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.

Since we are kinda of on the subject, with LPNs and RN's pay, why isn't it that ADNs and BSNs have different pays. Two years more of college and they might get 25cent to a dollar more starting pay if they are lucky. Seems strange. I know most Hosp will require BSN for sup jobs, but it still seems weird to have the same starting pay. My bills are higher...lol

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

RE: Happy2behere96 ;) 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.......In the SNF/LTC facility I work at the procedure is that the RN or LPN (we don't have an RN on nights where I work) calls the doc,(nurses don't "pronounce" at this particular facility) say something like..." at 1132 pm John Doe had no vital signs, resident is a dnr, diagnosis is.... end stage renal disease, chf, copd etc. May I have a phone pronouncement please?" Then after you get the phone pronouncement, you call the coroner to release the body, telling them the resident's name, age, diagnosis, time of death per md pronouncement,who the md was giving the pronouncement, and if this was an "expected death", they might also ask if there were any falls or injuries in the last 24 hours. They will then usually give a verbal release over the phone, then you call the funeral home to come and get the resident. Our documentation would say for example..."04/14/06 1132pm (or 04/14/06 2332) Resident has no apparent vital signs. nancy nurse rn/lpn 04/14 /06 2335 Dr. So&So notified of cessation of vital signs, received phone pronouncement.nancy nurse rn/lpn 04/14/06 2340 Coroner notified, received verbal release to release resident to funeral home. nancy nurse rn/lpn 04/14/06 2345 XYZ funeral home notified.nancy nurse rn/lpn 04/14/06 2355 XYZ funeral home here to pick up resident. nn rn/lpn Also chart what time family notified, if they came in, were present at bedside, emotional support given to family etc. Some places will let you do the block charting format so you don't have to keep signing your name over and over. When we block chart it says something like ...04/14/06 2332 Resident has no apparent vital signs, bp 0, p 0, r 0. 2335 Dr So&SO notified of cessation of vital signs, phone pronouncement received.2340 Coroner notified,verbal release obtained. 2345 XYZ funeral home notified. 2355 XYZ funeral home here to pick up resident. 2358 Resident released to XYZ funeral home. Nancy Nurse RN/LPN. Your facility should have this in your policy and procdure manual.

Specializes in L&D.

LPNs cannot take orders at the hospital I worked at.

Specializes in L&D.
I don't get it, I worked LTC and the LPN's took phone orders and DC'ed caths.

Even an aid can DC a cath. But no one can take an order unless they're an RN.

Specializes in Geriatrics, Cardiac, ICU.
Even an aid can DC a cath. But no one can take an order unless they're an RN.

You're right. I worked agency on a neuro floor and the nurse showed me how to to an in and out cath actually. I had never done one before, but the regular techs did it as part of their jobs.

I love nurses willing to teach.:mad:

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

i have seen this often in nursing homes because if they use a lot of agency the agency nurses are likely not to know even a smidgion of the policies like for fire , bad weather, etc as half of em come in on the blind not even knowing the place at all on a few hr orientation. however if an rn that works prt time like i did ( not agency but strictly for the facility ) then id be stuck with charge. matter of fact most nights shifts in nursing homes only have lpns on and they are in charge - however - then there must also be a "on call " charge nurse for that lpn to call in the event help is needed. we utilize lpns and they can do just abot anything we do - more in the hopsital than in then ursing home - at the hspital the only think they could not do was blood and iv pushes in the nursing home they are not allowed to do ivs ( at some facilities that is changing as they run low on rns and get them th training ) so i suspect its more a facility thing? hugs tracie

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

in half defense for writing others orders - i have in a pinch written someones orders or they mne when we are in an emergent situation ( ie i need to get an iv in and she writes the order up while im putting it in) however we never sign the prder for each other - we always look ito ver to be sure its writtne right and what i told her ( so nothing got lost in the translation which can happen ) and then sign the order we took. hugs tracie

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.

in her defense - if teh ptient was alert and oriented and if she attepmted to talk him out of it and he insisted she would have to give it to him as the patient hsa every right to that sleeping pill when he wants it as long as its not to soon siince the last one - i wsnt there so i dont know what she did or if she attempted to talk him out of it but that could be a scenario one hs to remeber - unfortuantely if there is an order and they are with it and their own person you culd be in hot jam if you dont give it. hugs tracie

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)?

The OP stated that this particular LPN has been @ this hospital for 32 years.

I can't stand working with people like that. There is no "I" in team.

Anyway, in PA an LPN can take an order for anything that is in her scope of practice. The hospital where I work hasn't changed their policy yet, but some of us have been pushing. We do primary care, where the LPN's take an equal assignment. When I am in charge I will try to avoid assigning them pts with central lines or a lot of IV push meds. This saves me time in the long run.

Sue

I found something out today that makes this whole situation even more maddening in my eyes! I usually work evening shift, so the LPN in the OP is the only LPN I end up working with 95% of the time. Today I worked days, and happened to be chatting with a different LPN about what our Nurse Practice Act does and doesn't allow them to do. (I didn't mention the situation in my OP.) I found out that LPNs CAN in fact take verbal and phone orders in my state, and can set up and adjust PCAs! She mentioned the LPN from the OP by name as said "but Susie absolutely refuses to do those things, she won't even check her own MARs." Turns out that when the laws changed over 15 yrs ago, "Susie" refused to change with them.

This is a nurse who NEVER fails to punch out exactly on time, even if one of her pts codes during her shift! No wonder she is so efficent, she just gets everyone to do her work for her. Too bad it took me 5 mos of working with her to figure it out. Stupid me, I just thought she was a good delegator.:angryfire

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.

In New Jersey LPN's most certainly cannot take telephone or verbal orders from physicians. However, it is unfortunate that you do not trust your co-worker enough to take her at face value with something as simple as removing a Foley Catheter.

Specializes in Geriatrics.
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.

In the hospital I work at LPNs are not allowed to take verbal orders, nor are we allowed to verify the orders once in the computer system. At the nursing homes LPNs ARE allowed to take verbal orders and verify them. Every place has their own policies. Never knew 2 that worked exactly the same way!!

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