Getting thrown under the bus

[Sugarcoma, RN]

So for the second time in my nursing career I have been basically accused of writing my own order. I am furious! The first time it happened the doc involved later admitted he had probably just forgetten and apologized. No reprucussions and no management involved.

I learned a HUGE lesson regarding this and now I ALWAYS repeat the order back exactly as I plan to write it and say "this is what you want me to order yes" and get confirmation.

I had an incident and called the doctor to advise on how they wanted me to proceed. Dr. stated to just leave until Dr. saw the patient in the am. I suggested several possible solutions but Dr. stated to just leave it. I repeated back DR. X you are advising at this time that this situation be left as is and handled in the am...this is the order I will write. Verbal confirmation given from DR. X and order written. I honestly don't know how I could have communicated this more clearly. Now Dr. X is saying they ordered me to intervene and has involved my manager. Management has said they believe me and nothing else has been said regarding this but I am still very fearful of what may happen. I wrote a note and the order to CYA but in reality what this comes down to is my word against Dr. X's.

I am now totally paranoid to take a verbal order from a doc. I have no idea what will happen over this situation, if my job is in jeopardy or if it ends with my managers investigation and I can relax now. Other Rns tell me as long as it is documented I will be fine but I am seriously concerned. I have a good rep and would like to keep it.

Any one else ever in this type of situation and have any recommendations on how to proceed?

[Jolie, BSN]

ALWAYS have a second RN confirm a phone order. Simply say, "Dr. So and So, I understand that you would like me to order XYZ. Is that correct? Please hold the phone for Nurse Jane, who will confirm this order."

NEVER take a verbal order (outside of a code situation) from a practitioner who is present. If s/he is there, s/he can sure as heck write the order.

[Sugarcoma, RN]

Jolie, I appreciate the advice. I know that this is what you are supposed to do but on my unit, well lets just say the ability to find another RN to confirm for you is pretty slim. High acuity, high ratios, etc. We take multiple phone orders a shift and I have been yelled at by docs who have told me something while standing at a chart and I have not written this as an order and called them back later to confirm what they told me. Its a crappy floor in a crappy hospital and I cannot wait to get out of here and go somewhere with physician order entry. So much potential for problems here and I worked too hard to get my license to let some one else take it away due to poor working conditions. I am so angry at myself right now. Just because everyone else does it.....I know better.

[GHGoonette, BSN, RN]

At least you know management believes you (maybe not so crappy? :)) As Jolie said, always get a second person to take the telephonic order with you and to countersign what you've written. I don't take chances even with the nicest doctors-if it's a toss up between your career and their own, they'll happily throw you to the wolves.

This particular specimen sounds like a very nasty skunk; do you have many like him in your hospital?

[nurse2033, MSN, RN]

ALWAYS have a second RN confirm a phone order. Simply say, "Dr. So and So, I understand that you would like me to order XYZ. Is that correct? Please hold the phone for Nurse Jane, who will confirm this order."

NEVER take a verbal order (outside of a code situation) from a practitioner who is present. If s/he is there, s/he can sure as heck write the order.

I've never had a second nurse confirm a phone order, nor have I ever seen it. I get phone orders often multiple times a shift, it's simply not feasible. That sounds kind of paranoid, but I guess our first poster has some reason to be.

[nurse2033, MSN, RN]

I'm so gratified to hear that management is backing you, too often it is the other way. As long as you wrote down what happened, you are in the clear. Let's say management didn't back you, now would be a good time to use your Liability Insurance to sue the doctor for slander. If you don't have insurance, this is a good reason to get it. Just continue to be clear with your communications and verbal orders. It's obvious you realize how important this is.

[Meriwhen, ASN, BSN, MSN, RN]

NEVER take a verbal order (outside of a code situation) from a practitioner who is present. If s/he is there, s/he can sure as heck write the order.

Agreed. In the rare instances I do take a verbal order from a doctor who is present, it's not without witnesses and you can be damn sure that they have signed that order before I ever let them off of the floor.

[Ruby Vee, BSN]

this happened to me once, too. my nurse manager called the doctor involved to her office, snapped a picture on him and posted it on the white board at the nurse's station with a sign saying "don't accept verbal orders from this man." when he demanded that she take it down, she said "man up and sign your verbal orders or it stays up."

he signed.

[tamari07]

We never have a second nurse listen to take a telephone order. The only time I have a second nurse to listen is for a DNR order. Fortunately we have CPOE and docs put in their orders on the computer. But I do get a lot of telephone orders. We just have to write 'read back and verified' next to our signature. It would be nice to have a second nurse listen so we have peace of mind that we wrote down the correct order, its just not feasible.

[highlandlass1592, BSN, RN]

Well, if your manager is backing you, then he/she needs to confront this doc. Is it possible to have the doc fax in an order?One hospital I was at, this happened quite a bit from a doc we refused to take verbal orders from, same issue as yours.

I'll be honest, most nurse practice acts don't require you to take verbal orders, in fact discourage it. But the reality is, depending upon the institution you work , they may be a fact of life. Sounds like you are doing all you can, you are in a difficult situation that really isn't winnable. Just keep charting, if a doc denies an order later, write up an incident report...then let them take it up his chain of command and have his superiors deal with it. Really all you can do.

[tyvin, BSN, RN]

Did you document in the client's chart what happened? Always document all orders and any special circumstances surrounding them.

[Old.Timer]

this happened to me once, too. my nurse manager called the doctor involved to her office, snapped a picture on him and posted it on the white board at the nurse's station with a sign saying "don't accept verbal orders from this man." when he demanded that she take it down, she said "man up and sign your verbal orders or it stays up."

he signed.

that is absolutely priceless !!