Verbal er orders...help me understand this - page 2

by tiltgirl

4,410 Visits | 21 Comments

I work in california, have worked in the same facility for 3 years, have never been written up for a med error or been disciplined for my work ethic in the er. I received a phone call today from my manger stating that the verbal... Read More


  1. 1
    This is the danger of taking verbal orders from anyone, especially from those you don't have a long-standing, trusting relationship with... and even then, if it comes down to your job or theirs, they may suffer from cloudy memory in order to save themselves.

    The current state of over-supply of nurses makes RNs fairly disposable--that's the unfortunate consequence of far too many grads for too few positions. You're replaceable; someone is waiting in the wings to take your job as soon as you collect your last paycheck.

    Things like this (the PA back peddling and denying that she gave a verbal) don't happen unless there was a subsequent problem. And, that problem could have been anything from the patient complaining of itching to the patient dying. So, no matter how minor or major the issue, the PA is going to cover her butt and claim you didn't have an order. And, the problem is you didn't have an order (well, OF COURSE you had an order, but not one you can prove). In a 'worst case' this goes to court and you're sitting on the witness stand trying to explain to a jury of non-medical folks that the PA told you to give a narcotic... the hospital's lawyer or the deceased patient's lawyer is going to ask you where that piece of paper was. Then he/she is going to pull out all the hospital’s rules and regulations about verbal orders, and all the laws about dispensing narcotics, and all the lessons you got in nursing school about ‘the right patient, the right drug…” No matter how much you try to explain, you’ll look worse and worse. And in the event of this ‘worst case’ scenario, the hospital will distance itself from you to save itself. So, early on, far before this goes to court (if it ever would) the hospital will protect itself and claim this is not standard procedure and you had no right to act independently. They may very well be doing this ‘distancing dance’ now.
    If it were so easy to refuse all verbal orders, we’d do so. But, that brings a different risk: the risk of delay in providing urgent or emergent care to the patient. Refusing to carry out verbal orders denies the patient of quality care. Refusing verbal orders also risks your job as you’d be seen as difficult and uncooperative.
    We always want justice and it’s in our culture to believe the good guy always wins. Sadly, this isn’t the case. There is no perfect solution—and maybe not even an acceptable solution. You were caught in a no-win situation. Appeal to your union, alert your malpractice carrier, and talk to your supervisor. Best of luck.
    mudd68 likes this.
  2. 4
    From now on when this PA and MD give you a med or treatment order, in neutral voice say:

    "here's the chart can you write for that?"


    Let them know that the trust is broken when it comes to verbal orders-and they are the ones who broke it.
    nuangel1, Aurora77, DawnJ, and 1 other like this.
  3. 1
    Another option I didn't see mentioned, is to ask a colleague to be given the verbal order after you. If another nurse is standing by, what could it hurt? Your best protection isn't a union rep. It's a witness. The other colleague doesn't need to hear a report from you, they should ask the person's name and then for them to repeat the order. The second person watches you write out the order and initials after your name. This avoids mistakes. It's proactive and professional. That way it would be harder to pretend a unit nurse is making up orders. Nurses need to get together to stop this type of problem.

    The other solution is a special phone where calls are recorded and used only for verbal orders. Frankly, I prefer this solution.
    mudd68 likes this.
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    Agree with alot of the suggestions here. I have another idea! No more verbal orders, or let's record them somehow, lol! (I know not practical so don't slam me). But really, if the doctor can only give a verbal he can just give the med his or herself and document! Please let us know what happens. Good luck.
  5. 0
    Many departments,unbeknownst to them, actually have a no verbal order policy except for emergencies.......even though no one follows it.

    EVERYONE PLEASE, PLEASE....check you policies. Even the most trusted provider will safe their own behind when the chips fall......after being a nurse in this environment for 34 years, believe what I say.
  6. 2
    Mudd, it is not impractical at all. I work in 3 ERs, and we're not allowed to take verbal orders in any of them except in emergent situations. And even then, nurses don't write the orders...the doctors just write the order after we give it.
    mudd68 and Esme12 like this.
  7. 0
    Esme makes a good point about knowing policy before being thrust into a situation where actions may be contrary to policy.

    But, employers sometimes claim the opposite...and employees have actually been reprimanded and terminated for what is known as 'belligerent compliance to company policy'. Yes, hard to believe, but true. It happens when a company perceives that an employee uses policy to refuse to do their job efficiently. (This is mostly associated with 'Bad Attitude Syndrome' so be careful! and in those cases it can be a legitimate issue.)

    When a doc or PA gives you a verbal order, you have (basically) two choices: comply with the order (then risk having the PA or doc later claim they didn't give you that verbal), or you can refuse to do it because, "Hospital policy 4.3.1 states..." (Then the PA or doc goes crying to your supervisor that you refused)... Either way, you risk disciplinary action.
  8. 1
    I had a similar situation occur with a doc. It was a Percocet order. He told me to give 2 tabs and then when I gave it and asked him to put the order in so I could document I gave it, he said he only wanted one tab not 2. When I said that he clearly told me 2 tabs not 1, he argued with me that he would never give me that order for the particular patient in question due to their age/diagnosis. I am not crazy, not frazzled easily and know what I clearly heard. I took it up with my manager at that very moment and I guess since the patient was still in the ER being monitored and there was no adverse outcome documented, it was handled within our department wihtout incident. However, from that point on (which was several years ago) I NEVER, EVER take a verbal order from him for anything, not even Tylenol. When he barks out an order, I respond "When I see the order in the computer, I'll give it". I am not talking about code situations. I am talking about a pain med, fluids, etc.
    I had a doctor ask me once, while in the room with the patient, if I was giving the Ativan he ordered. He never ordered Ativan. I told him, in front of the patient, if you order Ativan, I gladly give it. I don't know why some doctors try to make it look like the nurse's fault that medications aren't given in a timely manner. He probably promised the med to the patient, never ordered it and then tried to make it look like it was the nurse who was the one holding out.
    I have to say that I have a terrific working relationship with the large majority of docs in my ED. I do still take verbal orders from them and never have issues. However, there are 2 or 3 that I will NEVER take a verbal order from and will only medicate patients or perform tasks such as blood draws or IV starts once the orders are visible in the computer. It's about trust and once that trust is broken, you need to procees with caution when dealing with them in the future.
    I am interested to know how this turns out.
    Esme12 likes this.
  9. 0
    Our ER also has a no verbal order policy except for emergencies. With that being said, it happens ALL THE TIME as the MD's don't feel like taking the time to put the order in the computer. We have found a way around this. Whenever I need a verbal for something like pain meds etc. I write it out and then have the MD sign my order. It goes from a verbal order to a written order in 2 seconds flat. Much much better way of doing things. If they don't put the order in the computer within a reasonable amt of time, I just scan the written order to the pharmacy and they input it
    Good luck to you. That PA sucks and he/she sure is lucky that they don't work with me
  10. 0
    I agree with those who state no verbal orders unless you're in a code..then there's usually more than one person there....even if they want it NOW, I have written it in the Dr chart as a v/o, as documentation as well as a favor to the doc, now that its all on the computor they gotta write it. If they don't you need to continue to document the outcome of previous meds given. For that bad a fx you better give me adequate narcotics or that doc will be speaking to my attorney. Narcotics wear off rather quickly and 10 mg of morphine won't last forever...who knows about previous fx and possible tolerances which also need addressed. They are also not toxic, so as long as they aren't allrgic, and you should ask again before you give it...sorry this happened, I hope your employers back you up and use this as a learning experience. Never trust anyone with your pt and meds, document, document, document. Lesson learned. Most pas have to ask Dr permission to give narcotics, sometimes I go with them to hear it from the horses mouth...personally, I'd much rather work with arnp.


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