Accepting verbal orders from another nurse? - page 7

I'm a new RN a little over a month into my orientation on a busy med/surg unit. Tonight at a few minutes before the end of my shift I had finished reporting off and was sitting at the nurses station... Read More

  1. by   Creamsoda
    woah definately not right. Ive been a nurse while and I would NEVER do that. She can stop what shes doing and put the order in if its so important. I would never ever do that.
  2. by   Dreaming on the beach
    Probably wouldn't hurt to write it up and keep it in your locker so if the day ever comes, you can recall correctly the time/date/nurse name/pt number and what your manager said/nurse said/you said. Audits don't always happen quickly and when they do your name still has attached to it a narc administered by another nurse. Somebody will still have to check it out and who knows where all the participants will be at that time. In two years, will you really remember all the gory details? I have a little folder taped inside my locker where I keep any narc issues that may arise for whatever reason. Thank God, it contains one piece of paper to date but it's there in case. I can pull it out, refresh my memory and reduce my freak out levels.
  3. by   Nursetom1963
    Quote from amberrenae, RN
    Thanks everyone for the responses. I did not do an override to pull the morphine, it was still available to the patient in the Accudose from a previous one time order so I didn't realize there wasn't a current order until I got in the room. Because there was no override and the whole thing happened so quickly and right before walking out the door, I wasn't thinking about my name being attached to a drug that may or may not have been given so I appreciate everyone bringing it up and I will definitely be talking to my manager about the whole thing today.
    I don't know how your pharmacy does audits, but I think in my hospital you would get an e mail asking for explanation anyway; you pulled it but didn't administer it; doesn't matter if the other nurse did; you pulled it, they want to see YOU document it.
  4. by   NurseSpeedy
    Our policy for narcs is you pull it, you push it. (Or waste, return, etc).

    Back in the time of paper charting I may have written the order, asked her to sign the verbal order (not me, I didn't take it), and then transcribed it to the paper MAR and given it. Now everything is computerized so unless she entered it into the computer, I'm not pushing it. Unfortunately, too much diversion is out there and anything that looks iffy will place us under a microscope.
  5. by   ArrowRN
    If that other RN received the verbal order she needs to have entered it and the ordering providers name. You doing it would be practicing without orders and out of your scope. Many people will get mad at you for doing the right thing..just keep it up.
    I work at a part time hospital where they also take verbal orders...it feels so ancient. I've even demanded to physicians to enter their own orders because I was new...I just said I new to this and you need to enter the order yourself...do they get pissed...sure, but in the end I save my license and potential med error...in addition the physician will have to verify the order anyways.
    By contrast my fulltime job strick policy of no verbal or phone orders with exception of during a code.
    Verbal and telephone orders need to be a thing of the past, that's the goal of Electronic Order Entry. But then again some nurses feel they are practicing doctors doing it, when they just being a secretary.
  6. by   Kayauhs
    Something's smelly in Denmark!!!

    It took that other nurse longer to stand around and tell you what to do than it would have if she had just given it.

    PROTECT YOUR LICENSE! Always ask yourself "WHY"? Why would she make such a big deal about all this?
    The whole thing smells bad and you always need to maintain the chain of custody.
  7. by   dimpledRN
    I would use this as a learning experience. You were absolutely right to stand your ground. But unless you get the order from the doctor yourself don't pull a narc. And definitely don't give it to someone else to give because if you don't know them how do you know they aren't keeping it for themselves and now your name is attached to it? I haven't been put in that position and would never put a coworker in that position. That nurse was 1000 million percent in the wrong putting you into that position. I would talk to your manager if I were you just to cover yourself. I don't know how it is where you work but most managers would appreciate the heads up. Wishing you all the best!!
  8. by   luv2
    Never let anyone MD, NP, P.A verbally tell you to give a medication without an actually having a medication order because that is how nurses get in trouble. It not as though this nurse told you to clean this patient because they were short staff. The nurse verbally told you to place an order for a medication that you did not verbally speak to the provider.
    2 things
    1- whenever there is a verbal order legally 2 nurses are supposed to have readback.
    2-never let anyone tell you to take a medication without you checking the order first. If you do not see the order than get one from a provider. No verbal order especially with narcotic have the provider place the order themselves and have pharmacy verify the order before you taking anything.
  9. by   kbrn2002
    Quote from luv2
    Never let anyone MD, NP, P.A verbally tell you to give a medication without an actually having a medication order because that is how nurses get in trouble. It not as though this nurse told you to clean this patient because they were short staff. The nurse verbally told you to place an order for a medication that you did not verbally speak to the provider.
    2 things
    1- whenever there is a verbal order legally 2 nurses are supposed to have readback.
    2-never let anyone tell you to take a medication without you checking the order first. If you do not see the order than get one from a provider. No verbal order especially with narcotic have the provider place the order themselves and have pharmacy verify the order before you taking anything.
    Your first point confuses me some. If an MD/NP/PA verbally tells you to give the medication that is an order so yes, the med should be given but only after entering the order in the MAR. If you are talking about OP's scenario where another nurse said "this is the order, give the med" then no, I absolutely wouldn't administer the med before the order is in the MAR.

    Maybe the rules and regulations are different where you live, where I live we do not require 2 nurses for confirmation of a verbal order.

    With the exception of controlled substances. Pharmacy requires a written Rx for schedule 2 meds, while they prefer a written Rx for all controlled meds they will accept a verbal order direct from the MD for a small amount of Schedule 3's. We run into this occasionally if an Rx runs out over the weekend and we need to have an on-call refill the med in an amount to get through the weekend until we can have the primary refill the med on Monday
  10. by   psu_213
    Quote from kbrn2002
    Your first point confuses me some. If an MD/NP/PA verbally tells you to give the medication that is an order so yes, the med should be given but only after entering the order in the MAR. If you are talking about OP's scenario where another nurse said "this is the order, give the med" then no, I absolutely wouldn't administer the med before the order is in the MAR.

    Maybe the rules and regulations are different where you live, where I live we do not require 2 nurses for confirmation of a verbal order.
    I have never heard of the 2 nurse rule...

    I have worked in a community hospital where there is a 0% chance that a physician is going to go to his/her computer at home during the middle of the night and put in an order. I'm not going to let a patient sit there all night without pain meds because the doc is being a poo poo head. (And administration would never stand up to doctors who did not put their orders in.). I'm still going to put a VO in before I give the med, and I'm definitely going to make sure someone else puts in order in if they took the VO.
  11. by   Horseshoe
    Quote from psu_213
    I have never heard of the 2 nurse rule...

    I have worked in a community hospital where there is a 0% chance that a physician is going to go to his/her computer at home during the middle of the night and put in an order. I'm not going to let a patient sit there all night without pain meds because the doc is being a poo poo head. (And administration would never stand up to doctors who did not put their orders in.). I'm still going to put a VO in before I give the med, and I'm definitely going to make sure someone else puts in order in if they took the VO.
    I have heard of a 2 nurse requirement for a telephone order, but not a verbal. It sounds like some people here are conflating the two, and they are not the same.

    Also, I've given many meds immediately after a verbal order before it makes it to the MAR, usually as part of a procedure or semi or full blown emergent situation. In these cases, I ALWAYS repeated the order back to the doc, and then once I'd drawn it up, I'd say, "I'm now giving ____ x mgs. IV push." You can't be too careful, but there are some situations where it would not be prudent to say "I'm not giving that med until it's entered into the computer and put on the MAR."
  12. by   psu_213
    Quote from Horseshoe
    I have heard of a 2 nurse requirement for a telephone order, but not a verbal. It sounds like some people here are conflating the two, and they are not the same.
    I have never heard it for a telephone order either. Must be a regional/hospital thing. I have been the 2nd person on a line to witness an over the phone consent. but I have never had to have a witness for a phone order.
  13. by   Horseshoe
    Quote from psu_213
    I have never heard it for a telephone order either. Must be a regional/hospital thing. I have been the 2nd person on a line to witness an over the phone consent. but I have never had to have a witness for a phone order.
    I just have a vague memory of hearing of this practice. I personally haven't had to do that.

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