is this legal?

[dcnballmom, ASN, RN]

i was always taught that when you needed a physicians order for any type of treatment for a patient, you asked the physician first - before writing any type of order. in the facility where i work, there is a nurse that takes it on herself to write orders for all sorts of things - not medications, but treatments and orders for consults - the one that bothered me the most was when she wrote orders for a speech therapy screening on a patient when the doctor had specifically stated in the past that he did not want this done, but instead ordered thickened liquids for swallowing troubles this patient was having - the nurse that wrote the order - after finding out that the physician was adamant about not having the screening done - errored out the order on the physician order sheet, writing "wrong chart" on the order - in addition she also made a nurses note that the physician had given the order when in fact he had not - this again she errored out and again that it was the wrong patients chart - is this really a legal issue or am i making too big of a deal about this - I thought that as nurses we were to respect the physicians and work with them - not act as though we WERE the physicians

[steelcityrn, RN]

Sounds wrong to me. She has no license to be writing orders for a physician. Someone needs to stop that a.s.a.p. You as a nurse should not follow a order that you know was not obtained by a physician. One day that person is going to get in a huge amount of trouble by writing a order that was followed, and the physician found out, especially if its something he would have never ordered. If you get the right physician ticked off bad enough, and he is not that fond of nurses to begin with, he can really see to it that nurse is severly punished.

[TazziRN, RN]

VERY wrong! In some units, like critical care, nurses will sometimes order certain tests knowing that the doctor will cover them when they come in....very common in ER. But even those will be things like "Pt is wheezing, let's get a treatment and an x-ray." No consults or interventions.

Best way for TPTB to catch her is to check the other charts from the same shifts: if she truly wrote on the wrong chart then it will be corrected elsewhere.

[abundantjoy07, RN]

Sounds like she is engaging in behavior outside of her scope of practice as a nurse. And being sneaky about it doesn't make it any better. If she really thought the consult was in the patient's best interest then she should have spoken to her nurse manager after questioning the order with the physician...and not taking it upon herself to make up orders on her own.

No, she's not prescribing meds but still, if it feels wrong, then trust your gut instinct...it probably is wrong.

[lyceeboo]

Totally agree with TazziRN. I thought the first part of what she did was illegal enough but when she tried to cover it up with a fake nurses note about a fake Dr order....Wow.

[crissrn27, RN]

Lots of places have standing orders for things like PT, OT, or ST, mostly rehab or LTC. But it sounds like this girl was just pretending she was a doctor, and prescribing what she wanted. Makes me wonder what else she has prescribed. I would let NM know what is going on and let them deal with her.

[dcnballmom, ASN, RN]

NM knows - we have this fall protocol that tells us to write orders for prevention methods even before the doctor gets back to us about the patients incident - NM even asks us to write orders - this nurse IS part of NM

[DutchgirlRN, ASN, RN]

Definately wrong!!! We use critical thinking. Or at least I did when I worked on the floor. i.e. a patient complained about burning with urination. I'd collect a specimen and send it to the lab. Call the doctor to ok it or if he was expected in soon I'd wait and ask him when he came to the floor. I've never had a doctor not ok a lab test I ordered on my own. Never a med, consult, treatment. thats just wrong.

[crissrn27, RN]

NM knows - we have this fall protocol that tells us to write orders for prevention methods even before the doctor gets back to us about the patients incident - NM even asks us to write orders - this nurse IS part of NM

So was she following P/P? If the nurse were following pp then she was withing her scope. If not covered by pp then she wasn't. I have seen nurses that would just write what they wanted. I have seen this in LTC from a few nurses, and with NM backing it. Of course when the nurses were caught doing this the NM denied all knowledge.

But even if she was with in P/P she falsifed charting, by saying the doc gave her the order when he didn't. So even if the actually order were covered, the false charting is, of course, a big no-no.

[DutchgirlRN, ASN, RN]

I have seen this in LTC from a few nurses, and with NM backing it. Of course when the nurses were caught doing this the NM denied all knowledge.

I think if I worked there I would ignore what I was observing for fear someone would say I had known about it and therefore also went along. People can be very spiteful when they get in trouble. Be careful and watch out for yourself.

[TazziRN, RN]

Even if she was following P&P, the doctor had specifically said he didn't want the consult, and if she was following P&P, why falsify charting by claiming "Wrong chart"?

[gonzo1, ASN, RN]

This nurse is way out of line. Don't use her as a role model. I would stay as far away from her and her charting as possible. Should you have occasion that you have to implement an order that you feel she may have written without permission then question the MD first before implementing order. I would just say I was double checking the order, nothing about your fears that she wrote it without the doctor permission