"Taking a verbal" = writing your own orders?!

[delphine22]

So I'm orienting in an MICU. Having a nice conversation with a nurse, well regarded on the unit (just won an award), had worked there for decades, and is not my preceptor. She mentions that one of the problems I'm going to have coming to the unit, that many PCU nurses have, is I'm not used to the level of critical thinking doctors expect from me.

"For example," she says, "if I'm worried about my patient, I'll just go ahead an order a gas! If I think there's something up with his abdomen, I'll have a KUB done. This way I'm prepared when I call the doctor!"

I was horrified. For years I had been told the story of an ER nurse in my hospital who wrote a phantom order just once (not for a med, for a blood test I believe) and was fired on the spot. I can't even get skin care creams without an order. She said "Oh, we take verbals all the time."

To me, that's different. If a doctor rounds, and says, "OK, we'll recheck BMP and mag in 4 hours," I smile sweetly and say, "Will you be putting those orders in yourself, sir, or do you need me to write them for you?" We are 100% computerized order entry, and written orders are frowned upon unless they truly are from the telephone, but I don't mind if they won't be near a computer and it gets things done faster.

But I'd never dream of ordering a test without speaking to a doctor first! Luckily this will never be a problem for me; we have remote-monitored eICU at night, when I will be working, and there is always an intensivist available at the push of a button. And it's usually not a problem for her, as the usual daytime intensivist writes his own orders on the BMW in the middle of interdisciplinary rounds. But some weeks an off site intensivist is in charge.

I know I'm not crazy when I say it's wrong. But this is a judgement free zone: are there places where this is considered OK?

[delphine22]

The poster is from Texas.

I am from Florida, and call all male doctors "sir" and female "ma'am." Note I do not work in a teaching hospital; I don't think I'd call a resident "sir" but I don't know.

Before a nurse, I was a singer with an opera background. We called the conductor "sir" or "maestro" as a title of respect. We all had important roles to fill, but he was basically the captain of the ship. I give MDs the same respect. . .as long as they give it back. (I have been known to use "sir" sarcastically as well.)

[traumasurgRN]

I would be very careful when entering MD orders prior to speaking with the MD; here in SC, this is outside of our scope of practice, unless it is being ordered under a protocol or standing order. In my facility, we do have some protocols and standing orders which we can utilize for certain labs and such, and as a Rapid Response nurse, I have my own separate protocol which I follow and allows me to order labs, EKG's and nitro for chest pain. For my first 2 years of ICU nursing, I too was taught that it was an expectation to order labs, etc and obtain results, if possible, before calling the MD; however, upon being floated to another ICU in the same hospital, this was not the expectation, and I was punished for doing so, because another nurse felt compelled to alert her director about my practicing outside of my scope. I have ben told many many times by the surgeons in my unit that we can write and do whatever we need to keep the pt alive, and they would sign off on it in the AM, however, I act with extreme caution in doing so. Once bitten, twice shy I suppose.

[chare]

Like many here, I was skeptical that it was really legally acceptable to act first when necessary, and discuss with the MD later, but at least according to by state's BON surveyors, that's not only acceptable but it's their expectation of a competent critical care nurse.

Which state is this?