Do RNs have to take PA's order?

I'm in LTC in PA. We were told we were no longer able to take verbal orders from a Physician Assistant.

I havent been a nurse long enough to have much experience in this matter. When I worked at the LTC we didnt have any PA's. In all three ICU's Ive worked in we didnt use them either. In the two ER's Ive casualed in they did use PA's. Mostly for smaller stuff like sutures and casting etc. I havent been in a position to have to take many orders from them accept labs, imaging etc. Ive been more than glad to assist them now and then.

One ER I work in uses a PA and if I recall correctly he intubates.

As far as taking orders from NPs I dont take them too seriosly (ICU). If its minor stuff I go ahead and enter it. If its meds then I usually wait until the attendings round. I worked with two outstanding NP's at a tenet facility in CA, but whatever they wrote their attendings usually changed anyway.

I know of one trauma center in WI that uses a PA in its ICU who stays on the floor and also does certain procedures ie chest tubes etc-

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I havent been a nurse long enough to have much experience in this matter. When I worked at the LTC we didnt have any PA's. In all three ICU's Ive worked in we didnt use them either. In the two ER's Ive casualed in they did use PA's. Mostly for smaller stuff like sutures and casting etc. I havent been in a position to have to take many orders from them accept labs, imaging etc. Ive been more than glad to assist them now and then.

One ER I work in uses a PA and if I recall correctly he intubates.

As far as taking orders from NPs I dont take them too seriosly (ICU). If its minor stuff I go ahead and enter it. If its meds then I usually wait until the attendings round. I worked with two outstanding NP's at a tenet facility in CA, but whatever they wrote their attendings usually changed anyway.

I know of one trauma center in WI that uses a PA in its ICU who stays on the floor and also does certain procedures ie chest tubes etc-

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Can't you get in trouble if something happens and you didn't give the med a pa/np ordered? I would be worried that it was outside my scope to decide what I will and won't accept from a PA/NP.

There is a risk to everything in life. I have had to question and go over the head of doctors with orders I could not accept, although I do not take this lightly. I would hesitate even less regarding a PA's questionable order.

But my state laws have established the RN is liable if she follows an order leading to a bad patient outcome. Unfair as it sounds, we do have to think before we accept an order. We always have a choice.

I can understand a questionable order but all med orders aren't followed until the attending arrives. Guess I just don't understand. I thought PA or NP's did give orders for treatment/meds/etc. and that the RN's needed to treat those the same way they would an MD's order. Sure would like to know before I get on the floors.

Hi!! Just thought I'd let you know what our PA's do!! RN's DEFINITELY take all orders from them, written, verbal and telephone. The PA's round and see all patients (they have to, they work for cardiothoracic surgeons who are usually in surgery most of the day....when they're done for the day they make it to the unit to look at all patients, write last minute orders and sign off on the PA's orders), write orders, discharge and do all paperwork and prescription writing. They help in the O.R. by endoscopic vein harvesting and assisting. They perform many advanced skills such as pleural tube placement at bedside, thoracentesis, central line placements, femoral line placements if needed, and they decide when the patient needs all these things. I asked one PA if there's anything they're not allowed to do, and he told me he can basically do anything that the surgeon trains him to do. They of course work for the surgeon's and the surgeons need to sign off on whatever the PA writes, and they'll change orders if they see fit, but believe me it doesn't happen often. The PA's are very good about consulting the surgeon's if they're undecided on what to do for a patient. So they're quite independent and make good money. I looked it up on salary.com and in this area base pays for PA's and NP's are the same. Nurse anesthetist made much more. I really wouldn't call it dead end either. Now we just hired an NP for the unit, and I know she'll be helping out with a lot of things like the discharges, etc. Her role is still being hashed out, but I'm sure she's going to be a huge asset to the unit! And I BELIEVE NP's are able to do quite a few advanced procedures themselves, don't they actually do cardiac caths in some areas? I'll never say that one career is BETTER than the other, they are different roles (at least in the area I work in) and it's an individual choice as far as what someone wants to do.

Hm, allele and I must work on very similar CT units. Ditto exactly what he/she said (less the NP part).

I think our PA's have got it made. I think what they do is awesome and the pay is outstanding. Their hours are M-F with weekends/holidays off. I will say that sometimes, especially if a surgery runs longer than anticipated, they can have long days. For the most part they do just about everything our docs do and sign their "name PA/attending name" to orders. In CA I don't think the docs have to sign their orders as it is implied that they are already working under the doc.

I have not been that impressed with a PA I worked with on PCU. He would come around to pull the sheaths for a Dr. that only alllowed him to do it, and he would never apply adequate pressure, nor would he care about hearing the patient ended up with a significant bleed that I would hold pressure on myself for 15-20 minutes. He seemed to never be interested in anything the nurses had to say. I'll take a CRNP over them anyday.

Um, yeah.

what would make you think that you didn't have to take a PA's order?

i didn't know we could pick and choose? :-)

The PA's I know are especially smart. Wouldn't hesitate in a second!

Um, yeah.

what would make you think that you didn't have to take a PA's order?

i didn't know we could pick and choose? :-)

The PA's I know are especially smart. Wouldn't hesitate in a second!

That is what I thought. Thanks.

Um, yeah.

what would make you think that you didn't have to take a PA's order?

i didn't know we could pick and choose? :-)

The PA's I know are especially smart. Wouldn't hesitate in a second!

I can take anyones order I choose to within reason. And if I dont like it I can go over their head. If I still dont like it I can refuse and have my charge take the order. That has only happened to me once, and the charge refused the order also, called up the chain of command until the Chief of Staff was involved.

Just because I am a nurse doesnt make me a custodian for MD's, Residents, PA's, and NPs. And notice in all my posts I capitalize those titles out of respect for their educations, hard work, and positions.

I cant count how many times an MD from another service, or other practioner has come in and written orders having not even evaluated the pt or looked at recent notes. Thats in more than one hospital, in more than one state.

I repeat, you do not have to take an order. You may go above the practitioner for comfirmation.

However, I do advise that you have all your "evidence together, then present your case" when you make your stand.

Another thing. I do not accept notes as orders either. If you want me to do it you damn well better write it as an order, on an order sheet. Or give a verbal. Period.

If you see fit to do whatever anyone tells you to do so be it.

Nursing in ICU or ED is not for the faint of heart-

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when I was checking out the PA program's about 10 years ago they weren't allowed to write narcs. thanks for the update, don't see too many in LTC but they have always been a great asset, I usually preferred PA's and NP's over some of the doc's. they seemed to be a bit more compassionate and had a better repore with the nurses. some of the programs the courses could transfer if you wanted to go to med school. I was really interested in the PA program but NM didn't have one at the time, they have since started a program. years ago they had one for the native Americans but for some reason they were not able to do as well in that program so they closed it down. the one now seems to be doing much better.