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.

[Parul]

Thank you all! I will go ahead and find the policy about taking verbal orders from doctors in case of NON emergency and will post it in the nursing station. It will help me and all my fellow nurses to just point to that policy when the doctors are just being lazy or want us to do something that is non compliant with our policies. Where can I find standards about taking verbal orders in GA? Would it be available on the GA nursing board website? I tried to search that website, but nothing came up. May be I wasn't looking in the right place. Thanks!

[swayman2202]

I am a CNA, but currently due to problems with my pregnancy, i work in medical records at a home health agency.

We have a form for doctors, an RN has to fill out the order that they want approved and we fax it to the Dr. who signs it and returns it. They also make changes to the order if it does not suit their opinion (i guess thats how i should word it) we also have an LPN that writes ordesr the only diffence there is that the RN review it before it goes to the Dr. so I dont see the problem with writing and order while doctor is present. as long as dr. signs it.

[netglow, ASN, RN]

Oh I don't like this.

At one facility, in ICU it seemed several docs and even some NP refused to put in their own orders! This was such a time drain on the nurses. Word was that it was suggested the RNs do it as a courtesy... mostly because the docs were bucking learning the software, and so spoon feeding just got to be the norm. This was often not just meds. One time just as a patient was afib (soon to code), the cow went down, and the card just rattled of a few drips from the doorway... unfortunately there was no computer now in the room to transcribe as he spoke (he was aware of this) and we were up to our ears in patient care/iso. He could've gone to another system and put it in so it could get to pharmacy!!

[nicole109]

Honestly, I don't have a problem with writing MD orders--if they aren't constantly depending on me to do it for them because they are being lazy, and if I'm not completely bogged down myself. Like any other professional relationship there has to be give and take. And I know that the doctors are just as busy as we are most times, so even if they are just standing there, I have no problem taking down a verbal order, so that they can move on to the next thing. Imagine if you were the nurse waiting for that doctor to return a page or come and talk to your patients family or whatever, and I was arguing with the doc to put in his own order for a colace or a CBC, when I could just take the verbal and write it myself...we are all busy, and we all have to work together. Don't get me wrong, I have told serveral docs where their pen belongs bc they constantly rely on us to do all of their work--but we do all need to work together.

[RelloydRN]

If its a resident physician I'll give him my pen. If its the consultant, I'll call his resident to do the writing.

Anyway, my facility now uses computerized charting and it is against the policy to use some other employee's log-in username.

[CoffeeRTC, 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!

Yep...we do that. In LTC we do alot of telephone orders too.

[highlandlass1592, BSN, RN]

Thank you all! I will go ahead and find the policy about taking verbal orders from doctors in case of NON emergency and will post it in the nursing station. It will help me and all my fellow nurses to just point to that policy when the doctors are just being lazy or want us to do something that is non compliant with our policies. Where can I find standards about taking verbal orders in GA? Would it be available on the GA nursing board website? I tried to search that website, but nothing came up. May be I wasn't looking in the right place. Thanks!

To answer your question, it may be on the BON website, you may need to look up your nursing practice act. But it may benefit you to call the board in Georgia directly, they may be able to direct you to the pertinent portion of your practice act a without you having to spend so much time searching.

This really brings home the important point that you MUST become familiar with your state's practice act. As nurses, we are responsible for knowing the act and our limits of practice. Remember, ultimately it is the BON who says whether or not you can practice, they issue your license.

[MassED, BSN, RN]

as a total sidenote: are they teaching in school that patient's are now called "consumers???" That is ridiculous. First patients, then clients, now CONSUMERS?

I would think the med questions and orders are specific to your facility.

[SandraCVRN]

We are not allowed to take verbal orders unless an emergency of the doc is scrubbed in. Some of them will pick up their phones and say now it's a telephone order, LOL.

[TDCHIM]

as a total sidenote: are they teaching in school that patient's are now called "consumers???" That is ridiculous. First patients, then clients, now CONSUMERS?

What's wrong with "consumer?" It sounds a heck of a lot less pretentious to me than "client;" to me, that sounds like nurses are executing stock trades rather than providing care! "Patient" makes the most sense, but of the management-ese options, I'm a much bigger fan of "consumer."

Okay, sorry for the digression.

[dscrn]

as a total sidenote: are they teaching in school that patient's are now called "consumers???" That is ridiculous. First patients, then clients, now CONSUMERS?

I would think the med questions and orders are specific to your facility.

...and theb "guests":jester:

[Tait, MSN, RN]

We are only allowed to take telephone orders for MD's physically not on the floor. I work nights so I am not sure how often verbal orders happen during the day but my rule is "one less possible mistake". If you are standing there, you can write the order.

Tait