"No New Orders Received" ..... ?

Nurses General Nursing

Published

When you notify the physician of something regarding your patient and receive no new orders, do you document that?

I can just document: "Notified MD of infant's increased work of breathing. Will continue to monitor."

OR

I can document: "Notified MD of infant's increased work of breathing. No new orders received. Will continue to monitor."

What do you do, and why?

Specializes in NICU.
But if you DO chart that you diligently contacted the docs, supervisors, etc, then you're covering yourself. Right? They'd have a hard time pinning it on you for not advocating for the patient, I would think. But who knows!

Black secretions in the repogle is sometimes normal? Oh that's a new one. Like the time my kid's arm blanched (and I mean the WHOLE entire arm turned white) when I flushed the PAL ..... and the resident told me "that's how you know it's working". Ummmmmmm ...... :nono:

No, I agree with you, that's what I mean. Document, document, document.

And frankly, I'd tell the chief resident (or fellow, or whoever) if a resident told me a blanching PAL was a good thing. It doesn't always mean you have to pull it immediately, but geez. Time for a learning moment. I did call the fellow in the case of the black gastric secretions. And it wasn't a little bit, I'm talking 25cc over 2 hours. Bad. That's what I love about a teaching hospital - the fellows know us well enough by now to at least CONSIDER our opinions over the resident's. The thing that's bad about nights is that there's not usually an attending physically in the building. I'm still not up to calling them at home at 0300 to argue.

.....

Specializes in NICU.
No, I agree with you, that's what I mean. Document, document, document.

And frankly, I'd tell the chief resident (or fellow, or whoever) if a resident told me a blanching PAL was a good thing. It doesn't always mean you have to pull it immediately, but geez. Time for a learning moment. I did call the fellow in the case of the black gastric secretions. And it wasn't a little bit, I'm talking 25cc over 2 hours. Bad. That's what I love about a teaching hospital - the fellows know us well enough by now to at least CONSIDER our opinions over the resident's. The thing that's bad about nights is that there's not usually an attending physically in the building. I'm still not up to calling them at home at 0300 to argue.

Luckily we always have an attending neo on nights, sleeping just down the hall. And yeah, I told the neo about the PAL, just because the resident's response kinda scared me! Ended up pulling it a few hours later. Luckily I've never had to call a doc at home, that'd scare me!

Specializes in NICU.
Luckily we always have an attending neo on nights, sleeping just down the hall. And yeah, I told the neo about the PAL, just because the resident's response kinda scared me! Ended up pulling it a few hours later. Luckily I've never had to call a doc at home, that'd scare me!

My primary baby's day shift primary is notorious for Monday morning quarterbacking during report. The morning after the parents had rescinded the DNR and the baby proceeded to code x 3 (never done it before in his 5 months - I swear he knew and was screwing with us) she had an absolute fit and insisted I should have paged the baby's primary attending (who wasn't even on service at the time) at home at 3am to discuss whether we ought to be doing compressions. Uh-HUH. :uhoh3:

When I've fought and fought-and it looks like I'm not going to get what I want-I say this (and I really feel that the pt is in distress)

"So, just so I can document this correctly-you are OK with the pt doing X and with his VS being X, and you don't want to do X?"

i just came upon your post and felt compelled to respond...

yes!

this is what i have been doing for yrs.

i always (always, always) tell the dr., "since i'll be documenting my concerns in the nsg notes, i need to confirm a, b and c."

the look on their face (or the looooooong pause on the phone) is my 'warm and fuzzy' for the day.

oh,.

and of course, the new orders. :)

leslie

Specializes in NICU.

Ahh, reflective listening.

"So if I understand you, what you're saying is..."

Who knew therapeutic communication would come in just as handy with docs as with patients? :lol2:

Specializes in Cardiac.
i just came upon your post and felt compelled to respond...

yes!

this is what i have been doing for yrs.

i always (always, always) tell the dr., "since i'll be documenting my concerns in the nsg notes, i need to confirm a, b and c."

the look on their face (or the looooooong pause on the phone) is my 'warm and fuzzy' for the day.

oh,.

and of course, the new orders. :)

leslie

Yes indeed! I just said this during the last shift I worked. It's amazing how they completely stop in thier tracks when you say this.....

Yes, I agree that you should always document that no new order were rcvd. Case in point: I was working ICU one night and had a 400 pounder that was tanking with no BP. Called the doc for some orders and he gives me a 250cc challenge. I rolled my eyes, gave the bolus and had the doc back on the phone within 5 minutes. I made no less than six calls to the doc, hoping to get some pressors on board. I documented EVERYTHING, including every single vital sign, assessment finding and lab value that I had given to him along with his exact response. Finally the consulting nephrologist comes in very early, so I grab him and drag him down to the room. He started to get angry at me asking why I had let the patient deteriorate to such a point. I explained to him what I had been going through with the attending and he really went ballistic. There was a phone on the wall outside the patient's room and he called the attending and really blessed him out. The next morning I was in the DON's office having been accused of not relaying vital information to the attending. I retrieved my notes from the night before and showed them to the DON and the hospital CEO (who had gotten involved by this point). They both agreed that the physician was in the wrong and was trying to cover up his own inaction. I got an apology from the DON, but never got one from the attending. He avoided me like the plaugue from then on.

Yes, I agree that you should always document that no new order were rcvd. Case in point: I was working ICU one night and had a 400 pounder that was tanking with no BP. Called the doc for some orders and he gives me a 250cc challenge. I rolled my eyes, gave the bolus and had the doc back on the phone within 5 minutes. I made no less than six calls to the doc, hoping to get some pressors on board. I documented EVERYTHING, including every single vital sign, assessment finding and lab value that I had given to him along with his exact response. Finally the consulting nephrologist comes in very early, so I grab him and drag him down to the room. He started to get angry at me asking why I had let the patient deteriorate to such a point. I explained to him what I had been going through with the attending and he really went ballistic. There was a phone on the wall outside the patient's room and he called the attending and really blessed him out. The next morning I was in the DON's office having been accused of not relaying vital information to the attending. I retrieved my notes from the night before and showed them to the DON and the hospital CEO (who had gotten involved by this point). They both agreed that the physician was in the wrong and was trying to cover up his own inaction. I got an apology from the DON, but never got one from the attending. He avoided me like the plaugue from then on.

It might also be a good idea to make copies of your nurses notes. MDs, and others, have been know to remove notes from the chart to make you look bad, and exonerte them. I have seen it happen more than once! CYA!!

Lindarn, RN, BSN, CCRN

Spokane, Washington

Specializes in Med/Surg.
Well I asked the question, because it is something to question, as I've had someone recently tell me that it's not appropriate, but couldn't give me a good reason why.

If I notify the doctor about something and don't receive any new orders, then I always type in my notes "no new orders received".

I was just curious as to what everyone else does, but by the looks of it, my first assumptions were correct.

Thanks everyone!

I always chart when I called, who I called, when they called back and if I received new orders I chart "new orders received" and if there are no new orders I chart "no new orders received." Doctors will cover their butts and lose yours in a second...its a dog eat dog world out there. :uhoh3:

It might also be a good idea to make copies of your nurses notes. MDs, and others, have been know to remove notes from the chart to make you look bad, and exonerte them. I have seen it happen more than once! CYA!!

Lindarn, RN, BSN, CCRN

Spokane, Washington

Luckily, with the trend toward paperless, this is less of a problem.

Also know that when you present your copies as evidence, you will have to answer for why you have personal copies of a patient's medical record. That violates the policies of every hospital I know, and likely would violate privacy laws as well. You could very easily burn the a** you are trying to cover.

double post

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