Can a doctor ask a nurse to write the order when she is standing right there??

[Parul]

Hello All,

I am a relatively new nurse and work for a psych. facility. Many times, the doctors just ask us nurses to write the orders for them when they are right there..These are the orders when they are not very clear about what to do or they want us to do something that is against the policies. i.e. -- we had a patient who required many very expensive medications. Our policy says that we will only administer the medications that were ordered for the patient from our pharmacy and will not use any medication that the consumers bring with them from home. But there are exceptions when the doctors would give us an order to use consumer's medication. So, the other day when the case worker brought in medication for one consumer -- doctor just told me to receive the medication, identify them and confirm what they were and write an order on her behalf to use those medication for the consumer. My manager inter wined and said -- sorry doc, but nurses can not dispense the medication. So, the doctor gave us a nasty look and opened the bottles to see if the medications were what they said on the bottle. She also said -- well, how am I suppose to know what medications are these??? Lucky for her -- all the bottles were sealed, so she just gave all of them to us and said -- ok, you can write down all the medications and write the order for me now..CAN SHE DO THAT??? Can someone please tell me where can I look up the information about when are the nurses responsible to write the orders for doctors?? I will appreciate some guidance as if how to handle situations like this. ..thank you all.

[Orca, ADN, ASN, RN]

I would say no. If the the medication was misidentified - or the outside pharmacy misfilled the bottles - there could be a big liability issue. I would have the doctor write her own order.

Ultimately the doctor is responsible for any orders she issues. Nurses sometimes write orders for signature as a courtesy, but they are certainly not obligated to do so. I would be especially reluctant in an iffy situation like this one.

[caliotter3]

What was the doctor doing that they could not take the chart and write it out themselves? Lazy? Self-important?

[onetiredmomma]

I know psych is a different world. On the medsurg unit where I work if a pt has an order to take own home meds we send them (in the original bottle, no a med minder) to our pharmacy to verify and relabel before we can use them. And yes I have had a Dr give me an order as he is heading down the hall to go to the next unit. Sometimes if they are working on another pt chart and I ask for something I will write the order and then put the chart in front of them to sign or give them the chart and ask them to go ahead an write it "since you have to sign it anyway".

[CaLLaCoDe, BSN, RN]

Yes, I have written orders up for doctors while they were rounding on my patients. Trick is to have them sign your written work and not have them skip out on you!

[brownbook]

It might vary from instutition to instution what is legal. However it is extremely dangerous and nurses are discouraged from writing orders for doctors. You should not have to be dealing with this issue. You can look through your policy manuals yourself, however manuals are often vague, nothing is black and white. Or ask your manager to show you what the policy is. If it is clear that you cannot do this post a large sign at the nurses station and then just point to the sign when asked to do it again.

[Whispera, MSN, RN]

If a nurse can't write what the doctor says he's ordering, in person, how could the nurse take a phone order? I understand we don't want to take responsibility for mis-hearing the doctor and ordering what he didn't intend, and we don't want to do his work, but....

[NicuGal, MSN, RN]

if you consider that a verbal order...then no you should not write it. We aren't allowed to take verbal orders unless it is an emergency. Moot point now that we have computerized ordering/charting.

[lorazepam]

It sounds like your manager is very knowledgeable about the do's/don'ts. She sounds like a good person to consult with. Also, as explained in the above posts, different states have different legalities. Different facilities have different policies on the situation you described. Keep patient safety first. The doctor doesn't sign your paycheck, consult with your manager.

And think of this experience as an opportunity to develop thick skin. As you become more experienced, you won't be afraid to confront doctors about issues related to patient safety, or accountability. You may even develop a clever way to get the physician to lift a pen and write the order themselves!

[brownbook]

Whispera, phone orders are legal. Completely different issue from when the doctor is on your unit. Even with phone orders, be very careful. Say at the end (before he has a chance to hang up) whatever words come easily to you, something like "I will read back your order." and read what you wrote. Then write on the order sheet "verbal order read back."

[anITNurse]

It is legal in NC to take verbal orders, but the hospital policy forbids it except durring an emergency.

[ProBeeRN, BSN, RN]

in homecare we "write" all the orders and they are then sent for signature. I will always read back over the phone for labs or meds. I will go ahead and write orders for say extra nursing visits or continuation of a wound care as needed. I keep in touch with the MD office to let them know what I'm sending over. Honestly I think they are barely looked at before they are signed. Apples and oranges in your situation though.