Accepting verbal orders from another nurse?

[amberrenae, RN]

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 when a float pool nurse I had never worked with before asked me to push morphine for her patient. She had just started giving report and was trying to avoid overtime. I brought the morphine into the room but wasn't able to scan it because the patient didn't have an order for it in the eMAR. I returned to the nurse and told her the morphine wasn't ordered, and she said she had taken a verbal order and I should enter the order. I said I didn't feel comfortable entering orders I hadn't taken for a patient I didn't know, and she said I could just push the morphine without scanning it and she would enter the orders and document administration when she finished report. I hesitated again, and she snatched the morphine from my hand and stormed off to give it herself.

Am I in the wrong here? I don't want to be seen as not being a team player and I'm sure things like this happen, but I also don't want to risk the license I just earned.

[apopkamom]

You were absolutely correct. If there was no order written by the MD in the chart, and the morphine was not on the EMAR you should not give it. You also were correct in not entering a verbal order that you did not receive. The nurse that directly received the verbal order from the MD is the one who is responsible for entering it into the chart. The only concern that I would have is that in the hospital where I work, the nurse that pulls the narcotic from the Pyxis is the one responsible for that med. If you pulled morphine from the Pyxis and you did not give it, it should have been returned to the Pyxis by you. If she "snatched " the morphine, that you pulled, from your hands to give to a patient, without a written order, without the med on the MAR, without scanning, you need to let your unit supervisor or nurse manager know immediately, because it looks like you pulled a vial of morphine that just disappeared.

[nursinglove30]

OP just practice this phrase over and over again "sorry but I am just not comfortable with doing this." And say it with your most serious poker face ever. As student this has gotten me out of a lot of sticky situations during clinical. I am there to learn all day but I need to follow the program's guidelines as well.

[KDubMSDir]

You need to tell your nurse manager about this, because her expectation of you were way past unreasonable. And if you pulled the drug, you need to follow up with your manager as soon as possible. Send her/him an email while it is all fresh in your mind. By the eay, great job, you absolutely did the right thing. Nurses are NOT allowed to take an order from another nurse. The nurse who took the order had the responsibility of entering the order.

[Horseshoe, BSN, RN]

No you were not wrong and wise to do what you did.

I have however taken orders from a very wise charge nurse when a patient was decompensating and the doctor took 10 years to get to the bedside. When the doctor arrived she would just calmly tell him what he did so he could enter the orders in the computer. I would take her over a resident any day!

And it will only take ONE doctor to refuse to put in the order (that he did not give) to get her in extremely hot water. I don't care how smart a nurse is, unless she is following ACLS protocol or standing orders, she is practicing medicine without a license if she gives drugs without an order. It all works until the day it doesn't. If you take a verbal order from another nurse without prescription privileges, YOU will be in hot water if and when a doctor refuses to put in an order he never gave, no matter how much trust you have in her over the resident.

[JS McCabe, RN, BSN]

You did exactly the right thing. One should never give a med---especially a narcotic, and especially if it's not her/his patient---without seeing the order in the patient's MAR. I wouldn't have given it either, certainly not on another nurse's word that she'd taken a verbal order. The other nurse was out of line. Good for you!

Well said VivaLasViejas! I agree completely!! You did the right thing by NOT giving the med amberrenae!

[hotpeppa]

I'm not even a nurse, nor an official nursing student (I haven't even taken any preqs) and even I know that situation sounds sketchy as hell.

[Creamsoda, ASN, RN]

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.

[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.

[Nursetom1963, BSN]

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.

[NurseSpeedy, ADN, LPN, RN]

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.

[ArrowRN, BSN, RN]

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.

[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.