Verbal Orders, Do you take them?

  1. In my Hospital, a 300 bed teaching facility that has a level one trauma center and 24 hour coverage by all specialties, our surgical ICU is not allowed to take verbal orders. This practice stems from the nurses not being able to trust the residents to own thier verbal orders, and to prevent the doctors from allowing nurses to practice medicine without a license.

    We have had many incidents in the past where residents have retracted verbal orders on rounds, when confronted by an attending. This is very bad, because our nurses come out looking like fools, and face the very real possibility of having and action filed against their license. Like I said above, to protect ourselves, we no longer take verbal orders. How do you prevent similar situations from occuring in your institution? Also, what is your policy regarding verbal orders.

    The interesting thing, is that my most experienced nurses, know which residents they can trust and therefore continue to take verbal orders from some doctors. They know that they can get them written in the AM before rounds. Now, some of my inexperienced staff is trying to do the same and they are now getting hung once in a while, because they do not know who will own their orders in the AM.

    Our staff is very vocal, and are getting upset that we cannot take verbal orders, and the rest of our institution can. We need to address this issue, but I am at somewhat of a loss, in how to aproach it. If verbal orders come back like they were two years ago, we are going to have many nurses practicing without a license.

    So how would you rectify this perceived problem?
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  2. 29 Comments

  3. by   psnurse
    Of course I take verbal orders. I don't work in a teaching hospital, so I don't have anyone in house most of the time. I have to take verbal orders.

    I have never run into someone not owning their own order. I can only imagine that I would confront them, then and there. Probably not too nicely either.

    If the person supervising these residents was required to take all calls for verbal orders, I wonder if that person couldn't invoke some sort of procedural change. Bottom line, in my opinion.... this is their problem... they just haven't been faced with the proper impetus to get them moving in the direction of a solution.

    In the meantime, I wonder if verbal orders should be required to be signed by 2 nurses. (A waste of at least one nurse's time) Or if a recording device could be placed on one phone and all calls for orders could be made from that phone.

    We have a recorder on one of our phones. But it is to keep physician abuse under wraps, not for failure to back up one's orders.
  4. by   justanurse
    And, so far haven't been burned. I re-read my orders back so I know & the Doc knows I've got it right. Did hear about a very good Critical Care nurse who worked in ER and had a Doc tell her to start TPA on a CVA patient. She re-verified it with him and had consent signed, gave the bolus and then he tried to retract the order. The ER Doc stood up for her, as he had heard the exchange of order & confirmation. Now that is one Doc I will be leary of in the future.

    But, of course, you have to be careful of all of them. They are the doctor after all and don't make any mistakes. The mistakes are always the nurse's.
  5. by   canoehead
    Dishonesty from a doc is absolutely unacceptable (and from a nurse too). Why aren't the attendings supporting the nurses they have worked with for years, and presumably know them to be honest. Those residents need to be hung out to dry, if not by the attendings on rounds, then by the nursing staff in the ICU at the time they deny giving a VO.

    I would also get that recording device, or have a second nurse sign as a witness, and then let them try it. I agree that this is not a nursing problem, but a physician one, and needs to be brought up to the powers that be. I think that lying in rounds should be noted on a residents record, and be grounds for disciplinary action.
  6. by   nur20
    Yes, I take them also. In the private field there's not much choice. So far, so good, We also wear out the FAX machine
  7. by   deespoohbear
    We also take verbal and telephone orders. I don't work in a teaching facility either, just a small county hospital. I deal with the same docs day in, day out. There is only one doc I don't trust when it comes to verbal orders. If he gives me an order that I think he may try and deny later, I get a second nurse for a witness. I haven't ran into any problems. But, again, I am at a small facility where we don't have residents. If we had to wait for the docs to write all the orders, we be in big trouble in the evenings and nights. Haven't any trouble with the nurses writing orders without the doc's consent. I guess our nurses just aren't that gutsy. Good luck!!!
  8. by   P_RN
    I can think of at least two cases where verbal orders were denied by physicians I "trusted." One told me to get some labs on a post op A/P spinal fusion patient I called him about who was spiking a temp. shaking chills, hallucinating. I said "CBC, SMAC, Urine?"

    He said "whatever"......

    I repeated "CBC, SMAC, Urine" and he said "OK." Fortunately he had a LOUD voice and others in the room could hear what I said and his replies.

    I got to work the next day and found out he had totally DENIED ever speaking to me. He had also made the comment to "tell her (me) that there were jobs in food service I might be able to handle."

    Bottom line, after I got the head of the department and the director to meet with the nurses, this physician's privileges were suspended. He still won't talk to me.

    Oh yes....the patient had a roaring wound infection and nearly died......the relief physician had to pull her out of it.

    Another case was written post-op orders I carried out......and sent the back copy to the pharmacy.......the next day the resident tried squeezing order #13 at the bottom. She had forgotten postop abx. The pharmacy had the back copy which had only TWELVE orders on it. She tried then to say she had called and added the antibiotic. No good......*I* wasn't there at the time she said she had called.......Liar, Liar......

    Verbal orders should really be ONLY for emergencies. And don't you believe when it comes down to YOU or THEM....that they will look out for YOU!
  9. by   egmorgan
    At our hospital we would not survive without telephone orders, however in the Uk you always need to second nurse to confirm a telephone order. I guess two nurses checking is better than one.
  10. by   Norbert Holz
    My experience is to be fired (or placed on the do not use list) if any error or doubt is ever presented. Isn't that common pratice in the profession or is Tampa a unique place?
  11. by   mcl4
    The interesting thing, is that my most experienced nurses, know which residents they can trust and therefore continue to take verbal orders from some doctors. They know that they can get them written in the AM before rounds. Now, some of my inexperienced staff is trying to do the same and they are now getting hung once in a while, because they do not know who will own their orders in the AM.

    Our staff is very vocal, and are getting upset that we cannot take verbal orders, and the rest of our institution can. We need to address this issue, but I am at somewhat of a loss, in how to aproach it. If verbal orders come back like they were two years ago, we are going to have many nurses practicing without a license.

    So how would you rectify this perceived problem? [/B][/QUOTE]


    I'm a bit taken back that a nurse would go against policy and write verbal orders when knowing this was not acceptable.
    Why put your job/license at risk.
  12. by   mcl4
    Originally posted by canoehead
    Dishonesty from a doc is absolutely unacceptable (and from a nurse too). Why aren't the attendings supporting the nurses they have worked with for years, and presumably know them to be honest. Those residents need to be hung out to dry, if not by the attendings on rounds, then by the nursing staff in the ICU at the time they deny giving a VO.

    I would also get that recording device, or have a second nurse sign as a witness, and then let them try it. I agree that this is not a nursing problem, but a physician one, and needs to be brought up to the powers that be. I think that lying in rounds should be noted on a residents record, and be grounds for disciplinary action.

    Wouldn't it be far easier to hand the resident the chart and tell him/her to write the orders. Teach these residents from the start to write their own orders and then they will not be so depended on nursing staff to do their job.
  13. by   mcl4
    [QUOTE]Originally posted by psnurse
    [B]Of course I take verbal orders. I don't work in a teaching hospital, so I don't have anyone in house most of the time. I have to take verbal orders.

    I have never run into someone not owning their own order. I can only imagine that I would confront them, then and there. Probably not too nicely either.

    Do you mean telephone orders or verbal orders. Verbal orders to me are the ones nursing write when they are making rounds with physicians and they give verbal orders. I see them as two different areas? Hospitals and other facilites have different policies and some require a physician to cosign the order within a specific time period.
  14. by   mcl4
    The interesting thing, is that my most experienced nurses, know which residents they can trust and therefore continue to take verbal orders from some doctors. They know that they can get them written in the AM before rounds. Now, some of my inexperienced staff is trying to do the same and they are now getting hung once in a while, because they do not know who will own their orders in the AM.

    Our staff is very vocal, and are getting upset that we cannot take verbal orders, and the rest of our institution can. We need to address this issue, but I am at somewhat of a loss, in how to aproach it. If verbal orders come back like they were two years ago, we are going to have many nurses practicing without a license.

    So how would you rectify this perceived problem? [/B][/QUOTE]



    Is there a good reason why residents can not write orders?
    With the shortage of staff, I see no reason why we should be doing the resident's job. I tend to think we enable physicians to be more dependent on us to do the simplist task as writing what they want done for their patients.

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