LVN writing orders?

[ZanatuBelmont]

Hi guys and gals,

I've been employed as a nurse since August (I graduated at the end of July). The other day we decided it best to D/C the liquid Hydrocodone/Codeine we had for a resident that can now take tabs PO.

"Sure, no problem," says I.

So I write the order, which read, "D/C Liq. Hydrocodone/Codeine and replace with PO tablets." Then I charted "New order for PO tab Hydrocodone/Codeine - void order if not signed by appropriate authority within 24 hours."

The next day my ADON jumps all over me. "Honey, in LTC, we don't get orders signed within 24 hours. That rule only applies to the hospital. Sometimes we won't even see a doctor for a month."

So my question is this. I thought the "must be signed within 24 hours" rules was UNIVERSAL? Or is there something in the Nurse Practice Act which allows a LTC LVN to write an order and it not matter if it's signed for 30 days?

I feel like this LTC care facility is the EASIEST way to lose a license... ugh. I just want clarification about my ability to "write an order" that isn't signed from a doctor within 24 hours.

[caliotter3]

When I send orders to the doctor to be signed, I never chart them on the MAR or implement them until I know the order has been signed. That is too risky as I see it.

[txspadequeenRN, BSN, RN]

in ltc your adon is right....you may not see a doctor for weeks .if ltc nurses waited to have every order signed by the doctor we would end up with very sick patients and probably a pile of lawsuits...a verbal order is legal and the standard in ltc...lvn's have been taking and writing orders for years in long term care . practice is different in the hospital and the nursing home and it does take time to get used to.....

[eldragon]

We have 3 doctors to deal with in the LTC where I work, and one stops by once a month to sign orders and see patients. The other comes by about once a week and the other twice a week.

So yeah, we write the orders and the doctors sign them when they come in.

[traumaRUs, MSN, APRN]

However, it is best for you to find out what your state board of nursing or health dept - whoever governs your LTC decides is the best practice.

We all know that just because "its always been done this way" that it may not be the right way.

[TheCommuter, BSN, RN]

I am an LVN who has been working in nursing homes in Texas for nearly 4 years, and there's absolutely no way that the MD/DO is going to sign orders within 24 hours. The typical nursing home physician will see his/her elderly residents once a month, and spend an hour at the facility signing all the orders that have accumulated since the last visit.

The overwhelming majority of orders at a nursing home will be telephone orders since the doctors seldom come. The state will jump on you if you don't implement these orders within a timely manner. For example, all antibiotic orders must be initially dosed within 4 hours of receiving the telephone order.

LTC is a whole different animal when compared to the hospital setting. You will have less staff, fewer resources, and no doctors physically available. Therefore, you must implement the telephone orders as soon as you get them, or you will have a bunch of very sick, possibly dying residents in your facility. Don't worry. The orders will get signed later.