Nursing order

[PJROR]

This is an odd question. I work with a nurse who writes some really odd and uncomfortable nursing orders. In my facility we often write nursing orders to let other nurses know there is a possible skin issue. This nurse has began writing orders for procedures that I am not real comfortable with. I do not mind doing them but feel we should have a DR order first. My question is what orders can a nurse write? Any web sites you know of with details would be great. I am just worried about getting into legal hot water with some of these orders.

[CoffeeRTC, BSN, RN]

Does the doc sign off on these orders?

Is there another way you can communicate things to each sift? I'm not sure what type of setting you are in, so it might depend.

[Whispera, MSN, RN]

Tell us what some of the orders are, so we can make a more logical judgement of what's legal or not...

[Jokerhill]

You need to see your nurse practice act for your state.

[PJROR]

Orders such as rectal checks daily etc. No they are not signed by a doctor.

[ChristineN, BSN, RN]

Orders such as rectal checks daily etc. No they are not signed by a doctor.

Well, at my facility, RN's are allowed to put in orders based on protocol for skin related care. Orders such as "turn every three hours" or even orders for prescription lotions and ointments do not need a doctor's order. I would probably give the doctor a heads up that this pt has a stage #1 or is at risk for skin breakdown, just so he is aware, but as long as your protocol allows nursing orders related to skin care, I don't see a problem.

[RochesterRN-BSN, BSN, RN]

What kinds of skin treatments are you refering to that yu are uncomfortable? Skin care has a fairly wide scope of practice I ahve found in most places. This is why most hospitals have a skin care team to help with difficult things and give suggestions. When medicated things like say an antifungal are needed yes you have to get the order to get the cream--The team is made up of nurses and usually headed by a WOCN RN and they usually can give you guide lines for what the bes treatments are for various skin things as well as what things you can implement with and without an order.....In a nursing home things a a bit different but you should still have someone who is experienced in skin care to kind of be in charge and a protocol in place for these guidlines.

[encourageu]

I always had the same question. I work at a long term care facility, and the nurses have always written orders, then got the doctors to sign off on them later. But what about when a doctor writes an order for a "ua c&s", can the nurse write an order for "may straight cath"? I feel uncomfortable with that because its invasive.

[tewdles, RN]

I don't work in LTC, why would you do daily rectal checks?

[sasha2lady]

Daily rectal checks???? For what? Ive never seen one for that before...hmm....I work in LTC and we have a 2 pg front and back skin care protocol that we have to use. Its big...it ranges from skin tears to all wound stages to redness etc.....Its handy for some things but for others its a real hassle. We have a wound doctor that comes in once a week and he usually changes the orders anyways. check your protocol and practice act.

[Nursynursemn]

This is a good question. Rectal checks are done in an effort to determine whether or not the patient is constipated. It is usually done three days with no bm and prior to the use of a biscodyl supp, which might be on your standing nursing orders. However, if you do not have orders to give a supp, you probably shouldn't be doing rectal checks, it seems that there should be some sort of rationale and follow through for the next step. I am learning quickly that you need to maintain boundaries and advocate for your own license.

I recently wrote an order to offer a pain medication prior to therapies, which the patient had available prn. I was fired for this and reported to the board. You never know what might transpire. I did not harm, but the powers that be, thought otherwise.