Can home health RN's take verbal/telephone orders from other RN's, MA's, etc???

[pengwen]

I worked on a hospital floor for 2 years as an RN before I came to home care (which I absolutely love!!!). All through nursing school and during the time I worked in the hospital it was a well known fact that RN's could only take a verbal order or telephone order from an MD or APRN. Since I have come to home care I have noticed that home care RN's (I work in intake and have seen it here especially) take verbal orders from RN's in the field or from MA's or receptionists at MD's office's. I have refused to do so because I think it was against Utah's nurse practice act. I have read the Utah's nurse practice act and it seems quite vauge. I don't see any specifics about taking verbal orders.....

My boss has really put the pressure on me to prove that RN's cannot take verbal orders from other RN's..... does anyone know if this is a law or if this is part of instituational protocols???

Thanks!

Gwen

[bcjams]

Call the board and ask to speak to their legal counsel. That should clear it up. I had a legal question about our NPA and they were very helpful.

[pengwen]

Thanks! Good advice. I will call tomorrow!! Gwen

[DDRN4me]

The way we used to do this was to take the order, get the persons name, and write the order, then, "Taken form Mrs. Smith, agent for Dr. Jones" our legal dept said that should be sufficient, especially for orders such as recert,, etc. if it was something i reallly needed to speak with the doc for, i would say please have him /her call me back.

[hoolahan, ASN, RN]

I plead the 5th.

[erroridiot]

It depends on the type of order.

If it is a physician, NP or PA order it must be written by the licensed person who received it.

If it is an order such as an assignment, it depends on the nurse practice act in your state which should define who can supervise the RN.

However, in the agency I am currently working at (big mistake and long story), the top RN has been using office clerks as QA, field staff supervisors and even as nurses taking after hours calls.

I don't let them tell me what to do - because they can't. This is a violation of the nurse practice act in this state.

[NoCrumping]

It depends on the type of order.

If it is a physician, NP or PA order it must be written by the licensed person who received it.

If it is an order such as an assignment, it depends on the nurse practice act in your state which should define who can supervise the RN.

However, in the agency I am currently working at (big mistake and long story), the top RN has been using office clerks as QA, field staff supervisors and even as nurses taking after hours calls.

I don't let them tell me what to do - because they can't. This is a violation of the nurse practice act in this state.

Sounds like my agency....... good thing I am only part time... but why do they risk this?

[erroridiot]

Sounds like my agency....... good thing I am only part time... but why do they risk this?

Well, each agency would have its own dysfunctional dynamics.

In the case of my agency, the top nurse has poor clinical skills and can't function as a knowledgeable resource in the clinical arena - so she delegates it to her "darling" clerks. The clerks are her very own dysfunctional family. They workship the ground whe walks on and do the most pathetic brown nosing I have ever seen - all for the privilege of practicing nursing without a license while they are at work. They change answers on the OASIS, cross out things in the charts (which are just left that way) and enter what they want into the computer for transmittal. They get their "jollies" by making fun of the field staff and believing that they are professional home care experts. They control the flow of information throughout the agency and cut off anyone who does not conform to their nonsense by blocking information, complaining about them to the top nurse and getting them in trouble, and spreading horrible words about the person to all the rest of the agency. This is sort of a bully, mobbing in the workplace approach. It works, because they remain in control.

When survey time is coming, the top nurse places a nurse (make that victim) in some quasi-supervisory capacity during the survey, makes the poor nurse 100% responsible for the plan of correction and then gets rid of the person as soon as she can and goes back to her dreamy dysfunctional workplace. She has also sacrificed nurse victims so she can take vacations, spend more time on her business, etc.

The office clerks get their needs met. The clerks get to have their most evil dreams of power come true and function as licensed professionals. The top nurse gets worship and conducts her own business on the side while she is at work and lets the field staff do whatever they want with no direction or intervention for problems at all. The clerks and field staff love her clueless management style while they run wild and free. The top nurse gets to believe that she is the very best manager in the world. When the field staff don't show up or fail to address important problems she just ignores it or remains blissfully unaware. This makes the field staff very happy and some of them run scams making unwarranted visits.

QA is neglected except for modifying the incoming OASIS to maximize reimbursement or belittle staff.

Everyone wins except the poor patients and the sacrificed nurse victim.

[renerian, BSN, RN]

LOL I am with you........

renerian

[pengwen]

LOL I am with you........

renerian

If any of you wanted to know (at least for the state of Utah) I found out my answer after some searching....

The action of taking a verbal order actually falls under the Pharmacy Pracitce Act for the State of Utah instead of the Nurse Practice Act (which is extremely vague).

I was finally able to get my pharmacy manager write an email to the woman in charge of all pharmacy issues at DOPL. He asked her how many agents can be utilized in a verbal order.

FYI - An agent is anyone that works for the MD/NP or is a tool in carrying out his/her orders. This means that the agent could be a secretary, CNA, MA, LPN, RN, etc. The Parmacy Pracitce Act states that a Pharmacist can take an order from the agent of the doctor. It does not say AGENTS and it does not say that an RN can take an order from another agent.... so we had to have this clarified. How many agents can be utilized???

In my home care agency, almost on a daily basis we see verbal orders passing anywhere from 1-4 agents (and on occation even more).

For example: Field RN calls MD for a continuation order of a mediation. The MD's RN or MA (agent 1) calls the field RN (agent 2) and gives her a verbal order. The field RN calls the local nursing intake and gives the verbal order to the intake nurse (agent 3), who then calls the IV pharmacy intake nurse (agent 4 - this is what I am in my company), who then gives the order to the pharmacist. Mind you - the actual order is only written down by agent 4 or the pharmacist!!!! Scarry isn't it????

I just find this process to be so potentially dangerous both for the patients involved and also for me as an RN.....

Anyway, the Pharmacy director for DOPL in the state of Utah responded to my pharmacy manager saying that there should only be one agent used unless it was absolutley necessary. Of course my manager believes that means she can take a verbal order from an agent anytime that she is familiar with the medication. I find this logic extemely flawed. I have wondered if she ever played the telephone game in elementary school....

So my manger still thinks that every nurse can choose to "interpret" what absolutely necessary means. Personally I am sticking to my guns. I will not take an order from an agent of the MD. I will only take an order from an MD or NP when it is necessary. I will always prefer an written order over a verbal order.

In the meantime I am going to try and get the pharmacy act changed in the state of Utah to state directly that the verbal order can only go from one agent directly to the pharmacist.

Thanks everyone for your input!!!

Gwen RN, BSN, CRNI