Nurses can't just write their own orders...can they?

I have worked some places where nurses who know their docs very well take some platitudes. But this can be a risky practice. You will be up a creek if you overstep your boundries and your doc refuses to sign your order. THen you are practicing outside your scope and the BON will get you.

Sure...we can write them, but then what if the docs won't sign them??? Risky practice as mentioned. I ran into this a whole lot in rehab facilities as an agency nurse.

And I've also been told verbatim by some docs to just write their routine meds as orders, particularly in the middle of the night, and they'll sign them in the am.

Usually I will look for an excuse to call the doc about something else, and then run the medlist by them, if I have any misgivings..

Also depends on the setting and my comfort level with the docs.

I know we don't have a license to practice medicine...but I do think you get to know your situation.....

I used to work inpatient rehab...we all new the rehab doc real well....we knew what we could and could't do with regards to orders...

For instance...small things....LOC, tylenol, pt used some sorta eye drop at home that wasn't carried over on the orders...these things we would not call for necessarily....and like say a UA C&S or stool for occult blood...if we saw something that warranted it, we'd write an order.

Now, with regards to everything else, we would call....but we would try to notice these things before end of office hours...although he never minded us calling even in the middle of the night b/c he knew it would be warranted.

Now, I notice you have posted on the travel nurse forum...I would think you would probably not get to know any of the MD's that well while on assignment...so I would do what was prudent....the other nurses will have to answer for them selves.

Kathryn

you could loose your lic. get sued, get fired, and loose your rep.

is that worth doing someone else's job?

not me.

HEY !!!!!!! If you don't read ANY other POST READ THIS

I also once had a doc who ALWAYS wrote, "resume home medications", as an order. So, like idiots, the nursing staff wrote the orders for the meds that the Rx bottles provided.......most of the time. A nurse before me wrote for Oxycontin 60 mg, 2 tabs everyday. ? 120 mg of oxy? I questioned it, and HARD. Called the pharm to see if that was even a correct dose, or did she mean the total dose was 60mg, and each tab was 30mg? Called the doc, he didn't have a clue... he said 120mg. OK. I clarified the order, as I had called him to make sure 120mg was CORRECT. He said yeah, she had been in bone CA pain for a long time. OK, if that's the case, seems ok..... Well, I gave it. It was written by the doc, AND I clarified it.

Her resp dropped down to 6/min, and her family was kissing her good bye. She was a DNR. She didn't die, but "woke up" days later..........

Well, the order, as by her Rx bottle was 30 mg a day. How that nurse got 120mg ???????????????????????

And the doc was an idiot. He had no clue, nor did care much.

BUT, the nurse who wrote the order, was an idiot as well.

We all went up for a small investigation.

Just leave the medication ordering up to the doctor. If he wants to not have a clue, let HIM/HER write for that much Oxycontin.

The doc did argue that he "never would have prescribed THAT much"

He didn't win cause I clarified the order, but the nurse who wrote it, could have also been held accountable, cause he said "she misinterpreted my original order".

Docs are powerful. Nurses WILL lose their licenses before they do.

And if, by nursing judgement, and obtained knowlegde you feel a dosing is incorrect, DON'T give it without question, and clarification.

I'm not saying not taking an verbal/telephone orders.......

but I think I could have done better by saying, hey doc, how about I give her some Morphine 2-4 mg now, and you come write what you want later....

I don't do it. We have a doc that is notoriously always telling us "just write for it, I'll sign it". He's pretty easy going nice guy and usually orders the same thing when we call like Phenergan is his drug of choice for nausea. A nurse wrote for it and the patient had a reaction and the doc smugly said "I never wrote for that medication". He was kind enough not to make a big deal out of it. He could have made a stink and this nurse could have lost her license.

Don't do it. As was said, it's practicing medicine without a license. Period.

A sure fire remedy to this problem would be to have a list of things nurses can do, and a list of things nurses cannot do according to the BON in each state. When a doctor tells a nurse to "resume previous meds" or "write the order, I'll sign it later"..............hand the doc the paper with the list of things the BON states a nurse can or cannot do........no verbal confrontation necessary. Then, leave it at that. He writes it, or report him to your NM for not writing it. Seems plain and clear to me when done this way. Better than having your license revoked, and losing your job for doing something nurses are not legally allowed to do. :)

Personally I love standing orders and the docs who use them!! :)

Regarding writing the meds after a doc has told you to 'continue home meds'...of course ya'll are right about what can happen. I sure would never consider doing anything like this as an agency nurse in any case!

Sadly, facilities I've worked in frequently allow docs to write 'continue home meds' on their SO's...and browbeat the nurses if they don't keep the docs happy. Good old 'employment at will'...

I don't do it. We have a doc that is notoriously always telling us "just write for it, I'll sign it". He's pretty easy going nice guy and usually orders the same thing when we call like Phenergan is his drug of choice for nausea. A nurse wrote for it and the patient had a reaction and the doc smugly said "I never wrote for that medication". He was kind enough not to make a big deal out of it. He could have made a stink and this nurse could have lost her license.

Don't do it. As was said, it's practicing medicine without a license. Period.

Maybe he does that deliberately, hoping the nurses will write the orders, then if something does happen the nurse is at fault and not him.

Reminds me of the doctors that deliberately yell at the nurses when called so that the nurses won't call them and then if something happens to the patient and the doctor wasn't called it's the nurse's fault and not the doctor's.