How do you know when to get an order?

FurBabyMom, MSN, RN · Dec 24, 2015

But, don't you have multiple witnesses in the OR. I guess in that circumstance it could be better, since many people can hear what the surgeon is saying. Although, it can be pretty loud in the OR.

You do. But I don't think you've experienced what happens when you're trying to operate and run a code. Or the chaos that ensues in the average emergency case. Or the average scheduled case when things aren't perfect. Or during the average case when things are normal but a normal level of noisy?

Conversely - you have multiple people capable of giving orders - resident, attending, anesthesia attending, anesthesia resident (or CRNA - where I live they can order labs and meds pertinent to their care). I do *not* put orders in for anesthesia - they almost always can. I do *not* put orders other than specimen, radiology, etc that are needed for the procedure, unless I cannot get around it. I will put in orders for "put patient in bed" or "transfer patient" to get an ICU bed if it's urgent and nobody (surgeon, NP with the surgery group, etc) can.

Editorial Team / Admin · Dec 24, 2015

But, don't you have multiple witnesses in the OR. I guess in that circumstance it could be better, since many people can hear what the surgeon is saying. Although, it can be pretty loud in the OR.

Yes, but frequently I'm the only RN working with 2 surgical technologists. Only an RN can accept a verbal or telephone order. So, there are witnesses, but per policy they aren't allowed to be a second signer.

And what FurBabyMom said about the noise.

nursepenelope · Dec 24, 2015

I received a phone order for medication change. I made the changes, per order and protocol, aced the doctor the order to sign. When he came in, he denied giving me the order. In front of everyone, I reminded him that I repeated back the order twice for him to confirm. His memory came to, and he couldn't deny the fact that I had verbally asked him to confirm the order. Phew!!! That was scary, but I had the confidence that I had done the right thing, and he knew it. Scary, but it happens!

sailornurse · Dec 25, 2015

The username bstobsn would seem to refer to someone with a BS who is planning on or is actively pursuing a BSN, so I don't think the name makes any claim that the person currently has a BSN.

Moot point since OP changed her username, but per TOS you can not claim titles not yet earned which is the issue I had with the "BSN" part of the original name. OP is considering nursing/ is not yet a pre nursing student so having BSN is not allowed.

joanna73, BSN, RN · Dec 25, 2015

There was only one physician that I was concerned might throw me under the bus, so I called him for everything and documented the calls.

Many physicians are reasonable and when they trust your nursing judgment, they will not throw you under the bus. However, you should know what your standing orders are in addition to facility policy, and the expectations of the charge nurse before entering any gray areas. Otherwise, there are legal ramifications.

If you need an order, get the order.

However, I have administered tylenol without an order, documented it and informed the physician the next day. So it depends, and there are many variables.

NurseAshleyy, BSN, RN · Dec 27, 2015

I work long term care and it is rare that we have a physician around to physically put in orders when needed. As that is the case we do have a set list of standing orders, mostly for things that can't wait for a physician to get back to you on or basic things. So I take verbal orders on a daily basis. As stated previously I always cover myself with charting and thus far have never had an issue with it. In my facility the doctor also has so long to sign off on those verbal orders so I feel that also protects me.