Accepting verbal orders from another nurse?

  1. I'm a new RN a little over a month into my orientation on a busy med/surg unit. Tonight at a few minutes before the end of my shift I had finished reporting off and was sitting at the nurses station when a float pool nurse I had never worked with before asked me to push morphine for her patient. She had just started giving report and was trying to avoid overtime. I brought the morphine into the room but wasn't able to scan it because the patient didn't have an order for it in the eMAR. I returned to the nurse and told her the morphine wasn't ordered, and she said she had taken a verbal order and I should enter the order. I said I didn't feel comfortable entering orders I hadn't taken for a patient I didn't know, and she said I could just push the morphine without scanning it and she would enter the orders and document administration when she finished report. I hesitated again, and she snatched the morphine from my hand and stormed off to give it herself.

    Am I in the wrong here? I don't want to be seen as not being a team player and I'm sure things like this happen, but I also don't want to risk the license I just earned.
    Last edit by Brian S. on Mar 21
  2. Visit amberrenae, RN profile page

    About amberrenae, RN

    Joined: Jan '18; Posts: 5; Likes: 75
    Specialty: 1 year(s) of experience

    91 Comments

  3. by   Davey Do
    No, amberrenae, you weren't wrong. When it comes to heavy duty meds or procedures, the nurse taking the order should follow through with the process.

    On routine stuff that doesn't involve controlled substances and the like, if the nurse is busy or wants to go home, I'll enter the order but always enter the other nurses initials and then my own.
  4. by   Sour Lemon
    Quote from amberrenae, RN
    I'm a new RN a little over a month into my orientation on a busy med/surg unit. Tonight at a few minutes before the end of my shift I had finished reporting off and was sitting at the nurses station when a float pool nurse I had never worked with before asked me to push morphine for her patient. She had just started giving report and was trying to avoid overtime. I brought the morphine into the room but wasn't able to scan it because the patient didn't have an order for it in the eMAR. I returned to the nurse and told her the morphine wasn't ordered, and she said she had taken a verbal order and I should enter the order. I said I didn't feel comfortable entering orders I hadn't taken for a patient I didn't know, and she said I could just push the morphine without scanning it and she would enter the orders and document administration when she finished report. I hesitated again, and she snatched the morphine from my hand and stormed off to give it herself.

    Am I in the wrong here? I don't want to be seen as not being a team player and I'm sure things like this happen, but I also don't want to risk the license I just earned.
    Your behavior was completely reasonable. Her's needs some serious polishing.
  5. by   VivaLasViejas
    You did exactly the right thing. One should never give a med---especially a narcotic, and especially if it's not her/his patient---without seeing the order in the patient's MAR. I wouldn't have given it either, certainly not on another nurse's word that she'd taken a verbal order. The other nurse was out of line. Good for you!
  6. by   MunoRN
    I normally wouldn't have a problem putting in a order for a nurse that they were passing along to me, I just put per so and so in the order, but the situation you've described is messed up.

    She had you taking out an opiate by overriding it on a patient who had no order for it and at the end of your shift, which pretty much checks every check box for actions suspicious for drug diversion, and then to top it all off she takes it from you to give herself which means there it won't even be charted under your name, there's pretty much everything wrong with that.
  7. by   TriciaJ
    You did the right thing. It would be one thing (but still risky) if you had a longstanding relationship with a coworker and totally trusted her. But you're new and still proving yourself and she's not regularly on your unit and you didn't know her from Adam. Way too many red flags and I wouldn't have touched that with a barge pole.

    Bringing her patient a beverage or an extra blanket? Sure. Administering morphine without an order? No.
  8. by   Crush
    You were right. I would not give any medication without the order being in the MAR, especially a narcotic. If she was avoiding overtime, well geez, it does not take that long to put in that verbal order she got. I mean seroiously, how much time does it take to enter in the order?
  9. by   AceOfHearts<3
    On a med-surg unit I would not have pulled morphine (or any narcotic) without an order unless it was an emergency, especially for a patient that wasn't mine. It really wouldn't have taken long for that nurse to enter the order. If they entered it and needed pharmacy to verify it still I would have no problem calling the pharmacy with the request and then giving the med.

    We frequently override and pull heavy duty meds and narcs in the ICU, but it's for bedside sedation/procedures and we always make sure we get the order at the end and the providers are literally right there in front of us.
  10. by   Buckeye.nurse
    You did the right thing. In addition, I would mention it to my preceptor (you said you are still in orientation?) in the context of a learning experience. Being a team player is important. As another poster said, I'm more than happy to grab a blanket, or a drink, or take another nurse's patient to the bathroom...but narcotics diversion is still a very real thing. Always protect yourself, your login, and your pyxis profile from suspicion.
  11. by   Rocknurse
    Of all the things you could ever choose to be lax on, narcotics is the one NOT to. If there was ever the slightest question of the order, the pull from the pyxis, the administration or the discard of this medication, you would have been the one pulled into the manager's office and facing serious consequences. I urge all nurses who are administering narcotics, take a pause, take a breath, and think. Make sure you pay extra special attention when giving this med. Check and double check your orders, make absolutely sure you've charted on it correctly, and never, ever put the half used vial in your pocket to waste later that you'll find still there later when you go to do the laundry. The consequences of failing to pay attention can be extremely damaging and devastating. Get in the habit of being vigilant whenever dealing with a controlled med, and let someone else huff and puff and tut, toss their hair and have a little tantrum. It's not your problem. It's your way or the highway. Perhaps a little time management on her end wouldn't go amiss. If you give someone else's patient a narcotic, there better be a legit order or just refuse to do it.

    There should be no shortcuts in narcotic administration. In case you think nobody's watching....they are. You did the right thing. You might be her best buddy now when she needs you to do her a favor, but she'd be the first one throwing you under the bus when the proverbial waste product hits the fan.
  12. by   dudette10
    You pulled it under your name with an override from the Pyxis, then she took it from you to give it. Did she really give it? Has there been any follow up on your override without a corresponding order and administration under your name?
  13. by   Crush
    Quote from amberrenae, RN
    I'm a new RN a little over a month into my orientation on a busy med/surg unit. Tonight at a few minutes before the end of my shift I had finished reporting off and was sitting at the nurses station when a float pool nurse I had never worked with before asked me to push morphine for her patient. She had just started giving report and was trying to avoid overtime. I brought the morphine into the room but wasn't able to scan it because the patient didn't have an order for it in the eMAR. I returned to the nurse and told her the morphine wasn't ordered, and she said she had taken a verbal order and I should enter the order. I said I didn't feel comfortable entering orders I hadn't taken for a patient I didn't know, and she said I could just push the morphine without scanning it and she would enter the orders and document administration when she finished report. I hesitated again, and she snatched the morphine from my hand and stormed off to give it herself.

    Am I in the wrong here? I don't want to be seen as not being a team player and I'm sure things like this happen, but I also don't want to risk the license I just earned.

    Ok, so I just reread this. You pulled the morphine for an order that was not in on the MAR at the time. So you did an override on the Pyxis? When she snatched it from your hand did you witness her giving it? What did the other nurse getting report from her say? If you are still orienting (?) what did your preceptor say about this? This would make me nervous. You may want to consider following up on this.
    Last edit by Crush on Mar 20
  14. by   not.done.yet
    You were right in not giving it. You were wrong in pulling it without an order and then letting it get into her hands. Decent chance you just got played.
    Last edit by not.done.yet on Mar 20

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