., "In consultation with Betty W. RN.... or I mentioned my suggestion of_______to Nurse BW who witnessed my getting a verbal order from Dr. Con at 2300." Word it anyway you iike. Just write the narrative ASAP after documenting the exact time with your witness that the order was said.
    When I was a ICU and ER staff nurse I had to take verbal and phone orders all the time. A number of times a physician denied giving an order. It was never a problem for me. I never experienced anyone doubting that the order had been given if I said it had been. Usually just ask "Indi are you positive the doc ordered xyz?" I would say "yes I am sure" and that was the end of it from my point of view. It was alwasy assumed the order had been given and the problem was with the physician and something to be dealt with by her boss.
    If a doc gives you a phone or verbal order and then denies it and your nursing managment doubts your word then I would find a new place to work. I wouldn't work for any organization that doubted my professional integrity. Like I said never been a problem for me and were I still a staff nurse I would take those orders (if the situation required it) without a second thought.
    Nurserton, jalyc RN, Orange Tree, and 1 other like this.
  2. 1
    That is similar to my experience when I was a new nurse in 1973.

    I worked L&D at a BIG county hospital. LPN's were not supposed to give IV pushes, but we commonly did IV Pitocin in delivery rooms for the doctors who were scrubbed and working. They would then sign the MAR BEFORE leaving the room. One doctor refused to sign for me. My head nurse told me not to give anymore for him; to call an RN back as needed.
    Next delivery was a bleeder and all the RN's were tied up in other deliveries and C-Sections so he had to break scrub to give the Pit. He was furious and complained all the way to the Chief of Staff, wanting me fired for my 'refusal to follow orders'. lol
    My HN explained what had happened and instead of me being fired, L&D was designated a "Critical Care Unit" and LPN's with proper training were then allowed to give IV pushes legally.

    OP, one HN always told us, "If you come to me with a problem, bring a solution with it too." Advocate for changes that will help both you and your patient.
    aknottedyarn likes this.
  3. 1
    Quote from eatmysoxRN
    First off, why would you call a low acuity ICU a SICU, which in my mind stands for surgical intensive care unit?

    .
    Yes, I thought that was pretty insulting as well. And the OP's scramble to say she meant "MICU" instead wasn't very flattering, either. A low acutity ICU is a low acuity ICU. MICUs can be pretty high acuity. But anyplace that has a MICU probably has another ICU as well . . . usually a SICU. Hospitals with more than one ICU are likely to have higher acuity patients than a small hospital that has just one ICU.
    psu_213 likes this.
  4. 1
    Quote from netglow
    OK, no. None of you work with the OP. So cut the crap about the acuity of her workplace, PLEASE. Sheesh.
    Nope, none of us work with the OP, but the OP is the one who started the crap about the acuity of her workplace. Some of us found it insulting that the OP said she called her workplace a SICU because it was low acuity. Then some of us found it insulting when she said oh, no, she meant MICU. Perhaps the OP should apologize for denigrating SICUs and MICUs.
    psu_213 likes this.
  5. 7
    Quote from IndiCRNA
    Ya this has happend to me a number of times. However I have never viewed it as MY problem. It's managment's (nursing and physician) problem. Obviously you wrote the order as "T.O Dr.Liesaboutorders". The last time my nurse manager called me about an unsigned order and asked me if I was sure about the order I had recieved. I said "yes, now good luck with that, bye bye".
    One hospital I worked at we had a doc who would refuse to sign tephone orders occasionaly. After this happend to several nurses we all got together and agreed that none of us would accept phone orders from him again. That meansd he had to come in so many times that he ended up just sleeping in the hospital when he was on call. This made his life so miserable that he quit. Man was he mad! He used to threaten us with being fired (our NM laughed at him) and all sorts of other things.
    You need to remember this particular physician is a person with low integrity and NEVER take another phone order from her again.
    The bottom line is indeed that this physician lacks integrity.

    If the OP had the doctor's name down correctly and knew who she was speaking to, recorded the correct date and time of the phone call and transcribed the order in the correct chart, it's up to the physician to sign the order she gave. And then D/C it and write a more appropriate order.

    The last time a physician refused to co-sign a telephone order he gave me, my manager asked for his name badge. Flummoxed, he gave it to her. She copied it, blew it up to poster size and posted it in the nurse's report room with a sign that said "Do not take verbal orders or telephone orders from this person." Of course, that room was the same room where we took our breaks, held our potlucks and the physicians had family conferences. He was so embarrassed at having his picture posted thusly that he begged my manager to tell him what he could do to have that picture removed. I came back to work that night and saw "I am sorry I lied" written on the dry erase board about fifty times.
    nu rn, ChristineN, CountyRat, and 4 others like this.
  6. 0
    Quote from modernhippie_
    I'm a new grad working on my own for almost a month now, starting in ICU at a hospital where the acuity of the patients is rather low, so I consider it a SICU. I had a pt with a history of cvs with right sided weakness. She was obese and refused her scd stockings. I knew this woman was a huge risk for clots, so I educated her and charted the education and her refusal. To cover my butt, I called her attending md to let her know, and asked if sag wanted to try an alternative DVT prophylaxis. She stated ..this pt was on a Helprin protocol right? I said yes but it was stopped. She said ok give her 30mg lovenox sq daily. I wrote it down on the chart and got the med from pharmacy. Gave teaching to pt on lovenox and administered med. I documented a MD notified for the refusal and that new orders were received. I get a call a week and a half later from my unit manager saying that the dr refused to sign the order because the pt has HIT. They sent a HIT test out during the shift prior to minr, but I hadn't seen the results and not sure if they were even back yet. The unit manager asked if I was sure it was tht dr I spoke to. I said yes, and in the chance that it wasn't, it had to be someone who was covering for that dr since they were clearly aware of who the pt was, even stating to they knew she was previously on a Heprin protocol. The mgr told me I need to be sure, and asked if I'm trying to say the dr was lyng? I was shocked!! I told her to check the phone records and see if that particular MD called on the date and time tht I charted her telephone order. She said she can check to see who was on call tht day. I JUST got my license a few months ago, and I'm shaking at the thought of loosing it over a matter of her word against mine. When r they going to start recording every phone call so ths doesn't happen. I am so angry and I wanted to know what I could do to prevent this from happening again, if anything.
    Sorry to read your predicament. In the hospital where I work, the phrase :MD NOTIFIED or MD CALLED is never allowed. Every MD has a name. Next time you receive any order, ask and write the name of the MD first before you proceed.
  7. 0
    Sorry to read your predicament. In the hospital where I work, the phrase :MD NOTIFIED or MD CALLED is never allowed. Every MD has a name. Next time you receive any order, ask and write the name of the MD first before you proceed.
  8. 1
    The phrase "MD notified" is not acceptable in the hospital where I work. Every MD has a name. Next time ask the name of the MD or whoever is giving you orders, and write it in your documentation. This might help you and save you all the unexpected heartaches.
    psu_213 likes this.
  9. 0
    This is why I like to read these blogs, because I learn so much. Although, I am not working at this time, I will implement having a second nurse verify the order, as it makes sense to avoid any misunderstandings.
    My question is do nurse mind doing this with each other? I ask this, because I would like to implement also the walk around when receiving report from a peer as well as giving it, so we are both on par on how we are receiving/giving the patients, but a friend told me that doing this will probably not make me a favorite in the unit as come time to go home, everyone wants to go home, not more to do.
  10. 0
    Quote from Onyameate
    The phrase "MD notified" is not acceptable in the hospital where I work. Every MD has a name. Next time ask the name of the MD or whoever is giving you orders, and write it in your documentation. This might help you and save you all the unexpected heartaches.
    It is not acceptable anywhere, particularly if you are taking a verbal order. I basically trust all the ER attendings with whom I work; however, they get busy too. If I tell them about a critical lab result that does not get fixed, and the pt has a negative outcome as a result, just charting "MD aware" is not going to save me.


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