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.

Specializes in designated med nurse,med surg,hh, peds.

I think the problem could be in part , that LPN programs don't have a standardized curriculum,and the scope of practice varies so much from state to state. One school will teach iv therapy, one will not, some places LPNs can drop an NG some places they can't. Some schools teach critical thinking, some do not. Another rationale I have heard is that the LPN may not recognize an "off" order as quickly as the RN. Just my humble opinion.

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Specializes in Critical Care, Emergency, Infusion.

Along the lines of the same subject (however, I may be reaching here. . .) I get very irritated when I call a physician's office for a telephone order and the medical assistant takes the message to give to the MD 'between his office patient's'. Then the MEDICAL ASSISTANT calls me back to give me the MD's order. I know I am not allowed to take orders from a medical assistant by my state's practice act, but for some reason the docs just don't get it. This was never a problem when I worked in the ICU, but now that I am working med/surg again, I am constantly battling these PCPs. The other nurses on the floor have no problem with taking orders from non-nurses. They state they would have to wait too long for the doc to ever call back, which is exactly what happens to me. And if their not calling me back delays a patient's discharge, I let the patient know exactly why their going home is delayed -- their physician is not returning my phone call.

Just my two cents.

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this may be slightly highjacking the thread, but what is the big deal with telephone or veral orders?

T.O. arn't as big of an issue as VOs are. Like someone said, if the physician is there to give an order verbally they can get the chart and write it to avoid any possible confusion. Of course in an emergency situation VOs are taken.

As far as the O.P. I wouldn't write an order I didn't take. I would have told the LPN to write it herself ( practice act permitting) or call the doctor back and give the phone to me and ask her not to put me in that situation again.

I can understand LPNs not being able to take TO/VO in a acute setting as I'm sure it has to do with license limits/restrictions.

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I think the problem could be in part , that LPN programs don't have a standardized curriculum,and the scope of practice varies so much from state to state. One school will teach iv therapy, one will not, some places LPNs can drop an NG some places they can't. Some schools teach critical thinking, some do not. Another rationale I have heard is that the LPN may not recognize an "off" order as quickly as the RN. Just my humble opinion.

this is what i was thinking could be the rationale as well, but wouldn't the same "risk" occur with a written order? I am just confused...

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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

I know this is off the subject, but was anyone else offended by this? EMT's and Paramedics are not fit to work alongside RN's and LPN's. I am not suggesting that RN's and Paramedics are interchangeable, but there is some overlap in their skill sets. Paramedics and EMT's are trained professionals not just "ambulance drivers".

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I know this is off the subject, but was anyone else offended by this? EMT's and Paramedics are not fit to work alongside RN's and LPN's. I am not suggesting that RN's and Paramedics are interchangeable, but there is some overlap in their skill sets. Paramedics and EMT's are trained professionals not just "ambulance drivers".

Yes they are trained professionals, but they are not nurses no matter how bad they want to make us (at our facility) think they are "far superior".

Matter of fact, the EMTs are being placed above nurses in many areas as far as rank goes. But what to expect when you have an LPN as a charge nurse over RNs.

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Wow, sounds like a way different dynamic where you are. Where I live EMT's are allowed to function at about the same level as aides, not even close to RN's and Paramedics are pretty limited in what they can do inside a hospital.

Once again, sorry to get off the subject. BTW there is another thread called "CNA acting as RN" that has a lot of similar themes, people reading this one might enjoy it as well.

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This is a little off topic but...re:traumaRUs - In Illinois LPNs can take verbal orders and telephone orders, and our scope of practice varies from facility to facility. LPNs can do much, much more in a critical access facility as opposed to a jacho facility.I found this out just last week when I interviewed for a job at a critical access hospital in central Illinois. At this particular facility, LPNs did many RN tasks,starting IV's,giving IV meds, about the only things we did not do were anything to do with a central line,or start the blood transfusions.(Didn't take the job, I don't do dayshift,and had a few reservations about the facility) Working in the SNF/LTCs around here, many times there are no RNs on nights,so we have to call the doctors and take phone orders, we also call the coroner with time of death, and get phone pronouncements from the docs. I do not claim to be on the same level as a RN, actually would like to go back and get my RN in the next couple of years. As for the post, IMHO in the future if this happens again, tell her "you took the order, you write the order" if it continues, ask for an inservice on the legalities of writing an order you didn't personally get from the doctor, and make sure your supervisor/nurse manager has EVERYONE sign a completion/comprehension form, that way, you can say to the other person, "you know I can't do that, don't you remember our inservice?"

;) This is off topic, but regarding your calling docs to pronounce death, how does this work? I mean do you chart Doc pronounced death at such and such time. Could you explain to me the steps you take when someone dies in your facility if you wouldn't mind. This is a debated topic in my facility. RN pronounces death or there is no official note stating time of death. Thank you

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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."

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traumprincess,terrific explanation & that is a great way to tell someone ty but no ty...I am LPN in a hosp. setting and I would NEVER, EVER take a TO, nor would an RN let me b/c it is against hosp. policy. One RN did ask me to give a push and I simply said no I can't against state policy..i didn't care what she thought and actually she was fine with that..we all must protect our nursing license. I am going to work in setting for clients w/ MR and lpns are supervisiors and take TO, I live in PA and lpns, if allowed by facility policy, are allowed to take TO but must receive training 1st.

Jus my2cents,

melinda

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I did this very thing in my second hospital position as an RN. Had an LPN who just did all kinds of things that were screwy. She was sullen, a loner and kept herself separated from the rest of the staff. She basically did things the way she wanted and didn't follow directions--very difficult to work with. I won't deny that I had a bit of an attitude about her myself then. I was still new to nursing and had a lot more to learn about getting along with people and being a supervisor. However, the straw that broke the camels back was when I had to run off to get a unit of blood from the blood bank (only an RN could do it in that hospital) and in the 5 minutes I was gone she gave 30mg of Dalmane to a patient. This was 4:30am in the morning. It was all I could do to hold my temper. Her reasoning was that the patient was asking for the sleeping pill, it was ordered as a prn, so she gave it to him. I went to the PTB that day. To my knowledge nothing was done to her, but I can't know for sure. I ended up being so disgusted with the responses I got from both my head nurse (who was a former classmate) and one of the nursing administrators that I was the problem and not the LPN that I ended up saying, "I quit" and left. This was around 10am, almost 2 and a half hours after my shift had ended. I could be quite a hot head in those days and 25+ years later I realize that I handled the situation totally wrong, but I won't give in on my main beef of the patient being given a large dose of a hypnotic at 4:30 in the morning. Her rationalization was totally off the wall. Had she bothered to check, I had told her, she would have found that the guy had indeed been snoring away for most of the night shift.

Not that I'm trashing LPNs (my mother was an LPN), but I've worked with a number of them who mistakenly believe that they possess the same assessment and judgment skills as an RN and that simply is not true. In addition, some will voice anger that they aren't paid near as much for doing the same job as an RN. Say what? It is so interesting to watch the transition of an LPN to an RN. Then, they see the difference themselves. However, unless they go back to school, there is no way to show the rebel and rambo LPNs where they are wrong because they just can't see it. There is a reason that most states don't permit LPNs to perform as fully in acute hospital settings as they do in nursing homes. Even in nursing homes, and I've worked in plenty, I saw LPNs make some serious errors of judgment that an RN wouldn't. They are not schooled in the critical thinking skills to the degree that RNs are. There has been talk since I was first licensed back in 1975 about grandfathering all LPNs to RNs. Hasn't happened yet and I doubt that it ever will unless the cirriculum of the practical nurse training programs changes significantly to focus on those two elements of critical thinking and decision making. Most of us RNs agree that in nursing school every other sentence out of the mouths of our instructors was something like, "now as the nurse, how are you going to put all this information that you know together, and what are you going to do for this patient?" We are taught to understand the "why" of what we are doing.

OMG!!! Daytonite, I could not AGREE more with you! I am an LPN in a hosp. setting and I can't stand when people say, "oh your doing the same work as the RN but getting 1/2 the wage:angryfire No I am not!, I don't have that critical 2nd year of schooling which is the THEORY of nursing, that is why we PRACTICAL nurses! Yes I have my own pt assignment and are responsible for my own pts but I practice w/i my scope of practice, AND NOTHING MORE..I work with some awesome RNs who help me understand any theory I want to learn and help me piece "it all" together. In fact I want to go get my RN so I can understand more of the "why" of what we need to do for our pts.

jus'my2cents,

Melinda

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Specializes in 5 years peds, 35 years med-surg.

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it was the same where i worked. we didn't have to have an rn sign our notes. we did just about everything the rn did except spike blood and give iv push narcotics or heart medicines. i'm amazed at what so many lpns can't do in some places. i would feel like an aide.

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I know this is off the subject, but was anyone else offended by this? EMT's and Paramedics are not fit to work alongside RN's and LPN's. I am not suggesting that RN's and Paramedics are interchangeable, but there is some overlap in their skill sets. Paramedics and EMT's are trained professionals not just "ambulance drivers".

In our area, EMT training requires a certian number of hours in the ED so they know what goes on there, but they act pretty much like aids while in the ED. There are different scopes of practice. EMTs are allowed to do things RN's can't like intubate in emergencies, outside of the Hosp. Once the patient gets to the Hosp the laws are different. There are many things an RN can do that an EMT is not allowed to do as well. EMT's have different training. Parametics might have just about as much as an LPN, but it is different skills. It's not that either is better or worse, but different. They have different scopes of practice as well and that would cause a whole lots mess.

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