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.

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

So do I get this post right? Are you saying that you and other LPN's at your hospital are putting thier jobs and yours and the RN's Liscences on the line by going outside of your employers policy? Are you saying you are putting all of you under a huge risk for litigation on the off chance that something goes wrong? Are you also begrudging the OP for not wanting to do this and trying to protect her job and liscence by doing what is right and legal?

Hmmm.... Good luck. Sounds like a big reckless risk to me.

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.

OP did not say it was a trust issue. It was a SOP issue. In her area it is not in the LVP's SOP to take VO. She said she would go behind her to cover her tail and do what was legally right.

In Texas, LPNs (LVNs as they're known down here) can take verbal/telephone orders. And write them out themselves. It's "medcations aides" who can not take verbal/telephone orders. I find that very strange that in other states it's not allowed. We all take the same boards. And yet the practice acts in different states can be so different! It boggles my mind..:uhoh3:

Here in Virginia, LPNs can do TOs...plus anything else an RN can except do IV meds (though I've done it many times) and hang blood. LPNs can be supervisors, primary care nurses, and managers. Been those too. I couldn't work for a state that won't let LPNs work "side-by-side" with RNs. Many RNs have come to me for help...especially in vent cases.

In the hospital I work in LPN's are not allowed to take orders, but we are working changing the hospital policy. Other hospitals in Ohio let LPN's take orders. When I answer the phone and the doc tries to give me an order I always explain that per hospital policy I cannot take an order from them. It has gotten alot of the docs on our side to help us change the policy.

Where I live LPNs can take TO, hang blood and push IV meds (with the exceptions of a few meds).

Specializes in L&D.
So do I get this post right? Are you saying that you and other LPN's at your hospital are putting thier jobs and yours and the RN's Liscences on the line by going outside of your employers policy? Are you saying you are putting all of you under a huge risk for litigation on the off chance that something goes wrong? Are you also begrudging the OP for not wanting to do this and trying to protect her job and liscence by doing what is right and legal?

Hmmm.... Good luck. Sounds like a big reckless risk to me.

I believe the poster you were speaking to is an RN. She/he was taking the OP's side.

At my institution, we changed the policy recently that anyone who takes an order (LPN, RN or in some instances Repiratory Therapy) has to read the order back to the Physician. The process is to take the order, write it down on an order sheet and read the order sheet back to the MD. This process should decrease the amounts of errors in transcribing the order from taking it on the phone to the order sheet. It is not acceptable to write an order for anyone, ever. This is the policy. As we know, not following policies can lead to trouble. With so many things happening around us in the nurses stations, it's easy to get distracted and not get the order recording correctly. It's best to protect yourself and most of all, protect the patient.

What would have happened if the LPN told you to take the catheter out of the worng patient and you did?

Recently, a nurse told a student to take the NG tube out of a patient because the doctor told the nurse to remove it. The student approached her instructor and told her that she needed to remove the NG tube. When the instructor asked about double checking the order, the student pulled the chart and the order had not been written. The nurse told the instructor that she had not gotten to writing it yet. The instructor informed the student that she needed to understand that you never remove anything from a patient unless it is in writing or you took the order yourself. She also told her that she had to write the order on the chart before removing it so that she didn't forget to go back and write it afterwards. She let her student know that she did the right thing by asking before proceeding; that if she had removed the NG without checking, she would have recieved a failing mark for that clinical.

i have worked in many types of facilities...lpns who work in ltc often have to take charge as rns are available only 8-4 m-f....and those who work day shift often will not receive any help from rn as they are involved in care plans..we have a lpn as tx nurse and she is not suppose to assess a wound or decub but she winds up doing everything except the sign-off

we receive orders from the mds via the office nurse, reading it back should be sop because in the transfer of info from doc to office nurse to floor nurse there can be a mix up..have them spell the meds too..takes a few minutes but can be a life saver if there is any doubt

my dtr and i were talking today and she said that when she is charge she always does the pushes and blood for lpns on floor..yesterday she had a team and the lpns were coming to her for these...she asked where the other rn [charge] they smiled and said she was in the break room eating some ice cream

WOW there are alot of judgemental generalizations being made on this thread. I don't think it is fair to alot of LPN's....Before you cast judgement always think....If you were an LPN, then you understand the education and schooling that is done and how boards are...but as a straight forward RN, becareful...there are alot of LPN's out there who will blow your socks off with their knowledge and critical thinking skills. Honestly critical thinking is something a person just has...I don't believe you can be taught it to an effective manor. HOWEVER, you must have a full understanding of the knowledge you are critically thinking. Honestly there is where the difference lies between most LPN's and RN's...the A&P required for RN's is much more indepth (from my experience)....than what it is for LPN's...it is that knowledge base that provides the tools for an RN to critically think differently. Supervision is also taught at a greater level. RN's remember this, if you take on that role as a supervisor it is your RESPONSIBILTY to know what an LPN's practice law states and the facility policy, so you can inforce them properly. Cause the BON is gonna say why didn't you know? LPN's it is your RESPONSIBILTY to know that law and policy and work within, regardless of your experience. Honestly it comes down to being an effective supervisor, knowing your staffs limitations for each individual. I have worked in many different areas of nursing, policy was changed once on my ability to show a capability. Honestly I believe when it comes to a LPN it is very individually based, I worked with some that I would trust more with their judgement than alot of RN's I worked with, HOWEVER I have also worked with some who don't care about learning more, advancing them selves to be the best nurse for their pt they can be.

Each state and each facility is going to treat LPN's differently, many of you are correct the role is not clearly defined, I believe it is like that to allow flexibilty with the facilities.

Honestly people CYA (Cover Your A**) don't write orders for anyone and dont' give anyone orders to write. I am very very possessive and protective of my patients...I won't let others have the possibility to cause harm to them....so I won't let others interfer....I am respect for that level of responsibility by my patients and coworkers.

Now in regards to the patient who wanted the sleeping med....the poster who said he had the right to recieve it was correct, even at 0430. What if that patient normally slept till 1000? To me it sounded as if the poster didn't want to believe this patient...to me, if I was your patient and you denied me a form of comfort...we would go rounds. A patient has a right to that, maybe he just was trying to get through his hospital stay by sleeping a little extra...if there wouldn't be any adverse effects from that...then let him be comfortable. To me that is like denying pain meds...it is one thing not to believe a pt but it is a completely different thing to deny them what they feel will make them comfortable...afterall nursing is caring.

To the OP, ALWAYS ALWAYS take responsibility for your actions, you could easily do that by confirming those orders with the MD...If you make a wrong, do your best to report it and take responsibility....after all it can always be a great learning experience.

Does anyone have an answer for the quesiton why LPN's shouldn't take TO or VO??? Honestly I would think TO is more dangerous to take then VO, at least you got the doc right there to continuously repeat them...but serisiously....do LPN's have hearing problems or something?

Sorry so long.....but I hate things that are so judgemental or generalized....

Every hospital has its own rules and regulations, since this is not allowed at your hospital, someone needs to remind the LPN of her job description.

I hope nothing negative comes out of it. All the best.

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.

Daytonite, you sound like you deal with a lot of anger when it comes to LPN's. You make it sound like all LPN's are good for nothing and worthless dirtbags. :nono: I feel sorry for you. Just to let you know there are alot of great, hardworking LPN's out there that really care about the patients and their well being and want to do the best job that they can. :nurse: Just because you have worked with a couple of dirtbags, that just happen to be LPN's, you shouldn't fault us all. There are some dirtbag RN's and Doctors out there too. The letters that follow your name shouldn't automatically place them on your trash list!

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