Help PA nurses

I am employed at a hospital that employs NPs and PAs. At first everything was fine and we all enjoyed the interaction with "real people" rather that exhausted interns, or ever worse, attendings.

Suddenly nursing admin told us not to take verbal orders from NPs or PAs because of state laws. This did not go over well since NPs, RNs, and PAs know that PA state regs made it very clear that we can accept orders from these practitioners in Dec. 2003. So they made a stink and now we are all still in dispute.

There is no law written in any of our hospital guidelines saying NOT TO. Many nurses I know are still taking V.O.s but putting their supervising docs name. Also tele nurses always take orders from PAs since they all work so closely together, they put both names down.

I take issue with this on several issues.

1) I have to bother the trauma NP to come a write a simple order that an intern who just graduated med school could give me over the phone.

2) sometimes it takes longer to get an order now

3) If I take the V.O. from them I am not breaking any laws so long as thier MD signs it but I risk admin sanction. or maybe not?

4) I know hospitals can be as strict as they want, however, JCAHO says V.O.s should only be in emergent circumstances but I, nor the nurses I work with feel comfortable demanding that anyone MD, NP, PA stop what they are doing to come write a sleeping pill order!

So I have some questions for PA nurses

1) Do you take VOs from NPs?

2) Do you write their Doc's name, their's or both?

3) Does your hospital have WRITTEN policy in the hospital bylaws or nursing regs about how this is to be followed?

4) Do you share my frustrations?!

Thanks for any response

maggie

I no longer work in PA, so I don't know the current regulations regarding NP practice, but I have worked with NPs in the past, in a number of states, and this has been my experience:

1.) Verbal orders were not accepted from NPs. Since I worked in an ICU setting, this was not a problem, as the NPs were in house and readily accessible to the unit. I never had a problem with any of them being unwilling to come from the call room to write an order.

2.) If you choose to accept a verbal order from an NP, it would be my personal advice to write it as such, as including the name of a physician who was not actually involved in the process may come back to bite you in the butt at a later time. What if the physician does not agree with the order and refuses to sign it? Then you've done something (given a med or treatment, for example) without an order from anyone.

3.) Yes, the hospitals in which I worked had written policies against accepting verbal orders from NPs (and some prohibited verbal orders from residents as well.) The rationale was that these providers were in house and could be available to write their orders. Attendings could give phone orders when they were not present, and verbal orders in emergencies. If they were present on the unit, they were required to write their orders as well. If you take a VO against your hospital's policy, you may be disciplined by the hospital, regardless of what state law says.

4.) It sounds like much of your frustration stems from having to disturb the NPs to write trivial orders. I understand that, but do not agree with it. While I make every effort not to disturb anyone unnecessarily, there are times when their expertise is needed, even for "small things". If you are truly in need of an order, do not feel like you have to apologize for calling the NP.

Just an aside, since PAs must practice in conjunction with a physician, it has always been my understanding that their orders had to be co-signed by a physician. For that reason, I would not accept a verbal order from a PA. Is my thinking outdated?

I agree and thank you. I should not feel bad about having everyone do their job. The regs at the hospital say VOs should only be for order clarification or when a written order is not practical. In general the climate permits much more VOs than are necessary.

As far as the NPs and PAs are concerned, either of their written orders are valid without cosignature in terms of being immediately followed, but their Docs do cosign them at a later date.

It was kind of overnight that we stopped taking VOs from midlevels and I think the residents would not appreciate it if we started doing the same with them. But we'll see.