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

Nurses General Nursing

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Last night, towards the end of the shift, most of the staff was either in the report room taping or busy in their pts rooms. We didn't have a secretary, and the charge nurse was away from the desk. One of the LPN's was charting at the nurse's station. When I came around the corner, she was just hanging up the phone. She said, "That was Dr. Soandso. He wants the foley in 716 to come out at 5 am. I repeated it back to him. Will you write it for me?" I know that it wasn't the right thing to do, but I wrote it anyway, signing my own name after the doc's.

I guess we should have called him back and explained that the nurse who took the telephone order was an LPN, and isn't allowed to do so, but we didn't.

I know I was in the wrong, but I am frustrated at her too. She should have told the doc that she couldn't take the order and put him on hold for a minute to find an RN. I've seen her do this once before.

Does this happen where you work too? Just wondering.

How does this fly with the practice act? RNs supervise LPNs not the other way around.

LPNs can supervise "administratively" but not clinically. Pretty crafty if you ask me but it is all legal.

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.

Specializes in Geriatrics, Cardiac, ICU.
How does this fly with the practice act? RNs supervise LPNs not the other way around.

I worked at a nursing home where the ADON was an LPN AND I've been at yet another nursing home where the DON was a LPN.

Specializes in A myriad of specialties.

That's so very unfortunate about LPNs not being permitted to take verbal or T.O. orders! Like 12 HRS AT A TIME asked: what ARE LPNs allowed to do? ( I didn't see a response to that)--so are they treated as glorified aides in your state? Had that LPN just relocated to your state(perhaps she was accustomed to doing this in another state)?

That's unbelievable that an LPN can't take an order to remove a foley.

Where I work we call the doctors and get orders all the time.

I could really get on this soap box and say alot but I won't. It wouldn't do any good anyway.

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.

Just a thought so you might avoid a big RN vs LPN thing.... I will not write orders that another RN takes either. If someone is comfortable taking the phone order they need to write it themselves. Otherwise it just gets into a he said she said etc... if the order is ever written wrong or if it is written on the wrong patient etc. So, the person who heard the order, read the order back to the MD should be the only person who WRITES the order(maybe this is what needs to be said to her). I have had another RN ask me to write her verbal order and I told her no, let me help you with this or that, you go and write what YOU heard. No feathers were ruffled and I felt good about myself at the end of the day. It is not that I do not trust others, it is just that I like to be positive about what I take responsibility for??? I never want to shoo away help, but I have had drs insist they did not say what I wrote. If I actually did not hear it how could I stand proud by what I wrote??? So, you could tell her, "you are sure she is trying to be helpful, but you just are not comfortable writing T.O you did not actually take, but thanks so much for your help."

Sorry, I guess I was confusing.

Basically what I am trying to say is this does not have to be about RN or LPN. This is basic nursing knowledge, you write your own verbal orders, you do not ask anyone else to write what you heard, nor do you write what someone else heard. Period. Everyone at your facility probably needs to be aware of this.

JMHO

I saw some unusual things at my job last night.

We just got a new system put in for administering and charting medications.

So we're still trying to get the bugs worked out of that.

Okay, so I was giving meds last night and one of my people had Cipro 500mg, PO BID. There were 5 tabs left on the card. However, the computer would not let me chart it. It said the order was given from 4/4 until am of 4/9. So my question was....do I follow what's on the computer or do I give this medication?

I checked the patient and he still had purulent drainage around his GT, which is what it was ordered for. So I gave the med.

I investigated further and found the dayshift card and the dose for the 9th am dose had not even been punched out! So he missed that dose.

I investigated even further and on the chart, the nurse who did the order was NOT the nurse whose signed it.

I know everyone's handwriting. The intials were not written by the owner. One nurse did the order and another nurse wrote the other nurse's intials and signed and dated it for her.

So I left my supervisor a note and told her about the error in the computer.

And I found out today that the order was entered wrong and they had to put it back into the computer corrected, to give a total of 10 days, instead of 5.

But what this is going to look like is that it will appear that I didn't give my dose of Cipro that night. The space on the med sheet will be blank where my initials should be, when the sheets are printed out at the end of the month.

The only back up I have on this is that I left the supervisor a note about it. How she will correct it I don't know.

But I never want anyone intialing anything for me, writing my orders for me, and I will never do that for someone else.

Another situation I had once, involving the very same supervisor in the above incident that I reported to is this.

One day she was on the phone with the doctor and he gave her an order for an antibiotic. She took some notes on a scrap piece of paper and then handed it to me and told me to write it up.

I wrote it up, but I left the signature line blank. I went ahead and faxed it to the pharmacy and got a call from the druggist as to how much med we wanted. I told him I wasn't sure the order was just given as I had faxed it to him. He says, "Well, I'll send 5 days then." I say, Ok, and if we need more we'll reorder.

After this I gave the blank order sheet to the supervisor and said, "Please review this and sign it."

She said, "Didn't I say it was for 10 days?" {it also was for an antibiotic.}

I said, "No you didn't tell me 10 days. I wrote what you had on the paper." She looked for that piece of paper and found it....she had NOT written 10 days on it.

So it got be a mess....the person DID end up needing more medication. It was for a UTI.

So....see what kind of messes you can get in for writing orders and intialing stuff for other folks?

I did the above because she told me to write it, but I covered myself by making her review it and sign it. She couldn't blame anyone but herself for the 10 days being left off.

Specializes in med/surg, telemetry, IV therapy, mgmt.
I do have to admit, I am somewhat intimidated by this LPN. . .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?!"

Relax. You don't need to confront her about this incident. If it ever happens again all you need to do is calmly tell her, "Jane, I can't take an order from you that you've taken from the doctor." Act as if this incident never happened. Pick up the phone and call the doctor back to confirm the order. If the doc has a hissy fit, calmly tell him that he was actually giving an order to an LPN and you are merely following hospital policy by calling him back to verify the order yourself. This is one of those times when I would choose not to narc on a co-worker after catching them doing something they weren't supposed to do--especially since it can be easily fixed.

If, for any reason, this LPN decides to start talking about this sometime in the future I, personally, would deny taking any order from her. Bad memory, you know. There's not much that can be done discipline-wise when an incident involves the word of one employee against another and there are no other witnesses.

You know, you didn't mention it in your post, but how did the issue of the patient's foley and that it was going to need to be d/c'd in the morning happen to come up when the doctor called? Was the doc calling for an update on his patient's condition? Are LPNs at your facility allowed to report patient's conditions to the doctors?

Hang in there. I've worked with my share of LPNs just like this one. I wish they would just go back to school and get their RNs and put them and us out of our misery of having to deal with their illegal antics. The sad thing is that LPNs who act like this carry a lot of anger over their position in the nursing world and they mistakenly feel they are entitled to exercise some of the same job duties as RNs. It is so reinforced in their thinking that they forget that some of the things that they have gotten away with are illegal, could result in termination from their jobs and possible loss of their nursing licenses if anyone dared to stand up to them and report what they did. They often get away with this because they are very good at using intimidation and fear of extortion against younger or less experienced, less confident employees.

I answered the question regarding what LPNs are allowed to do in my state, but due to a comp glitch, it is gone. It was a long post that I don't feel like retyping, so I'll just make a list of what LPN's on my acute surgical unit cannot do. I hope this help clarify things.

Lpns cannot:

Take verbal or telephone orders

push IV meds

set up or chage settings on PCAs

hang blood or blood products

access heparin locked PICCs, ports or central lines for any reason, including to

I answered the question regarding what LPNs are allowed to do in my state, but due to a comp glitch, it is gone. It was a long post that I don't feel like retyping, so I'll just make a list of what LPN's on my acute surgical unit cannot do. I hope this help clarify things.

Lpns cannot:

Take verbal or telephone orders

push IV meds

set up or chage settings on PCAs

hang blood or blood products

access heparin locked PICCs, ports or central lines, or flush them

hang TPN

These are they tasks that I run into on a daily basis. I'm not sure if there are others under the law.

Lpns can assess pts in my state. On my unit, the LPNs take their own assignments equal in number and acuity to the RN's. They do not have a specific RN assigned to work with them. They ask whomever is available to do the tasks they cannot.

Sometimes in the real world, things don't always work out perfectly. I had an experience a couple of years ago where I was working with an LPN, an excellent nurse with over 20 years of experience. One of her patients was crumping and while I was attending to the patient, she was on the phone with the docs, as she knew the patient inside and out, and the only thing I knew about the patient was what was related in report. When the code team arrived, I went to the nurses station and wrote the verbal orders she received from the docs. Now the docs knew she was an LPN, but they also knew what kind of nurse she was. I didn't have much choice at that point, because I can't be coding the patient and taking phone orders at the same time. I trusted her abilities as a nurse and had no qualms in writing the orders. When the docs did come in, they signed the orders without any problems. In this situation, we did what needed to be done for the patient.

I have also had some LPN's take verbal orders and expect me to write them. I have had to explain to them the position they are putting me in, had them call the doc back and tell them that by rights they were not permitted to take phone orders, then put me on the line to verify the orders.

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