New MD orders

  1. I just wanted to share a story. I'm just having a hard time letting this go right now. It will take me a day or so to not think about this. I just started my job as a RN on the Med-Surg Unit and being a brand new nurse, I was still learning every little tiny things. Yesterday, in shift report the PM nurse passed the NP's order to straight cath a patient post foley d'c. The order that was passed on to me stated "Bladder scan by midnight or sooner and greater than 600cc straight cath". I bladder scan the patient a little after midnight and got between 300-400cc, since it was less than 600cc, I didn't straight cath the patient. Patient denies pain and pressure at this time. I decided to wait a little later and bladder scan again and at that time straight cath because it was greater than 600cc. I thought I was following the order correctly. I soon found out that's not what the NP wanted. NP wanted the patient to be straight cath by midnight or sooner. I was brought into the educator's office and was told to file a report that I didn't follow the order. I told her how I understood the order not to cath the patient unless it is greater than 600cc and followed it accordingly. She read the order again and said that it looks like a miscommunication. My unit supervisor was aware of this situation and when I saw her I talked to her about it and she said that it happens and learn from the experience. The experience that I learn at work will make me a better nurse and increase my critical thinking skills. She said that this is not consider as disciplining me but a lesson learn. So, I learn my lesson to always question new verbal orders that are passed down to me, and if I'm unsure of the orders, I have the right to call the person that gave the verbal order to re-clarify the order. She told me not worry about this and take this as a learning experience.
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    About rolvue

    Joined: Sep '16; Posts: 6; Likes: 3

    7 Comments

  3. by   meanmaryjean
    Let it go.

    This will happen a hundred times in your career. Nothing bad happened, you're not in trouble and you learned something. Really, life is too short to ruminate about this of all things.
  4. by   BSNbeDONE
    The only thing that I see that you failed to do was to make the deadline, which happens a lot on med-surg units. The repeat bladder scan, given your initial residual of 300-400cc, was an excellent nursing judgment call.

    As a new nurse though, next time, just place a call in to the NP or on-call provider to see if he/she wants the scan to be repeated (just to cover your bases). I dare say, had you been one of the veteran nurses, this little thing would not have been mentioned....just my opinion based on my experience. But do file this under experience as others have said, and let it go.
  5. by   Sour Lemon
    Quote from rolvue
    So, I learn my lesson to always question new verbal orders that are passed down to me, and if I'm unsure of the orders, I have the right to call the person that gave the verbal order to re-clarify the order. She told me not worry about this and take this as a learning experience.
    When you say the nurse passed down the verbal order to you, did you write the order out, or did she?
  6. by   GM2RN
    Quote from Sour Lemon
    When you say the nurse passed down the verbal order to you, did you write the order out, or did she?
    This was the first thing that came to my mind as well. If the nurse was passing on the verbal order but didn't write it, I would have asked her to write it before she left. In the case that she didn't write it, then always call the ordering provider for clarification on the order. Otherwise I agree with the others that this is a minor thing and you handled it the best possible way with the information you'd been given.
  7. by   rolvue
    The previous RN updated the NP and received a telephone order around 9pm. The previous shift RN enter the order into the computer system. The order was not completed on her shift so she passed it on to me. My mistake was, that I should had completed the order early but was unable to because I was busy with other orders that needed to get done for another patient, too.
  8. by   Sour Lemon
    Quote from rolvue
    The previous RN updated the NP and received a telephone order around 9pm. The previous shift RN enter the order into the computer system. The order was not completed on her shift so she passed it on to me. My mistake was, that I should had completed the order early but was unable to because I was busy with other orders that needed to get done for another patient, too.
    If the other nurse entered the order and you just carried it out (even a little late), I'm not sure how you're at fault. We'd all make a lot of enemies very quickly if we called to clarify every order that we didn't personally take. It seems like your actions were appropriate, to me.
  9. by   mmc51264
    this is why verbal orders are extremely discouraged where I work. Basically it has to be an emergent situation for them to do it

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