I work in a multi specialties clinic. In this clinic we have different orthopedic providers who usually come in once a week for their clinic. They all have different protocols on how their clinic needs to be run. Some doctors want to see and talk to"new" patients first, evaluate them and then order xrays with the views they need to see and eval the patients health. Other docs want the nurse to order the xrays on" brand new" patients before they even meet the doctor for the first time or even speak to him/her by following their protocol. I have see multiple times patients getting sent back over to xray for additional views after the doctor talks with them. Sometimes the patients do and sometimes they don't. My other nurse coworkers and myself feel this should not be happening and are uncomfortable with ordering these xrays. Are protocols legal orders? We can't get answers up the chain of command. Thoughts or opinions?

If there is a copy of the protocol with a physician signature protocols are treated as orders. Granted you need to use judgement with them, and always check with your BON. You would still be held accountable just like with any MD order. If you aren't comfortable don't do it.

I work with a podiatrist. She's done both- wait and then order or send them to x-ray first. It's definitely a judgement call. If the appointment notes say "toe fracture" and they have no recent x-rays in our system then, I'll save everyone time and send the patient to x-ray once I'm done with rooming. If I'm unsure of whether it may be bone or tendon related, I let the doc see them first. We had a patient the other day that came in with an "ankle" injury. She did have pain in her ankle, but was also pointing to the top of her foot, too. I didn't want her getting charged for two x-rays if she only needed one so I really urged the doc to go in and assess her first. Another patient came in and complained about toe pain. Well, in podiatry this could be arthritis, fracture, or nail related. Patient claimed it was maybe at the base of her toe. It was then end of a long day and I told the doctor about the patient's wishy-washy symptoms. She insisted on sending the patient to x-ray before spending five minutes talking to the patient to see what's wrong. The x-ray that took forever turned out to be negative and the patient ended up having to get a nail avulsion procedure.If the doctor would've spent that little amount of time taking a quick peek at the toe, time and money would've been saved.