Charge nurse to secretary? Legal issues?

Nurses General Nursing

Published

Hello

We have a secretary who takes the orders from the charts, enters them into the computer writes them on the MAR and then hands them over to our charge nurse. Our charge nurse checks the orders to make sure they are correct and then signs them off.

The nurses don't get paged when new orders are written, it is our responsibility to find the chart and look for orders (which can be a pain!)

I have two questions here.

We had a patient where the MD thought they were having a DVT and ordered a doppler of the LE's. Well the order was put in for "tomorrow" rather than "today."

Issues:

  1. The secretary entered the order wrong
  2. The charge nurse signed off the order, not realizing it was put in wrong
  3. The RN caring for the patient was not aware that the patient told the MD they were having leg pain.

The secretary working that day is an RN. Our usual secretary called in sick and they took our RN and made her secretary. She has never recieved proper training on entering in orders, but knows how to enter in the basic orders.

Questions:

-If the secretary who entered in the orders is an RN, could she be implicated if the patient has an adverse outcome if she enters in an order wrong??

-If the charge RN signs off an order, can she be implicated if she signs off the order?

FYI- I hate this system.

netglow, ASN, RN

4,412 Posts

Oh ugh. This stuff gives me a headache.

I hate it when RNs get caught up in the mess that administration has set up. Sure it happens in every profession, but in nursing, it's gonna make someone sick/sicker and the trouble one gets in is serious. Often, you are in IT and you don't know until it's too late.

Specializes in ICU, prior telemetry experience.

Does the CN "note" the orders when she signs them off? I believe thats where the liability would be held. If they dont and you still have to note the order when you get the chart back, you are liable for that order being correctly entered.

NPinWCH

374 Posts

Specializes in Family NP, OB Nursing.

This is why anytime I get an admission I personally check the orders as they were written by the Dr. We had a secretary and I almost always told her, "Please let me take my own orders off."

As I understand it, the responsibility mostly comes down to the RN who accepted the patient since she is ultimately responsible to ensure that any treatment or evaluation ordered is done, but that doesn't excuse the RN secretary or the charge RN who is supposed to compare the orders that were entered by the secretary to the actual written order.

Also, I'm confused as to why the RN caring for the patient didn't know about the leg pain complaint. Shouldn't that have been passed on in report so that the RN could assess the patient throughout her shift?

I always made it a point to review the chart and the orders and then compare them to the MAR and orders entered into the computer. I often found things missing or ordered incorrectly.

Specializes in Med Surge, Tele, Oncology, Wound Care.
Does the CN "note" the orders when she signs them off? I believe thats where the liability would be held. If they dont and you still have to note the order when you get the chart back, you are liable for that order being correctly entered.

Yes she notes the orders and signs them off.

This is why anytime I get an admission I personally check the orders as they were written by the Dr. We had a secretary and I almost always told her, "Please let me take my own orders off."

Also, I'm confused as to why the RN caring for the patient didn't know about the leg pain complaint. Shouldn't that have been passed on in report so that the RN could assess the patient throughout her shift?

I always made it a point to review the chart and the orders and then compare them to the MAR and orders entered into the computer. I often found things missing or ordered incorrectly.

Good point!

The patient never told the RN about the leg pain. The patient saw the MD and told him just before the day shift reported off to nights. Still a little strange to me as well.

Our computer system is awful. In order to check the orders you have to go one by one in the computer and it takes forever!

I would rather check my own orders off!

Our charge RN is a glorified secretary and she is pretty much worthless when it comes to patient care

Turns out the patient did have a superficial DVT.

Unless I go to the board is there a way I can check to see what the legal ramifications are?

Chin up

694 Posts

Specializes in Med surg, LTC, Administration.

I don't want to sound harsh, but all three are responsible. The one who entered it incorrectly is first in line. She should have double checked her work, or asked for clarification. As for the second person in line, I don't know why you call her a secretary in one breath, then an RN in another. It doesn't matter, she is a nurse and taking off orders IS in her scope of practice... There is no excuse here ...third, The charge nurse should have been the check and balance...she should have picked up on this error. She signed it, so is liable. As for the primary nurse, she should have known through assessment the residents status. I understand, circumstances come up...I understand how these things can happen. But the BON does not want to hear the primary nurse saying, " sorry, I didn't know". Our job is to know and we need to stand up and take it, when we make mistakes. We then learn from it and hopefully grow from it. Good luck to the three of you. I hope you all do the right thing and own up. It shows tremendous integrity and responsibility. Since the resident had no injury because of this, relax. Peace and good luck!

kcmylorn

991 Posts

That's the way we did orders and floor nursing in the B.C(before computers) days. We made due then- we checked our orders regularly, this was built into our time management skills , wrote the orders on the Written paper and pen kardex( we had 2 a treatment kardex and a med kardex), and signed the order off with name, title, date and time, every RN resposible for the care of that pt was responsible for making sure that order was correct( whether you were the one who took the order off or not). If it wasn't, we corrected it- with either a call to the lab, call to radiology, call to pharmacy, call to the OR. There was none of this writing people up crap, there were no fancy names/labels" patient outcomes" evidence based practices" "nurse driven" 'that being said" The only thing said was 'do your job!" Computers have made us very LAZY. and unable to remember the why's of what we do, why we do them and how we do them.( It's the same for medication and IV calculations- aka Pharmacology tests!)

CathyLew

463 Posts

Specializes in MSP, Informatics.

It is easy to say the RN who is taking care of the patient is responsible for all the orders... or the RN working as the unit clerk is responsible... but you have to look at what the hospital uses for its practice. If they give an assignment based on the fact that someone else is responsible for taking off orders--that is part of the acuity system. The hospital is saying that the nurse has to check the orders, that are taken off by another person in the hospital. If you want to dump everything on the RN assigned to the patient, then give that RN 2 patients, and no one to "help" them.

I always hated that in the hospital. You are the RN. You have someone (unit clerk) taking off the orders... you have an LPN to take vital signs, you have an Aid to help give care...so that means they can give you, the RN a larger patient load. But ultimatly.... you are responsible for everything! if the Aid drops your patient on the way to the bathroom....you are responsible. If the LPN doesn't do anything about a bad VS, Heart rate, or any assessment issue... the RN is responsible. If the unit clerk takes off an order wrong...you are responsible. I always said, if we are responsible for everything, take out the middle men, and give us fewer patients!

NicuGal, MSN, RN

2,743 Posts

Specializes in NICU, PICU, PACU.

Wow. Even before we went to computerized charting they stopped that practice where I work because of mistakes like that. When the docs wrote the orders, after rounds, they flagged the chart and it was the RN of the patient's responsibility to take the orders off and tell the secretary what to enter.

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