Fired for writing a nursing order?

caliotter3 · Jun 30, 2012

I would have passed the suggestion on to the RN unit manager and let her do any order getting, writing.

Nursynursemn · Jun 30, 2012

It wasn't a matter of getting an order, it was a matter of making sure that the patient was being offered pain medication. She was not able to participate in therapy or even get out of bed due to pain. There was a narcotic pain medication that was available q4h prn and the nsg staff was not giving it to her.

JustBeachyNurse, LPN · Jun 30, 2012

Just like LPNs can participate in care plan development but the care plan is technically written by the RN. I would defer to the RN, especially since this involves a narcotic.

caliotter3 · Jun 30, 2012

Just like LPNs can participate in care plan development but the care plan is technically written by the RN. I would defer to the RN, especially since this involves a narcotic.

This is why I would defer to the RN.

itsmejuli · Jun 30, 2012

Depends on where this LPN is working.

I'm an LPN in Alberta. As long as there was an existing order for PRN pain meds we could add a note to the MAR to give pain meds prior to physio. We also participated in care planning.

Lynx25, LPN · Jun 30, 2012

It wasn't a matter of getting an order, it was a matter of making sure that the patient was being offered pain medication. She was not able to participate in therapy or even get out of bed due to pain. There was a narcotic pain medication that was available q4h prn and the nsg staff was not giving it to her.

Was it a vague order like, "Offer pain relief solutions prior to therapy at 0900"

Or "Lortab 7.5/500 at 0900"?

That'd make a difference to me.

allnurses Guide · Jun 30, 2012

You need to contact the board that governs LPN practice in the state you're working in. I doubt what you did was outside of your scope of practice, but maybe your facility policies, so they can fire you based on that I'd suppose. Sorry this happened to you. Unfortunately it's part of a pattern that's been escalating for years.

Nursynursemn · Jul 1, 2012

Thank you for your responses. I guess I would rather have them upset I tried to manage pain, than not manage. It is terrifying to be fired and have my nsg license threatened at the same time. It feels a bit over board and over the top to me.

Nursynursemn · Jul 1, 2012

There was an order for Dilaudid 2mg 1-2 tabs po q4h prn pain.Per the (verbal) direction of the NP, who specifically said to make sure we are offering the patient pain medication. The patient had so much pain, she was unable to get out of bed or participate in therapy. There was already scheduled tylenol and ultram ordered, there were no other alternatives to managing pain. Ironically, I am the nurse who does breathing/visualization techniques as conservative measures. P.S. This NP hates me.

Nursynursemn · Jul 1, 2012

I didn't write specifics, I merely wrote, "please offer dilaudid prior to therapies due to chronic back pain" It was flagged at 0700, 1100. It was a matter of ensuring that the staff eval her pain level. This is covered under the actual orders, because they offer specific parameters for pain - 1 tab for pain 1-5/10 and 2 tabs for pain >5, so the offering would lead to them having to ask her to rate her pain. If she was having pain, they would have followed the specific parameters in the original order.

OnlybyHisgraceRN, ASN, RN · Jul 1, 2012

Honestly, that was not the best thing to do. I've seen nurses " write orders" and sometimes it comes back to hunt you. In this day in age always err on the side of caution. I don't do anything without an order unless it is life threatening to the patient.