Doctors Orders

[NGYSUN, BSN, MSN, RN]

I want to know how you all do it.

On my floor, we have to put in lab orders, and echos.

My question is, are nurses supposed to put in lab orders for the doctors even though the doctors didnt actually give one a verbal or telephone order.

On my floor if you don't they frown at you like some alien...

I'm just confused. They have been mean to me on that though. But. I see the way they talk about other nurses not putting lab orders and I wonder why or how come we nurses should keep track of patients labs and put in orders. One of the nurses told me, "you can put it in the doctors dont care" Really?!

Is this not supposed to be the doctors jurisdiction?

Please correct me if Im getting it all wrong.

[jadelpn, LPN, EMT-B]

You are not wrong. A nurse usually can't start putting in random lab orders until an MD decides what they would like to order.

So unless you have standing orders for labs based on certain conditions, who the heck is going to "cover" for you when the practitioner is going one way, and you are thinking that they may want to go another?

"And which labs are you thinking I need to put in? And I am assuming that when the MD realizes that we have ordered for him/her, you will take the responsibility for that? Didn't think so. I need an order to put labs in."

Now there are some policies that allow for a "rainbow" to be drawn with an IV insertion. And then you have bloods drawn waiting for orders.

If putting labs in is commonplace, then maybe a discussion about the need for standing orders.

[empatheticRN]

You are right this is a doctor's responsibility. A nurse can recommend labs or treatment to a doctor. And of course this comes with experience.

[GrannyRRT]

Since you mentioned Echo, is your floor utilizing or attempting to establish order sets for core measures based off the physician diagnosis such as for heart failure? There are also pre and post procedure order sets. Ideally the computer system should be set up for all the individual orders to appear for the physician but some require the orders to be individually entered by the UC or RN or RRT/RPFT.

[FlyingScot, RN]

One of the nurses told me, "you can put it in the doctors dont care" Really?!

Until one of them does and totally throws you under the bus.

Of all the sketchy/questionable practices and situations described here on AN that people question losing their licenses over this is the only one that I can most assuredly say you actually are taking that risk. Without some sort of standing order and from a legal standpoint you are practicing medicine. Yes I know that most of us know what labs the patient needs but that doesn't change the fact that we are not independent providers with the authority to order lab work. No only that but the Joint Commission is coming down hard on verbal orders. They want them minimized and only used in extreme circumstances.

Unless I have it in writing from the physician that he/she will support me in the style to which I have grown accustomed when I lose my license doing his job for him/her they can write their own darn orders.

[NewYorkerGirl]

Joint Commission is coming down hard on verbal orders. They want them minimized and only used in extreme circumstances.

Well finally, Joint Commission did something to help nurses out. Our Docs are lazy, too, and don't want to touch a computer. It's good to hear JC frowns on this.

[Soliloquy, MSN, APRN, NP]

Do you work at an hca facility? At my other hospital the answer was beck no and if any doctor told you to do that and got mad or made a comment, let the supervisor know and they'd take care of it. But hca facilities are different and seem to focus more.on what doctors want and making their lives easier so it falls on you. The problem is that if anything were to go wrong or you ordered the wrong thing, the doctor can easily relieve himself of responsibility. Everything falls on you.

[toomuchbaloney]

I'm gonna suggest that you look at the facility policy relative to entering MD orders into the EMR.

Most facilities that I have worked with WANT the MDs to enter their own orders, this will reduce the possibility of error.

You are obligated to follow policy.

If the doc looks at you like you are an alien that is her problem, shrug your shoulders and move on. Or wink, whisper "nanu nanu" and skip away.

[BR157]

Until one of them does and totally throws you under the bus.

Of all the sketchy/questionable practices and situations described here on AN that people question losing their licenses over this is the only one that I can most assuredly say you actually are taking that risk. Without some sort of standing order and from a legal standpoint you are practicing medicine. Yes I know that most of us know what labs the patient needs but that doesn't change the fact that we are not independent providers with the authority to order lab work. No only that but the Joint Commission is coming down hard on verbal orders. They want them minimized and only used in extreme circumstances.

Unless I have it in writing from the physician that he/she will support me in the style to which I have grown accustomed when I lose my license doing his job for him/her they can write their own darn orders.

Thank you for being so honest about nurses and orders. Most of us know this but some nurses have tried to claim they can do a lot without a doctor right there to write orders. This is a huge discussion when the Texas ENA president bashed Paramedics in a letter.

[ParvulusPuella]

Do you work at an hca facility? At my other hospital the answer was beck no and if any doctor told you to do that and got mad or made a comment, let the supervisor know and they'd take care of it. But hca facilities are different and seem to focus more.on what doctors want and making their lives easier so it falls on you. The problem is that if anything were to go wrong or you ordered the wrong thing, the doctor can easily relieve himself of responsibility. Everything falls on you.

I work at an HCA facility, and there is no way I could get away with randomly entering orders I think the doctor wants. Anything I enter has to have come from the doc or from a set protocol (such as continuing cardiac enzymes till peak). And working nights, i am allowed to enter telephone orders, but during the day the docs/PAs have to enter all their own.

[Momma1RN, MSN, RN, APRN]

Nope, you're not wrong. We often put in verbal/telephone orders, but never labs unless it's a STAT situation and the doc orders. It's not in our scope of practice to order routine labs without an order.