Accepting verbal orders from another nurse?

[amberrenae, RN]

I'm a new RN a little over a month into my orientation on a busy med/surg unit. Tonight at a few minutes before the end of my shift I had finished reporting off and was sitting at the nurses station when a float pool nurse I had never worked with before asked me to push morphine for her patient. She had just started giving report and was trying to avoid overtime. I brought the morphine into the room but wasn't able to scan it because the patient didn't have an order for it in the eMAR. I returned to the nurse and told her the morphine wasn't ordered, and she said she had taken a verbal order and I should enter the order. I said I didn't feel comfortable entering orders I hadn't taken for a patient I didn't know, and she said I could just push the morphine without scanning it and she would enter the orders and document administration when she finished report. I hesitated again, and she snatched the morphine from my hand and stormed off to give it herself.

Am I in the wrong here? I don't want to be seen as not being a team player and I'm sure things like this happen, but I also don't want to risk the license I just earned.

[Ruby Vee, BSN]

I normally wouldn't have a problem putting in a order for a nurse that they were passing along to me, I just put per so and so in the order, but the situation you've described is messed up.

She had you taking out an opiate by overriding it on a patient who had no order for it and at the end of your shift, which pretty much checks every check box for actions suspicious for drug diversion, and then to top it all off she takes it from you to give herself which means there it won't even be charted under your name, there's pretty much everything wrong with that.

And you've checked the opiate out of the system but haven't administered it. That's another red flag for diversion. If you haven't already, write yourself an email describing the situation as factually and as accurately as you can. Email it to yourself so you have a dated and timed copy. I'm on the fence about whether you should email it to your manager and/or pharmacy.

[cleback]

In outpatient world, nurses give verbal orders on behalf of the provider very often... sometimes followed up with a faxed order that is properly signed.

But in inpatient world, I would not, particularly with medications, particularly with narcotics.

[Leader25, ASN, BSN, RN]

You did the right thing,if she is from float pool then she could ask the ANM to do it ,it still requires an order.Dont mess around with narcotics and stupid nurses.

[Leader25, ASN, BSN, RN]

thanks for the update,you are not there to be popular,you are there to do your best for the patient,forget about that bimbo.

[SpankedInPittsburgh, DNP, RN]

No chance I'm taking a verbal order from another nurse for controlled substances ever

[T__BSN_AGNP21, ADN, BSN, MSN, LPN]

Good job protecting that well earned RN license!

[mmc51264, BSN, MSN, RN]

We are not supposed to take verbal orders for just about anything unless it is a code or an RRT and then we are supposed to track down doc or resident to get them to place them.

You did right. I would have never have given a medication like morphine without a written order let alone a verbal from a nurse who took a verbal. that is an accident waiting to happen and if you are the one giving it, it is on you.

[djh123]

Morphine?!? As they say in TX, 'Hail no!'... I would never, ever, give that on a verbal from another nurse (and when it's not in the system).

[Nurse SMS, MSN, RN]

Glad you talked to your manager and all is well. You did a good job.

I too would never take a verbal order from another nurse. Heck, I push back on taking them from physicians due to the high likelihood of errors! I will take a verbal in three instances - RRT/Code Blue, physician will contaminate the keyboard or keyboard will contaminate the physician. Otherwise no. And a verbal from another nurse...just picture trying to explain that one in court and you will have all the answer you need, whether its a narcotic or not.

Wishing you well as you grow and develop in your role. You have good instincts. This was a valuable learning opportunity.

[sugarmagnolia3]

No, you are not wrong. You can't take verbal orders from another nurse.

I would tell her to enter the order before I would give it. Or, say, I'm sorry, I'm not comfortable doing that, and offer to help her with something else.

She knows better, and is cutting corners.

[Irish_Mist, BSN, RN]

You did the right thing. This person can go sit in a fire ant pile for being so unreasonable.

[Qing]

You did not do anything wrong, but if you did override the Pyxis to get morphine out...it could be a problem. This is going to get flagged by pharmacy and could be seen as drug diversion or suspicious activity.

The place I used to work at ... nurses could take verbal orders, but it was not seen as a reliable one. So normally the doctors would chart the orders into computer too, after giving a verbal order on the phone. Then you wait for the order to show up in the computer and then pull it from the Pyxis to give to the patient. If this was an emergency, then it would different where there would be verbal orders and you would over ride the Pyxis to get the medication. Plus, there would be a person designated for documenting in that situation.

Sometimes, I would write a verbal order that the doctor gave me and fax it to the pharmacy. It would take about 5 minutes for the pharmacy to enter it into the computer and then I would pull the medication then. So if I had to do something and needed another fellow nurse to help, they would see the order if they were covering for you during a break. They would know exactly what to get and how much. If they wanted to clarify the order with the doctor, they could if they wanted to.

You need to follow up and make sure that float nurse entered the verbal order and scanned the medication for the patient. Did you witness her giving it?

What did the other nurse say who was receiving report from that nurse?

Be careful and be a little more cautious before going to the Pyxis. If you are on orientation still, then bring it up to your preceptor. You need to protect yourself and just because you login, doesn't mean they don't track what comes in and out. She used you to pull out the medication, and all that matters is that the pharmacy sees your name for pulling it out when there was no order at the time. Yes it can be rectified with her putting in the verbal order and scanning the medication, but it doesn't change that you took the medication out for her without an order. If the order was already entered and pharmacy verified it... you pulling out the medication wouldn't look so suspicious then.

Sorry for the detail and none of this is meant to offend you.

Okay, I answered too late, but good that it worked out for you. God job!