medical orders?


  1. 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?
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  2. 15 Comments

  3. by   canoehead
    In school we were taught not to take second hand orders, but I have I admit, when waiting for the doc to call back would take hours and I had a pt puking. I would be interested in the "official" answer too.
  4. by   mattcastens
    In my unit (a CVICU) we work very closely with the cardiac surgeons and their nurse clinicians. Frequently we will take orders from the clinicians as if they were physician orders.

    I feel comfortable with this because we work closely, so I know their scope of knowedge, plus I personally know that if they ever have doubts about what to do they will ask the surgeons.

    When taking the orders, this is how we write them:

    "T.O. Dr. Blank/Jane Doe, RN/Staff nurse signature"

    I would only advise taking orders this way if you know who you're dealing with.
  5. by   nur20
    THIS IS A COMMON PRACTICE. IN MY AREA OF NURSING THE PHYSICIAN HAS TO SIGN THESE ORDERS EVENTUALLY, BUT I TOO FEEL UNCOMFORTABLE WITH THIS
  6. by   olympiad27
    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.
  7. by   OneChattyNurse
    When I worked in LTC...the DR would write the order on the chart at the clinic...then his/her nurse would call the order to me. I would then write the TO and it was sent to him/her for signature. This was supposed to be signed and back in the chart within 48 hours. This was the problem...it RARELY happened within the timeframe. I am not sure of the legalities of this practice, but I can say it was the rule, not the exception! In the small town I lived in, we pretty much knew the nurses that were calling in the orders. Either I went to high school with them or their daughters!!! Once in awhile you would have a DR that would call in his/her own orders...but they were the ones that took the longest to get!!! I guess it comes down to how we have to go about getting the orders the quickest to benefit the patients!!

    Just my 2 cents worth!
    Shari
  8. by   rdhdnrs
    Check with your state board for a copy of your state's Nurse Practice Act and show it to your supervisor.
  9. by   canoehead
    You know it's great to be annoyed because a nurse isn't waiting to hear from the doc, but we all know how pissed off families get when their loved one doesn't have an order for vomiting or pain. So if I take an order that was relayed by the office nurse, and is safe (don't tell me that I can't judge whether an order for a couple of pain pills is safe) then the pt doesn't wait 4hours til when office hours are over.

    I know that (because I've tried it) if I insist on talking to the doc directly I will be waiting until they are good and ready to call, and some don't call back at all. And frankly I feel like it's an insult to my intelligence and the doc's time, especially if I need just an antacid, or a Tylenol order.

    After thinking about it, I realize that general practice on my unit is not to take all orders from office staff, but the docs always seem to call themselves when we ask for an order that we can't predict their answer to.
  10. by   olympiad27
    I think perhaps I should clarify or elaborate a little. It is not that the doctor cannot be reached, in fact he or she may be in the hospital where the nurse is that is calling . In some cases the doctor just walked out of the unit or off the floor. What happens is that nurses just are in the habit of calling or asking the doctor's nurse for an order for pain medicine, sedation, etc. It is so commonly done that they will turn to the nurse even when the doctor is in the unit ! No one sees a problem with taking their orders or even questions the legality of it.
  11. by   Clemmons
    I am currently looking for an answer to taking orders from people over the phone that are for scheduled procedures (all in the name of the Dr) It's annoying me that I cannot find an answer. Any suggestions?
  12. by   virmm1
    Quote from Clemmons
    I am currently looking for an answer to taking orders from people over the phone that are for scheduled procedures (all in the name of the Dr) It's annoying me that I cannot find an answer. Any suggestions?
    Who's giving the order? It sounds like the pt is trying to give orders . Is this right?
  13. by   akcarmean
    I know we have taken TO orders from a nurse in HHC but it has been after they have talked to the DR. and are just relaying the order from him. I have only dealt with the same PT since I have been an LPN in HHC. The doctor knows the child since birth and I know the DR. and he knows me. Not sure on hospital policy. I can see no harm in you writing a TO from a DR. then giving the pt the RX. I would definately check on my work place procedure and make sure that the order did come from the DR.'s mouth not the nurses. Thats just my opinion. Angelia
  14. by   purplemania
    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

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