LPNs need co-signer for verbal orders

[KatieNoelLPN]

I work in home health. THe other day a fellow nurse told me that any verbal order that an LPN takes has to be co-signed by an RN. I told her I didn't think so. I worked in a hospital for 5 years and the verbal orders taken by ANY nurse, LPN or RN, had to be co-signed by a doctor within 24 hours but not another nurse.She got really nasty and said 'Well, I used to be an LPN too and believe me you have to have an RN sign them.' We live in GA and I can't find anything in our nurse practice act about this.

[SuesquatchRN, BSN, RN]

In NY in my facility that isn't a requirement.

Ask your boss.

:)

[horrorxgirl]

I live in PA and I am able to write verbal orders without an RN cosign. However, when I first became an LPN around 8 years ago it wasn't even legal for LPNs to take verbal orders over the telephone. So it may depend on how long ago she was an LPN, as laws are constantly being updated and more responsibilities given to LPNs.

[Jules A, MSN]

Its probably a facility specific thing. At my hospital LPNs can sign TORC or VORCs.

[Simba&NalasMom, LPN]

I'm thinking it may be a company policy. I've always taken verbal orders in nursing homes (for pete sake, in LTC 75% of the time there isn't an RN around to co-sign anyway, LOL...and am I gonna wait until day shift when an RN comes in to give my 85-year-old drowning pneumonia patient his first shot of Rocephin? I think not.).

When I worked in home health, however, I always had to get an RN co-signer for verbal orders. At first I was pretty surprised (and I think it's also a pretty silly policy, but I guess that's beside the point). Oregon's NP act states the following, and this is for ALL nurses:

"May accept and implement orders for client care from licensed health care professionals who are authorized by Oregon statute to independently diagnose and treat." Guess how far I got with the home health agency when I showed this to management...you got it! I admit at the moment I have a chip on my shoulder about nursing in general, but my stinky attitude is "If you want us to get a co-signer, then you can bloody well make the racka-frackan RN's write their own blankety-blank orders." Humph. OK I'm kidding mostly, it's not the RNs fault...but gee whiz...it really burns me when it becomes obvious that management doesn't have a clue about the NPAs for the for which state they are presumably licensed. :angryfire

[SuesquatchRN, BSN, RN]

As an LPN you are not authorized to make nursing diagnoses and treat based on them. Ridiculous, and done all the time, but true.

[sasha2lady]

I'm in ltc and I've never had a rn cosign any order with me and the md signs within 24hrs. I take orders daily from our md I'd ask the boss about it.

[Simba&NalasMom, LPN]

As an LPN you are not authorized to make nursing diagnoses and treat based on them. Ridiculous, and done all the time, but true.

I imagine that varies based on each state's individual NP Act. :)

[CLUVRN, MSN, RN]

I'm also in home health and as an LPN, I'm required to have an RN cosign verbal/telephone orders per company guidelines. Guess it depends on the state you're in. I'm in Florida.

[expltcrn]

If your company is Medicare-certified, it needs to comply with the Medicare Conditions of Participation. This is what it says:

484.18 Condition of participation: Acceptance of patients, plan of care, and medical supervision.

©

Standard: Conformance with physician

orders.

Drugs and treatments are administered by agency staff only as ordered by the physician. Verbal orders

are put in writing and signed and dated with the date of receipt by the registered nurse or qualified therapist (as

defined in 484.4 of this chapter) responsible for furnishing or supervising the ordered services. Verbal orders are

only accepted by personnel authorized to do so by applicable State and Federal laws and regulations as well as by

the HHA’s internal policies.

Of course it doesn't state that LVNs cannot accept verbal orders, but it only specifies the RN.

I believe the logic behind it is that it is pretty specific that an RN be the coordinator of care in the Home Health Arena, and when any orders are received, it is usually because something needs to start happening, stop happening or happen a different way (clarification), which then translates to Care Plan review and revision/initiation/coordination as needed, which must be conducted by the RN.

My 2 cents - I am new to Home Health and had to read and re-read all these guidelines many times over!

Now, in the Long-Term Care arena where my expertise is - things are different state to state as I've discovered having practiced in California, Texas, Wisconsin and Illinois as a consultant!

[systoly]

I currently work in home health and have done so in three different states without ever needing a co-signer. Having said that, I don't see what the big deal is. I'd be much more concerned if I was the co-signer.

[NurseCubanitaRN2b, BSN, RN]

I don't work in home health but I do work at a clinic and I don't need a RN signature when I take verbal orders from the doctor. The doctor must come in and write his orders in the AM but certainly I don't need to call a RN for a signature, my signature is good enough. But I'm in Cali so it might be different.