Taking orders over phone from unlicensed . . .

[st4304]

I was just reading another post (But she's NOT a nurse!), which made me remember an incident that happened a couple of years ago.

I called critical labs to a family practice physician at his office for one of his hospitalized patients and had to give the results to one of his medical assistants (he does not employ any licensed nurses). A few minutes later, the medical assistant returns to the phone and tries to give me his orders. I informed her I could not take orders from her over the phone, I have to receive them from him. When she told him I was refusing, he got on the phone and we had a very terse conversation regarding the above. His opinion was that his medical assistants were nurses and, I quote, "A nurse is a nurse to me, I don't care what initials are behind her name." I informed him the state's nursing practice act but he still b*tched at me.

Has this ever happened to anyone else?

Your pal,

Sherri

[labornurse]

It actually happened to my daughter. She was going to have a C-section and had been taking anti-seizure medication (dilantin). The ob told her he wanted to get her levels and get a cbc and t/s. We went to the lab to get the blood draw. They looked at the order and it said "get wbc". I told the tech that he had told me that she was to get dilantin levels, cbc and t/s. We called his office and the MA that phoned in the order said, "Oh yeah I forgot the other part". Needless to say I was on the phone with the OB and informed him of what had just happened. He gave me the order and said he would deal with the problem. I have not since see or heard from this MA. I always make sure of credentials of the person who is giving me orders.

[pebbles, BSN, RN]

We don't have MA's or PA's where I work.... But I have often had med students try to pass themselves off as "doctor so-and-so"... I ALWAYS ask when I am getting orders from someone I don't know.

With the power doctors have in our medical system, is it surprising that people try to pass as qualified to fill that role....?

[nurseratchett29]

Our MA's call in scripts to the pharmacy--They have very little training as to s/s, s/e contraindications etc. I have never been comfortable with this but supposedly it's okay because they are under the MD's licenses. Now they will give injections==It was proposed to have them draw up and label all the injections and put them in the med fridge to save time===OVER MY DEAD, RIGOR MORTIS SET IT BODY!!!!!!!!!I am not giving an injection that I didn't either A)draw up myself or B) wasn't pre-prepared by a licensed pharmacist with appropriate labeling. I cannot trust my license to someone else.

[RNinICU]

Never, never, never, would I take a verbal order from anyone but a physician. I will not take a phone or verbal order even from another RN. This is one area where our hospital does back us up. No verbal orders from anyone but an MD. We do not even implement orders written by a PA until the doc OKs them.

[RyanRN]

Did you know the latest focus from JCAHO is NOT TELEPHONE ORDERS, period. We are currently doing a study in my hospital, tis quite a nightmare trying NOT to take a telephone order. I work in ICU! WHO MAKES THIS STUFF UP?!?!?!

[Nurse Ratched, RN]

Ryan, JCAHO was just through our facility and suddenly we had a new TO policy. Now we have to add R&V (repeated and verified) to the end of the sig line. The policy says verbal and telephone orders are "discouraged."

[Dayray, RN]

No telephone or verbal orders? what are they thinking?

Could you imagine? Your patient is in SVT and there are no standing orders on your floor, its 2 AM. You call him, he gives you an order and you say "sorry cant take any telephone orders you'll have to come in and wright it."

After he ripps you a new one he will tell you "just to do it" and he will wright the order in the AM . Then you get the choice of risking your license if he decides not to wright it the next day or risking your license by not providing your patient with treatment.

I guess the other option would be haveing MD's wright standing orders for everything then we get to decide which order set fits the situation and risk our license yet again!

Thanks JCAHO!

[Ragin Cajun]

I couldn't agree with you more RNinICU.........it's just too risky......what we do IS that important. As far as PA's go, I wish some of these would NEVER write orders !!!!!!!!!

[Ragin Cajun]

Forgot to explain why I hate orders from PA's.........had one who used to write orders such as "one time only........STAT CBC, Sed. Rate in the a.m...........TWO WEEKS from now"..........

[RyanRN]

Thanks for the tip Ratched.

Stupid adm. REFUSED to let us write a T/O for a H & H of 6/20 to type and cross and transfuse. "There was ONE (1) incident when a pt. with Hct of 31 was transfused " and now they are making things FEDERAL CASES. Our only help is we can ask the house MD to come and write the orders (that is when the one and only one in the entire general hospital and out buildings HEARS the page and responds!!!! A delay like this can KILL!

Keep asking myself - would I want my family member or myself left in this situation of bureaucratic nonsense when I know damn well I am experienced, educated, and savvy enough to know my job. We are being held back from practicing in a professional capacity because of some patten leather wearing clippity cloppity, pearl wearing idiot sitting behind a desk who dreams up these policies in order justify their job and existence. Where do they find these people!

[Flo1216]

I once was taking a new birth control pill and had bleeding for almost 2 months. After the first month, I finally called the doctor and the medical assistant told me, " Oh, don't worry ...that's normal," I called several more times and she refused to connect me to the doctor. I wanted to claw her eyes out in disgust.