Nurses that write their own orders

Okay sterile irrigation costs $40.

Bladder Scan $300 to 600.

What is your choice considering the scan will probably indicate it needs to be irrigated. So another $40.oo

We use a bladder scanner several times a mos. It is floor equipment, just sitting in the clean utility room, and non-chargable. I'm not convinced of how accurate it is for residual after a small void, but it always picks up a FULL bladder.

We use a bladder scanner several times a mos. It is floor equipment, just sitting in the clean utility room, and non-chargable. I'm not convinced of how accurate it is for residual after a small void, but it always picks up a FULL bladder.

we also have a bladder scanner as floor equipment but if the patient is an outpatient you can charge for bladder scanner use x 1. I think ours is pretty accurate when used correctly which ours is hard not to it shows just where the urine is and if you are centered over the bladder or not....but then you also have to output and bladder tenderness to go by a point for good I&O's

Okay..I do remember using one of those in my travel nursing days. I have used one of those in travel nursing,,,, You chec for residual urine with it? Yeah, you check after each void. I bet they do charge for it. If you chart it. I hope they wouldn't charge much though. Well not $300.

well back to writing orders without physician approval - this week rumor has it that my nursing home ADMINSTRATOR did that very thing too for a wound specialist consult - and the physician was not very happy to find out that the specialist had seen his patient without his approval, rumor also had it that the DON was "gonna have to fix that chart" - now whether that is true or not i have no clue, but it seems to me that there is a lot of people that want to overstep their bounds on this type of situation - needless to say, i wont even write an order for protective devices without physician approval, as my facility does not have a policy for that either - if i wanted to be a doctor i would have been smart and gone on to med school, but nursing is my career and has always been - i appreciate reading all the replies on this subject in general, glad to know i am not the only person in the world with this sort of dilemma

I too have run into this with my charge nurses. I have had my license for a year and a couple weeks. If I need something like a laxative or tylenol or even a foley placed and it is not ordered, depending on who the doc is they tell me to just write itt. I will not just write anything. It is not in my scope and when it comes right down to it...if something happens it is my butt not theirs. No doctor is going to stand up in a court of law and say "ohhh I dont mind that nurses write orders for certain things....no its gonna be I did NOT order that. And its gonna be my license and I worked too hard for that.

I dont blame you for not writing orders regardless of who tells you its ok. We finally have a NP that covers for one of our doctors. Its been wonderful having her.

Good luck

well back to writing orders without physician approval - this week rumor has it that my nursing home ADMINSTRATOR did that very thing too for a wound specialist consult - and the physician was not very happy to find out that the specialist had seen his patient without his approval, rumor also had it that the DON was "gonna have to fix that chart" -

*groan*

perhaps an anonymous call to the BON (or to the agcy who licenses your administrator) is in order?

or both?

yeah, many facilities do this.

and it really needs to stop.

if one wants change, do it the right way.

leslie

I think the best thing you can do is get a list of standing orders. The hospital where I used to work had standing orders for each group of doctors that did rounds there. Another thing you could have done when you called the MD the first time with blood in the urine is to ask for irrigation if needed, then you already have the order if you need to use it. Doctors really get mad when the same nurse calls them more than 1 time per shift. They are a little ticky, you know.

Lots of luck

well back to writing orders without physician approval - this week rumor has it that my nursing home ADMINSTRATOR did that very thing too for a wound specialist consult - and the physician was not very happy to find out that the specialist had seen his patient without his approval,

I'm a fairly new RN and I now work in a Medsurg setting. Please set me on the right path here but where I am at "we"- the nurses on the medsurg floor- could write for a consultation for a patients case as the pt's nurse. The consultation- for woundcare, nutrition or PT, etc- would review the pt info with us, pt, chart and/or doc if available and then leave a note in progress notes with recommendations for the physician... who would then choose to write or not write orders based on that info.

My basic question: Is this OK? After reading this thread, I am starting to become a little more paranoid. (As if I weren't paranoid enough as a new nurse...)

I would think it helps the physicians to have other professionals involved in helping with pt care. My rationale follows that I am not "ordering" treatment, medications, etc. My facility also has several admission flags that tell me if pt answers yes to certain questions then to immediately refer the case to the coresponding department (ex: nutrition for tube feedings, wound care for stage 3, etc). None of our docs has ever objected and it seems to be accepted as the norm.

Do other facilities also have these flags and methods?

Thanks!

H

I'm a fairly new RN and I now work in a Medsurg setting. Please set me on the right path here but where I am at "we"- the nurses on the medsurg floor- could write for a consultation for a patients case as the pt's nurse. The consultation- for woundcare, nutrition or PT, etc- would review the pt info with us, pt, chart and/or doc if available and then leave a note in progress notes with recommendations for the physician... who would then choose to write or not write orders based on that info.

My basic question: Is this OK? After reading this thread, I am starting to become a little more paranoid. (As if I weren't paranoid enough as a new nurse...)

I would think it helps the physicians to have other professionals involved in helping with pt care. My rationale follows that I am not "ordering" treatment, medications, etc. My facility also has several admission flags that tell me if pt answers yes to certain questions then to immediately refer the case to the coresponding department (ex: nutrition for tube feedings, wound care for stage 3, etc). None of our docs has ever objected and it seems to be accepted as the norm.

Do other facilities also have these flags and methods?

Thanks!

H

It has to be incorporated into the facility's policy and procedures in order for them to bill for the NURSING consult. The consult and recommendations to the doctor are fine because you are not prescribing medical treatments: you are evaluating and addressing the pt.s needs FOR the physician. You are leaving the actual ordering to him.

I'm a fairly new RN and I now work in a Medsurg setting. Please set me on the right path here but where I am at "we"- the nurses on the medsurg floor- could write for a consultation for a patients case as the pt's nurse. The consultation- for woundcare, nutrition or PT, etc- would review the pt info with us, pt, chart and/or doc if available and then leave a note in progress notes with recommendations for the physician... who would then choose to write or not write orders based on that info.

My basic question: Is this OK? After reading this thread, I am starting to become a little more paranoid. (As if I weren't paranoid enough as a new nurse...)

JACHO has encouraged certain types of NUSING ORDERS. These facilitate pt care. When the initial assessments asks questions regarding home safety,possible discharge needs,etc... then a social service consult can be ordered by nursing. If flags are raised at admission or during pt stay on nutrition,a consult can be ordered,they make recommendations and then the doc needs to order. PT evaluations are usually needed for ROM,transfer help,post op needs,etc,, this can also be iniciated by the nurse with follow up orders by the doc. It is all in documentation and the admission paperwork. Follow ur facilties policies and u will be fine.

The op and above are talking more about procedures,meds,etc,,, that sometimes are ordered by nursing when it is not covered under our licence or scope of practice.

Take a look at the P&P at your facility. It should spell out what kinds of things would qualify as an NCO, nursing care order. At my hospital, I can order throat lozenges, a bilirubin level, or a change in meds from tablets to liquid form, among other things, without obtaining an MD order. As long as I stick to the "menu," I'm covered.

Hi everyone. This is my first time responding. I just started in a small ICU and during my orientation, my preceptor told me he just writes the order and tells the resident that they just wrote for a renewal of a med or a med for this or what ever. I told him that I didn't feel comfortable doing this and don't expect me to!! I explained that it was not in our scope of practice to do this and I wasn't going to jeapordise my license. He may of not liked my attitude but I'm ok with that. If I am uneasy about doing something then I ask or look it up in the hospital protocals and procedures. When residents give orders I hand them the chart and ask them to write it. Its call covering your butt.

I have been yelled at by Doctors so many times for calling them but thats ok, because the first time you don't and something goes wrong your going to get the blame for not calling!! And when you do call them make sure you DOCUMENT IT!

As far as the foley goes you never did say why the patient had the foley. Were they simply I/O, post op, Bladder CA ect... ? Whatever the reason if you are uncomfortable with something be safe and call!