nurses writing their own orders

[elizabethaRN]

I have recently started working in a LTC facility (previous experience was in a hospital setting as an RN primary care provider). It seems as if all the nurses here T.O. orders for the patients (LPN and RN alike). I was never specifically told that I was allowed to do this but it seems to be tha accepted practice here. Is is allowed under the nursing practice acts in my state of CT. Please advise. My DNS will not address this issue directly with me. Thank you.

[ayla2004, ASN, RN]

you need an doctor to ok a sample for a lab?

I do it al the time in the UK no order needed just my own iniative depending on what i observe.

[ayla2004, ASN, RN]

You need a doctors order for wound care?

[Virgo_RN, BSN, RN]

you need an doctor to ok a sample for a lab?

I do it al the time in the UK no order needed just my own iniative depending on what i observe.

Yes, labs must be ordered by a physician. Some facilities have protocols that can be signed off by the physician that include labs that can be ordered by the nurse based upon the patient's clinical condition, but again, it is the physician that is ordering the protocol.

[Virgo_RN, BSN, RN]

You need a doctors order for wound care?

Generally speaking, on the inpatient hospital units, you need a doctor's order to sneeze. Protocols are really a blessing, because they reduce the necessity of having to call the doctor for every little thing.

It's a little different in the ED, where there are nurse initiated protocols that have been approved by the Medical Director. There is a list of things that nurses can do without a specific doctor's order, based upon the patient's chief complaint.

[ayla2004, ASN, RN]

Thanks virgo rn

In the Uk in my hospital RN order a certain range of labs C&s of body fluids

various blood test, we use computer ordering.

However wound care espcially pressuer ulcer is seen the preserve of nurses and medic are not involved we have specialist tissue viability nureses to consult.

However dressing for surgical sites are stilll taken down during rounds and abx may be ordered. but what reqiem of dressing is up to the nurse. I will say we don't bill our patients and dressing come out of the ward budget.

[tewdles, RN]

Here in the USA nurses may not prescribe. The scope of nursing practice requires us to work under the "supervision" of a prescribing physician. Having said that, there are many situations where nurses work very closely with medical staff and have protocols which allow the nurse to initiate all sorts of treatment, including some medications without prior notification of the physician. However, the physician must be in agreement with the nurse functioning in this role and there must be a clear understanding, preferrably in writing, of the algorythms that the nurse will follow in the absence of actual MD consultation. This is not a matter of preference but rather a matter of law. Please be aware that IF something untoward were to happen, and there is no previously established agreement, you would NOT be covered! YOUR license would be at risk. I absolutely understand the logistics of working 2nd and 3rd shifts in a variety of settings. Do not let inconvenience jeopardize your livelyhood. If you have taken some liberties with ordering on an off shift, make sure to communicate what was ordered and why to the MD ASAP. Take the time to establish some written guidelines that both you and the physician feel comfortable with, these will create a much safer and more efficient delivery of care.

[ayla2004, ASN, RN]

Wound care dressings in hosptial is not seen as prescrbing this includes lavae and vac therapy initaled by tissue viability nurses.

in the commuinty patients do need a prescrition but the nurse recommds and the doc writes it. However often a nurses will have sone a course and can presribe.

Any other topical application or any other meds treatments need a prescription.

We do not take verbal or telephone oders except in a crsis sistuation and when another nurse can verfiy it. There is too high a risk of a doc saying they didn't order it. In the case of verbel even witha doc i trust i get an presription by putting the drug card under there nose.

[JomoNurse]

Our hospital requires orders for just about anything. I have to call each and every time. But really, no one is going to get in trouble for writing a Nystatin order for a rash. Better watch out, the State Board of Nursing is going to take you doooooooown for that! LOL.