Fired for writing a nursing order?

kcmylorn · Jul 2, 2012

In my neck of the woods- an order such as Dilaudid 2 mg 1-2 tabs po q4hrs prn pain is NOT a valid order. it has to be written as 2 separate orders: on the EMAR

Dilaudid 2 mg 1 tab po q 4 hrs prn pain

Dilaudid 2 mg 2 tabs po q 4 hrs prn pain; which really should be written: Dilaudid 4 mg po q 4 hrs prn pain( two 2 mg tabs is a 4mg total dose) Confusion and avenue for med error.

According to JCAHO- but does the LTC faciity participate in JCAHO? as not all LTC facilities participate; there are NO more verbal orders. It is one of the 13 patient safety goals

Some facilities, my experience has been in the hospitals, with some LTC; nurses, specifically the RN and I guesss would go for the LPN also, do not allow nurses to take verbal orders, or phone orders from NP's- it's one RN taking a verbal order from another RN. All doctor generated verbal orders usually have to signed within 24 hours of obtaining the verbal order- the time frame is facility dependent also

I think if I were an LPN seeing this order- I would have brought it to the RN's attention. It needed clarifying and rewritten correctly. JMHO

suanna · Jul 2, 2012

Being fired for this seems excessive. Could there have been more to your job problems than this single incident. Has the charge RN expressed a concern over you overstepping your role before this? I'm not saying I agree with the decision- I think adequate pain management is a primary goal in any patient care field. I just think it would be like you wrote a note in the patients official record that said "give the patient thier ordered medication on time". It could be interprited as a criticism of the other nurses quality of care- not something you want in the chart.

Nursynursemn · Jul 2, 2012

Being fired for this seems excessive. Could there have been more to your job problems than this single incident. Has the charge RN expressed a concern over you overstepping your role before this? I'm not saying I agree with the decision- I think adequate pain management is a primary goal in any patient care field. I just think it would be like you wrote a note in the patients official record that said "give the patient thier ordered medication on time". It could be interprited as a criticism of the other nurses quality of care- not something you want in the chart.

The day before I was dismissed, the provider wrote an order for medications (for the same patient) that were already ordered. I had to call her to tell her this and she was annoyed... With me. I think this contributed to this. It seems shameful, that time and time again, this same provider writes orders and has no clue what the patient is actually on, yet I have never said this, it is true. The same NP is very, very difficult to work with. She doesn't like to hear any updates, yet will complain that she doesn't know things. It is kind of like she creates a fear of her, for a while, she wouldn't even allow the floor nurses to speak with her, we had to go through the charge nurse.

Nursynursemn · Jul 2, 2012

It was a flag for the nurses to alert them that she needed to be evaluated for pain prior to therapy. We don't have scheduled therapy times.

applewhitern, BSN, RN · Jul 2, 2012

I have thought about this, and personally, see nothing wrong with alerting nurses to assess pain prior to treatments. I don't see this as "you wrote an order" at all~ the order was already in place. What a strange environment.

Nursynursemn · Jul 2, 2012

So good to hear from people in this subject! I really thought I was crazy thinking there maybe was something I was missing.

SHGR, MSN, RN, CNS · Jul 2, 2012

The day before I was dismissed, the provider wrote an order for medications (for the same patient) that were already ordered. I had to call her to tell her this and she was annoyed... With me. I think this contributed to this. It seems shameful, that time and time again, this same provider writes orders and has no clue what the patient is actually on, yet I have never said this, it is true. The same NP is very, very difficult to work with. She doesn't like to hear any updates, yet will complain that she doesn't know things. It is kind of like she creates a fear of her, for a while, she wouldn't even allow the floor nurses to speak with her, we had to go through the charge nurse.

She sounds like a hateful, toxic person. If things are as you describe, you are not the crazy one at all. The fact that she made you feel like you were the one at fault shows just how convincing she is. It sounds as though you did nothing wrong except advocate for a patient and she felt threatened. Definitely get legal help ASAP (rather than post here). :)

mermcm83 · Jul 3, 2012

Keep your head up and God bless with everything... That sounds strange being that you were using the good nursing judgement that they tell us to use. And there was already an existing order. My facility lets us do everything almost.

Dafabb, LPN · Jul 8, 2012

I hope you have a job all lined up before you move out to Ca. I just came back from there on a VA Contract after 11 mos.(LVN). I would not want to be out there with no income for very long. For every job there are 20 applications and more. I was in San Jose. Nurses talk. I listened. That's if there are any jobs available. Down Southern Cal market is saturated. So less jobs to get. North I really can't say except be thankful you are not a new grad....So please have a better plan then move and pray. Ca is not the state I would want to be in without a really good plan. I wish you well..........

jadelpn, LPN, EMT-B · Jul 8, 2012

If the NP gave you a verbal order, then she needs to write it, as she is right there and could have done so. If it were a telephone order, you would write it as a telephone order. If the NP said "make sure we are offering the patient pain meds" I would have immedietely said "please write an order for that". Because then it is not PRN it is "Dilaudid 2mg, 1-2 tabs, daily, one half hour prior to PT". I don't think this would fall under a nursing order. Remember, NP's or MD's can TELL you to stand on your head, but unless they write it, or verify they are ordering it, then it appears theat you wrote the order on your own.

Prairienurse1989 · Jul 12, 2012

If the order was for a prn, but pre therapy pain was an ongoing issue, perhaps seeking out a regularly scheduled order would have been more appropriate. However on the whole I don't see what you did as a huge deal, good luck and I hope everything works out for you.

Nursynursemn · Jul 18, 2012

My plans to move are on hold. I am seeking employment in my home state. I am finding it difficult and I am still stunned by what has transpired. Even more so, hurt. I tried to call the board, but the Tennyson agreement was read to me and was told to wait for the paperwork to arrive to answer my side of the story. In the mean time, I am stressing out. I need to find a place by mid September to live w/ no income, no job, no unemployment and I am scared to death about finding a new job. I am actually wondering why I want to remain a nurse in a "caring profession" that would treat other nurses this way. The idea that I may have to go before the board of nursing to explain my innocent actions, is mystifying to me.

In retrospect, as I look at the facts, I wonder what part of the Nurse Practice Act I may have violated, as I cannot figure it out. There are no policies w/in my facility for writing nursing orders. There is no mention of this either anywhere that I can find. I did no harm. In the grand scope of things, I guess I am glad that I got fired for this vs. something really terrible or awful.

Lawyers I have spoke to have said not to worry, that I most likely won't hear anything, but I am waiting and worried. I have rotten luck! Thank you to everyone for their comments and support!