I knew it wasn't right while I was doing it...

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You are reading page 11 of I knew it wasn't right while I was doing it.... If you want to start from the beginning Go to First Page.

DutchgirlRN

DutchgirlRN, ASN, RN

Specializes in OB, M/S, HH, Medical Imaging RN. Has 33 years experience. 1 Article; 3,932 Posts

So an RN in the US can take a telephone order for say a drug order and then just write it in and give it?

In Australia we have to have another nurse, one has to be an RN the other can be RN or EN (equivalant of LPN) verify the order by listening to it. When we write it up both nurses have to sign it.

That's correct. The only time we have to have two nurses on the phone to verify is when a consent is signed over the phone by a POA.

When hanging blood, setting up a PCA, setting up a heparin gtt or changing the dose on a PCA or heparin gtt, or when drawing up insulin two licensed nurses must sign.

Mulan

Mulan

2,228 Posts

That's correct. The only time we have to have two nurses on the phone to verify is when a consent is signed over the phone by a POA.

When hanging blood, setting up a PCA, setting up a heparin gtt or changing the dose on a PCA or heparin gtt, or when drawing up insulin two licensed nurses must sign.

That varies from place to place, some facilities do not require a second signature for heparin or for insulin.

DutchgirlRN

DutchgirlRN, ASN, RN

Specializes in OB, M/S, HH, Medical Imaging RN. Has 33 years experience. 1 Article; 3,932 Posts

That varies from place to place, some facilities do not require a second signature for heparin or for insulin.

That's correct I said "we" not everyone in the US, and I am thankful that we do require a second signature for heparin and insulin. Better safe than sorry. Can't have too many double checks when it comes to critical medications. ;)

Valerie Salva, BSN, RN

Has 19 years experience. 1,793 Posts

So are you saying LPNs cannot take TOs? That is strange. I have worked in 5 different states and LPNs can do almost everything RNs can do with few exceptions. As a matter of fact, the facility I work at, our charge nurse is an LPN and has RNs working under her supervision.

According to most state boards of nursing, LPNs can practice only under the direction of an RN. Your facility is doing it backwards.

Your charge nurse is practising under the supervision of the RNs she supervises?

"Licensed Practical Nurses function by law in a dependent role at the direction of the RN or other select authorized health care providers. Under such direction, Licensed Practical Nurses may administer medications, provide nursing treatments, and gather patient measurements, signs, and symptoms that can be used by the RN in making decisions about the nursing care of specific patients. However, they may not function independent of direction.

"Upon successful completion of the National Council Licensing Examination for Practical Nurses (NCLEX-PN) and subsequent licensure, the supervisory requirement for practical nurses changes to permit LPNs to function under the direction of an RN. Such direction has been interpreted to mean that the RN must be present on the premises or within a reasonable distance and immediately available by telephone when nursing services are rendered by the LPN. Again, the degree of direction should be appropriate to the circumstances."

http://www.op.nysed.gov/nurse-scope-lpn-rn.htm

LPNs can take verbal orders in my state, but my facility does not allow LPNs to take VO or TO.

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,510 Posts

Bringing this back to the topic:

"I knew it wasn't right while I was doing it... "

Performing nursing acts under the above circumstances is what will get one in legal hot water and potentially be under the spotlight of board of nursing.

Under "standards of care" states have similar language

PA:

RESPONSIBILITIES OF THE REGISTERED NURSE

21.11. General functions.

b. The registered nurse is fully responsible for all actions as a licensed nurse and is accountable to clients for the quality of care delivered

21.18. Standards of nursing conduct.

(a) A registered nurse shall:

(1) Undertake a specific practice only if the registered nurse has the necessary knowledge, preparation, experience and competency to properly execute the practice.

(2) Respect and consider, while providing nursing care, the individual’s right to freedom from psychological and physical abuse. (3) Act to safeguard the patient from the incompetent, abusive or illegal practice of any individual.

(b) A registered nurse may not:

(1) Knowingly aid, abet or assist another person to violate or circumvent a law or Board regulation.

http://www.pacode.com/secure/data/049/chapter21/chap21toc.html#21.11.

Nurses Practice under:

A. Nurse Practice Act of state licensed under AND the state in which they are employed when compact state.

B. Employers policy and procedures.

Employers policies can be more stringent that those of state paractice act; however then cannot permit practice /procedure if SBON does not

All nurses are expected to have read and understood the nurse practice act in state where employed. Some states have specific language on delegation of nursing tasks, working with LPN/LVN's and UAP (unlicensed assistive personal).

Other's like PA state are in process of updating their practice acts and gaining legislative approval.

If you HAVE NOT read your states practice act, time to do so is NOW! Our LINKS tab top right corner takes you to list all states board of nursing....most have practice acts online.

Agnus

Agnus

2,719 Posts

I do have to admit, I am somewhat intimidated by this LPN. She has worked at this hospital for 32 years. I have been there since Nov 2005. She is part of the woodwork. She is older and has WAY more clout than me. But those are my issues and are beside the point.

I won't do this for her again. I am mentally trying to muster the courage to talk to her about it before it has a chance to happen again, so that I won't be put in the place to hear "But you did it before?!"

I know that it is not worth losing my licence over, and I don't plan to open up a can of worms by confessing. I am concerned that she might bring it up to the manager to spite me out of wounded pride. I'm still mad at myself for doing it. And mad at her too. Thanks for your feedback.

You do not have to confront this LPN. Next time call the doctor. Explain that by your state's laws she can not take orders. That in the future if they give her an order you will not write nor sign it. In stead they can expect a call from you, as you will be happy to take their order directly from them. Or they can save themselves a phone call and ask to speak to an RN.

If need be explain that you understand that they have done it this way in the past and that you will not put your license on the line for the sake of convenience

You might or might get some flack for this. Keep in mind though that there is no legal standing anyone can take against you and that anyone who does not support you stands to face action by the state.

gt4everpn

gt4everpn, BSN, RN

Specializes in Licensed Practical Nurse. 724 Posts

I work in an LTC and LPNs are basically in charge of everything, telephone orders are allowed and we are the one's that take them.

twotrees2

twotrees2

913 Posts

According to most state boards of nursing, LPNs can practice only under the direction of an RN. Your facility is doing it backwards.

Your charge nurse is practising under the supervision of the RNs she supervises?

"Licensed Practical Nurses function by law in a dependent role at the direction of the RN or other select authorized health care providers. Under such direction, Licensed Practical Nurses may administer medications, provide nursing treatments, and gather patient measurements, signs, and symptoms that can be used by the RN in making decisions about the nursing care of specific patients. However, they may not function independent of direction.

"Upon successful completion of the National Council Licensing Examination for Practical Nurses (NCLEX-PN) and subsequent licensure, the supervisory requirement for practical nurses changes to permit LPNs to function under the direction of an RN. Such direction has been interpreted to mean that the RN must be present on the premises or within a reasonable distance and immediately available by telephone when nursing services are rendered by the LPN. Again, the degree of direction should be appropriate to the circumstances."

http://www.op.nysed.gov/nurse-scope-lpn-rn.htm

LPNs can take verbal orders in my state, but my facility does not allow LPNs to take VO or TO.

when this is done ( as is often done when agency who are not used to the facilities procedures) there is in my experience still an RN in charge on call just as if there wasnt an RN in building - which is completely legal i a told - unless i am told wrong :)

caliotter3

38,333 Posts

It is only sensible that if you were the one who took the order, then you are the one who writes the order. Nobody should be writing orders taken by another for any reason.

Simba&NalasMom

Simba&NalasMom, LPN

Specializes in Home health. Has 17 years experience. 616 Posts

It is only sensible that if you were the one who took the order, then you are the one who writes the order.

:yeahthat: It's just good nursing.

Paramedic LPN

Paramedic LPN

1 Post

And what gets me is we are starting to have ambulance drivers, er, I mean Paramedics work along side of RNs and LPNs doing NURSING duties

So, what's the problem with Paramedics doing nursing tasks. I am licenced as both and the Paramedic program is harder, longer and more intense than the nursing. Don't take this the wrong way but what does an LPN know that a Paramedic does not?

diane227

diane227, LPN, RN

Specializes in Management, Emergency, Psych, Med Surg. Has 32 years experience. 1,941 Posts

In my facility LPN's can take verbal or telephone orders. I would never write an order given to me by another nurse. I also don't give medications drawn up by another nurse. Just a precaution.

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