Entering All New Orders

bargainhound, RN · Jun 17, 2006

I hope as a group you can insist on some training.

Learn as you go is okay if you have enough help to take care of the

patients. Maybe your group can insist the charge nurses and unit clerks

stay until you are all comfortable entering the orders.

snowfreeze, BSN, RN · Jun 17, 2006

I think your hospital is heading in the wrong direction getting rid of charge nurse and unit clerk. The mistakes will rise, patient satisfaction will drop and nurses will quit and go work somewhere else.

The unit I work on has a 4:1 nurse patient ratio on daylight and 5:1 on evenings and I don't enter my orders in the computer system, the doctors do their own orders.

I am finding a lot of newer nurses in your dilemma, no senior staff to function as a reference nurse on their shift and no unit clerk to help and the charge nurse has an assignment so they can't help you quickly either.

My suggestion would be to go work somewhere else.

I also work in a LTC facility per-diem, I enter my own orders there and my nurse patient ration is usually 15:1 to 30:1, I usually don't get more than 2 admissions per shift there.

**canoehead, BSN, RN** · Jun 17, 2006

I don't understand how this saves money or time. Just having someone to direct traffic at the desk or answer the phone is such a huge burden off the nurses that the unit clerk, at least, is essential.

purplemania, BSN, RN · Jun 17, 2006

A charge nurse is essential regardless of how many other staff is on the floor. Someone has to have the final say and KNOW that the paperwork is theirs (census, schedules, call-ins, etc). As for unit clerk, I worked without one for years. It was nights on a pedi floor and I took 4 patients. There were 21 rooms. The nurse aide was cross trained to do order entry. I can tell you things got missed or delayed because patient care and paper work sometimes conflict. Sometimes you can't DO patient care without the orders being entered first. A real hassle. I sometimes had the House Sup find me a UC if we got slammed. A study could be done on your floor to track turn around times for labs, etc and how soon patients got their IV, meds, etc. to see if patient care is truly affected. Somehow it always looks more credible on paper.

meownsmile, BSN, RN · Jun 17, 2006

The only time we have to put in our own orders is between the hours of 11pm and 7am. We have a unit clerk all other times and she is valuable as a piece of solid gold. If it werent for the clerk i can see total chaos breaking out. Especially on days we have a large surgical load. Fight for your unit clerk!!! Charge nurse can be worked around. We use resource nurses,, a RN staff for that day makes sure lunch assignments are made out, the unit clerk brings any new admissions to them for room assignment, and they make the assignments for the oncoming shift. In general it should be rotated through the staff, but sometimes one person is better at it than others are so they take more than their share.

Do whatever it takes to keep your unit clerk, it will save you so much headache.

labor1 · Jun 17, 2006

The only time we have to put in our own orders is between the hours of 11pm and 7am. We have a unit clerk all other times and she is valuable as a piece of solid gold. If it werent for the clerk i can see total chaos breaking out. Especially on days we have a large surgical load. Fight for your unit clerk!!! Charge nurse can be worked around. We use resource nurses,, a RN staff for that day makes sure lunch assignments are made out, the unit clerk brings any new admissions to them for room assignment, and they make the assignments for the oncoming shift. In general it should be rotated through the staff, but sometimes one person is better at it than others are so they take more than their share.
Do whatever it takes to keep your unit clerk, it will save you so much headache.

I agree completely with this writer. I have been nursing for 33 years,on pediatrics,med-surg,postpartum and now mostly labor. A good secretary is a god send!! When we don't have one our time is taken up with answering the phone, directing visitor traffic, looking up reports for drs and the location of their patients on other floors and heaven know what else. It scares me to think of who could walk in when no one is at the desk.

Our secretares enter orders but the nurse is responsible for checking them.

On our floor she also admits patients into the computer which also saves us alot of time.

We take turns acting as charge nurse and are paid alittle extra when it is our turn. We still have a patient assignment,usually 2-3 labor patients or 6-7 patients on post partum.

Wise Woman RN · Jun 17, 2006

We have 5 to one patient ratio, no charge nurse, no secretary. One or two techs, but the nurses enter their own orders, answer the phone, answer the lights, attend to the docs, attend to the families, etc, etc... it's sometimes a madhouse... and entering orders involves not only entering on the computer, but also on the kardex, the daily report sheet, and the lab book, which is a book that the lab techs sign when the blood is drawn... nurses do all draws if picc or central line is present... I would give my right arm to have a secretary, and techs that move faster than a slow walk... which some of them do... but, I love my job and my patients... it's just never very easy, and I usually have a headache at the end of the day from everything... we also do paper charting... which is ungodly... 5 pieces of paper just for I&O... *sigh*

BGgirl · Jun 17, 2006

I work nights and have a 1:4 patient ratio. If the doctor is a resident he's expected to put in his own orders but a lot of times we have to take phone orders from attendings and are then responsible to put in the orders ourselves. We never see our unit clerk on nights and even if she was around they are unable to enter orders for us. The unit clerks used to do a lot when it came to admissions and oders before we went to entering things into the computer but now they've really cut back on their responsibility.

We have a charge nurse at night but they also have their own 4 patients so there's no way they'd enter your orders for you. You just need to depend on your coworkers to help you out. I've entered orders before for my coworkers and they also have done so for me. You really need a class on learning how to enter orders. We had a 4 hour class and then we have resource people whose job is only to help us with problems entering orders. They're available at all time.

sef1968 · Jun 18, 2006

thanks for all your great advice, but it sounds like i am up a creek without a paddle. it seems as though our administration just doesn't care about patient care anymore, just the bottom line. not only are they starting all this on monday they also went and fired half the staff a couple of months ago. and i guarantee they will lose more before all this is over. welcome to nursing!!!!! sad, really, really sad. just six months in my first ever nursing job and i'm already disgusted with it.

thanks,

stacey

cathy54 · Jun 18, 2006

:chair: Take a deep breath,stay focused and say a prayer that continues through the shift. It isn't going to get better.

Retired R.N. · Jun 18, 2006

I would like to know how many nurses out there are having to enter orders on their patients? And if you do enter your own orders, what is your patient ratio? My hospital is trying to get rid of the need for a charge nurse and unit clerk. Help I am a new nurse and am terribly afraid this is going to take all my time. We are also suppose to do this with no training. Learn as you go sort of thing. Thanks.

Is your resume up to date? If this happens you will probably want to find a different job. I have worked all sorts of "arrangements" and can say from experience that trying to get along without either a charge nurse or a unit clerk is a sure way to bring on chaos.

Are all the administrative officers giving up their secretaries?