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Discussion

Nurse Practice Act rules on orders written by LPN and RNs

Having come from a little larger hospital(200 beds) I was told in staff meetings that by a Doctor office giving a telephone order to an LPN and then the LPN giiving that order to an RN, it was a violation of the nurse practice act. Example: Dr. J./Office Person/ Sally LPN/Jane RN. Now I am working at a critical care access facility and they tell me it is not. Can someone explain to me why the same rules do not apply in both situations. Are all states this way?

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    • Experts

    I think different facilities interpret things the way they want it to read in order to suit their own purposes. As for following the rules, they will also flaunt their disregard for the rules if it suits them.

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    • Experts

    Does your state practice act address issue... might have info under "delegation" section. BON link found bottom every page.

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    • Author

    Thank you. I spoke with one of my professors in my MSN program regarding this matter. She acted like it was no big deal and happened frequently. It looks to me that it is up to the facilities till they are busted or maybe its how good their attorneys are.

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    • Experts

    IMO, based on how you wrote the situation I can't see how it's a violation of the nurse practice act. Also, a LVN telling a RN about what a doctor ordered for a patient doesn't necessarily qualify as delegation either.

    Look at it this way: the LVN happened to be the one who took the orders from the doctor on the telephone, and in several states that's perfectly legal for her to do. Now, those orders need to be carried out on the patient and in all honesty, the doctor doesn't care if Nurse X or Nurse Y or Nurse Z does it, as long as his orders are implemented. So does it matter if it's the LVN who took the telephone order that implements them, or if the RN who didn't answer the phone does them?

    (It goes without saying that scope of practice will dictate what the LVN can and can't do as far as the actual orders).

    So unless I'm missing something and/or you forgot to add a key piece of info, I really don't see what the problem is.

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    In my state a LPN can not take a verbal or telephone order. The last hospital I worked at had a few LPN's on the floor so when the time came, he/she would just get a RN and have them take the order..If the Doc was being lazy, the LPN would remind him, she/he could not take a verbal order and handed them the chart to write the order themselves..

    The hospital I am at now, no longer has LPN's on the floors so this is not an issue at all.. Crazy if you ask me but that's how it is here.

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    • Author

    Perhaps what I should have added was this is regarding the process of writing a telephone order itself. That is why I should have written it: T.O./P.O.: Dr. J./Office Person/ Sally LPN/Jane RN. Also the orders I am referring to one was for a narcotic and the other was for IVP lasix. I know each state varies. I was told by one doctor who came from New York City that he had to get up in the middle of the night and drive across the city to write a MOM order because the hospital would not let nurses take telephone orders. I appreciate the LPNs I work with. They are great nurses and I trust them whole heartedly, but I was just leary of the entire process seeing as how I was reprimanded by my previous employer for taking an order from an LPN and then it was a topic in zone meetings for several months afterwards.

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