Getting thrown under the bus

[Sugarcoma]

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?

[indigonurse]

You did the exact right thing. The only other thing you could have possibly done was to have notified your supervisor and/or the medical director if you feel that the MD was not acting in the pts. best interest and as a result the pt. may be harmed.

[KSRN2b]

This has been an interesting thread to follow for me as a pre-nursing student. What a tough spot to be in -- glad the manager is backing the poster. I think of the OP, "there but by the grace of God go I some day."

Am wondering if anyone has ever seen the practice of recording a phone call when orders are issued that way. Would allow a nurse to record what the doctor and nurse both say and without needing a second nurse to confirm the verbal order. Is this a practice anywhere and, if not, what are the reasons for not using. I gather that even though verbal orders are discouraged, they still happen in places.

Thanks to OP for starting and thanks to all posters who responded. I'm learning a lot!

[Zookeeper3]

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.

I know, it seems crazy... but we had a doc that had hung many nurses out to dry to the point they would be fired. We had to get a second nurse to listen to his phone orders. I know we're all busy, but we would simply say... "putting out a call to Dr. X can anyone hang for 5 minutes?'. We all helped cover each other and it was necessary and needed. We bonded together and would not let this dog take us down when his phone orders caused poor outcomes and he wanted to "change" them later. We had each others backs!!!!! It's so easily done if you support each other.

If a doc burns you once and they get away with it, just plan on them doing it again, that way you're covered.

[GHGoonette, BSN, RN]

This has been an interesting thread to follow for me as a pre-nursing student. What a tough spot to be in -- glad the manager is backing the poster. I think of the OP, "there but by the grace of God go I some day."

Am wondering if anyone has ever seen the practice of recording a phone call when orders are issued that way. Would allow a nurse to record what the doctor and nurse both say and without needing a second nurse to confirm the verbal order. Is this a practice anywhere and, if not, what are the reasons for not using. I gather that even though verbal orders are discouraged, they still happen in places.

Thanks to OP for starting and thanks to all posters who responded. I'm learning a lot!

Read the following post and learn some more....

I know, it seems crazy... but we had a doc that had hung many nurses out to dry to the point they would be fired. We had to get a second nurse to listen to his phone orders. I know we're all busy, but we would simply say... "putting out a call to Dr. X can anyone hang for 5 minutes?'. We all helped cover each other and it was necessary and needed. We bonded together and would not let this dog take us down when his phone orders caused poor outcomes and he wanted to "change" them later. We had each others backs!!!!! It's so easily done if you support each other.

In my country it is accepted practice that when telephonic orders are issued, the first (receiving) nurse records the orders in writing and hands the phone to a second nurse, who then listens while the doctor repeats the order and reads the written order back to him to confirm. Sounds a bit cumbersome, I know, but your career, the doctor's career and the patient's life depend on accurate transmission of information.

Emergency situations carry their own set of rules, but that's why you have codes and rapid response teams.

[KSRN2b]

Thanks GHGoonette for pointing out Zookeeper3's post. Is heartening to read about that kind of teamwork. Is the type of work environment I hope to be in some day.

[Zookeeper3]

Thanks GHGoonette for pointing out Zookeeper3's post. Is heartening to read about that kind of teamwork. Is the type of work environment I hope to be in some day.

I promise you once one nurse is burnt, you're all in it together.. you all have to be a team to protect each other. It only takes one other nurse waiting at the nursing station while charting to pick up the phone and co sign the order. We had to do it for each other and it stopped immediately and we never needed management, risk management or wait one year for a policy change. We all refused to accept phone orders without a second nurse listening. And yes we were called on it and yes, that doc wised up quickly. He is no longer with us, but it took a very long time for that to happen, but we were safe meanwhile.!

[SweetLikeSugar]

I work on a very busy post-surgical unit and having a second RN to verify phone orders just isn't gonna happen. Half of the surgeons are ****** that they had to be bothered in the first place. If we told them that they had to repeat the order to a second RN, their little heads would explode and their tiara's would go flying.

The only time that we got a second RN to listen on another phone was with an endocrinologist that was known for throwing nurses under the bus. Instead of giving a sliding scale insulin coverage, she would say "if the patient eats 5 bites of his meal, give this much insulin....if the patient eats 10 bites of his meal, give this much...etc." It got really messy (not to mention dangerous) and the DON and risk management had to get involved with some of her "complaints" about how the nurses weren't following her orders properly. It was really nerve racking taking care of her patients. Thank God she retired.

[kerussll]

Ugh this is why doctors need to write their OWN orders! At my hospital this is a new policy. It's great: you call the doctor, hear their order, then they put it in the computer. Once it's up, you can act. Sometimes you do have to tell them repeatedly that they need to put their orders into the computer and not just tell you. Still, I am thankful to be free of that liability!

[Guest717236]

Ugh this is why doctors need to write their OWN orders! At my hospital this is a new policy. It's great: you call the doctor, hear their order, then they put it in the computer. Once it's up, you can act. Sometimes you do have to tell them repeatedly that they need to put their orders into the computer and not just tell you. Still, I am thankful to be free of that liability!

That is a great solution!

[JoytoWorld]

"I wrote a note and the order to CYA but in reality what this comes down to is my word against Dr. X's."

A very real and far too common problem. I've certainly witnessed this type of behavior multiple times in my career.

If the patient outcome is other than what was expected or if the patient experienced unfavorable outcome from the MD's orders: a) MD denies order was given b) or states a different order was given, c) or states they were never notified of the patient need.

You wrote your note, however if the patient outcome is severe enough I've also seen: d) your note disappears from the record.

As you gain experience you start to see the conflict coming. Your nursing judgment speaks to you and sounds an inner warning. For those events I also would send myself an email in my personal email account describing the situation to myself, use initials to describe the persons involved and what my observations were. Stay factual and unemotional in the note. And do it timely. S/he who documents first has the strongest credibility. And that email is under your control and does not "disappear".

Also if you know someone you trust in management, give a brief report then or at the end of the shift of your concerns. Add to your email who (in initials) you reported to. As a manager I often advised my employees to add in their notes that they spoke with me, giving my title in the notes. "Discussed matter with DON/supervisor".

If you are unionized it would be a good idea to log a report with your representative.

Proactively you might have a meeting with your risk/quality manager and submit a WRITTEN request for the institution of policies that utilize some of the ideas you learned here. State that you believe it is in the interest of "patient safety". Once it becomes policy you have the support you need in the future: 1) nurse #1 writes order, nurse #2 reads it back. 2) all doctors must write their own verbal orders if present on the unit.

License protection is a very good idea. I've been with NSO for 20 years. It pays up to $25K in attorney fees per event. If an event such as this comes up, submit a report and get attorney counsel (and support) and the insurance pays the attorney. Sometimes all it takes is a friendly letter from your attorney to the MD for the accusation to change to a "it was just a little misunderstanding".

But what can you do now? Will do some research.

[Sugarcoma, RN]

Some really great advice in this thread that I appreciate very much. I am saddened to hear how many other nurses have found themselves in this situation but I did get a chuckle out of hearing how others have dealt with it. I love the story of your manager Ruby Vee, that made me laugh. Zookeeper it was really heartening to hear how your unit banded together against the offending doc.

Joy, some excellent advice! I emailed myself a synopsis of the event including the names of all people I contacted and who were witness to the event. I hope I never need it but you can never be too careful.

My husband wants me to quit immediately but he is a passionate and very reactionary man. Circumstances simply do not allow it right now as jobs are so scarce. I know at least one major hospital system in the area that has POE and I plan to keep applying.

I now realize how vulnerable I am in this institution, not just in regards to phone orders, there are many many other things that put me and every other RN there at risk. A change is long overdue and I am praying another opportunity comes along soon. I know there is no perfect work environment but I know from networking with other RN's there are better run hospitals in the area. In the meantime you guys have given me some great advice on how to protect myself in the future and I sincerely thank you for it.

[JoytoWorld]

If no written complaint was filed by the MD about you and it is just talk at this point, you may be able to do what alot of nurses should start doing to nip this behavior in the bud. If the MD has filed a WRITTEN complaint against you it is too late. Then it would be seen as you retaliating against the MD.

You can FILE a COMPLAINT with the STATE MEDICAL BOARD about UNPROFESSIONAL CONDUCT. I just researched my State laws, you can do the same in your State. Most of the Laws are now on the internet. Something like http://www.leg.state. (your state initials).us There are Laws (statues) and rules/regulations. Both are enforceable. The difference is that rules are usually written by a State agency and laws by congress. Research under "Complaints against healthcare professionals".

Definition: "Unprofessional conduct" means conduct detrimental to the best interests of the public or conduct that endangers the health, safety or welfare of a patient. I would certainly categorize lying about an order as endangering a patient.

You may be able to file anonymously. You can in my State. My State also REQUIRES any licensed person to report. In my State the report you file is CONFIDENTIAL, meaning they cannot reveal who filed. Though the MD will probably figure it out. Keep a copy of the complaint report in your own records signed and dated by you. Scan in the copy to your computer records as well. THEN if any action is taken against you by your employer due to the event you mentioned you can CLAIM Retaliation with the medical board/ nursing board or attorney general to protect your job. RETALIATION means that after you exercised a State or Federally granted right or a responsibility, someone with power has done something negative to you, such as had you disciplined, demoted or fired.

Good luck. Stand firm.