medical orders?

[olympiad27]

It is common practice where I work for RNs and sometimes LPNs who work for physicians to telephone or give verbal or written orders on hospital patients. We are expected to take verbal, telephone or written orders from them just as if they were the physician. Sometimes these orders are for lab tests and studies, procedures, and sometimes for medications. I feel very uncomfortable with this practice however I don't know what to do. When I brought it to the attention of several of the nursing managers they refused to believe that it was even going on. When I called the Board of Nursing they said that it all depended on the standard of care in the hospital. In other words it is ok if that is the standard of practice in the hospital. This doesn't seem right. I was taught that only physicians or PAs or NPs could write or telephone medical orders. Aren't these nurses practicing medicine without a license? Aren't we putting our own license in jeopardy by carrying out these orders?

[purplemania, BSN, RN]

Very scary. You really have no idea who you are talking to or if they have the training/education to interpret the MD orders correctly, etc. When we call an MD's office & cannot talk to the MD, we leave a message. If MD does not return call ASAP we call again, or get the House Supervisor to do it. We do not take orders from non-MD.s

[luvin it]

I know that the squeaky wheelis not always supported or welcomed. I fought w/ the whole Dallas County Med. Dept. as a new nurse because they didn't mesh-up to what I had been taught. I was a difficult time in my career. But, I was right to maintain those standards for myself and my practice. I didn't change much in the system and the Dept. "promoted" me into a postion w/i the immunization clinic. Other nurses called it a "cush" job. (how can you screw-up immuniztions?) I finally quit d/t bordom...I think the Nurse Director took long deep breath after I was gone.

I now work w/i a hospital setting. I have worked on a Med/surg floor and a Cardiac step-down unit. The step down unit was w/i a teaching facility w/ residents and interns. So that all being said here is my 2 cents worth.

I very seriously doubt that if you went to court after a problem occurance d/t taking an order from another nurse I doubt that it would stand-up. Don't for a minute believe that your hospital would "have your back". A law suit brings out the worse in nursing standard compared to common sense. For instance defend yourself on this question...how much did the office nurse know about the clinical picture of this pt. ? Had she been to the hospital? Did the Dr. report off to her each morning in regard to their DX, Prognosis, pending procedures??

If I am SO confident that Tylenol/MOM, H&H for a bleeder, is OK then I take responibilty and write the order as such....Dr. ordering/nurse RN... this seperates the fact that I did'nt actually talk to someone else before making that decision. I would NEVER use that to administer anything other than a benign med. or obvious lab. I would never do this if the Doc involved was not the type that is OK w/ my competence. But, I believe more in my clinical judgement than that of a someone that hasn't seen the situation. Also FYI tylenol and MOM are not always OK. Would the office nurse know that too?? For instance nausea and upper gastric pain does not always mean reflux...it is also an indicator of MI...do you want to explain in court why you took an order from MOM from an informed, underlicensed person after someone dies?

Clinical Spec., Residents, Interns are different. They are reported to on pt status. Have their own malpratice insurance. They have advanced degrees. You would at least have a leg to stand-on.

As a new nurse on the Med/Surg unit I once took the opinion of the HUC. She stated " we do it blah, blah. way". I can't even remember what it was about. I do remember on the way home, I thought to myself "what if I had to explain myself by saying that I made a decision by what the HUC said??" Woke me up...

[CCU NRS]

I am at a loss as to what to do about it though. Where do we stand legally taking orders from non-physicians? Who would be held responsible if something went wrong? I am sure that if my family member were sick I would be furious to discover that nurses no matter how good they are, were making these kind of decisions. It is unacceptable and possibly illegal.

1. Nurses are not making these decisions, the doctor they work for is making the decision and giving them the order.

2. You are a nurse you can take orders, so as a nurse they can take orders the orders should be written as such

TORB Dr Whoever/Nurse Whatsit RN/ Your name and degree

3. Legality should not be an issue as long as the person you are talking to is actually a nurse.

4. If you are talking to a nurse and you know he/she did not actually talk to the doctor, you can assume they have the support of the doctor to make such decisions.

I work CCU and many of our Doctors have RN's that round and if you need something you can ask them and if they feel oko about giving the order they are working witin the scope of practice under the doctor, in other words if you need a suppository for a temp and the nurse is rounding and she gives you the order you may assume she has an understanding that this would be ordered. If it is something more serous they can call the doctor and explain the situation adn get an order. I have no problem taking orders from these nurses.

[cadillac05]

How many "office nurses" are nurses? :stone Few doctor have RNs or LPNs in their offices. I, too, have questioned receiving orders from a office staff person, but know that doctors convey orders through them frequently. A real dilemma, as all the previous posts have indicated. It isn't the order per se, it's the legal implication that's at issue. Hard to buck a system controlled by the doctors.