Office/On Call LPN giving orders

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Specializes in Neonatal ICU, Pediatrics, ER, LTC.

I am the Director of Nursing in Illinois at a LTC facility. We have a problem with a Doctor who has a LPN on call for him at night. When the nurses call to get orders for high glucoses, falls, etc, the LPN is giving orders. Some of these orders are very inappropriate and the nurses are having to contact our medical director for further orders.

I don't think that we should ever accept an order from a LPN or RN on call for a MD. The Doctor states that they have a protocol, but I don't feel as if it right for a nurse to give a nurse an order, even off of a protocol. If we adopted the orders as standing orders with strict criteria, then the nurse would not be giving orders.

I am having difficulty finding a regulation in the federal/state regs or in the Nurse Practice Act. Any help I can get is appreciated!

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Specializes in Nephrology, Cardiology, ER, ICU.

I too live in IL and doubt that RNs can take orders from LPNs. This MD is in serious hot water over allowing this to occur. Found this at the IDPH site:

"Communicating and collaborating with other

health care professionals as delegated."

http://ilga.gov/legislation/ilcs/ilcs4.asp?DocName=022500650HArt%2E+55&ActID=1312&ChapAct=225%A0ILCS%A065%2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&SectionID=75382&SeqStart=14800000&SeqEnd=15600000&ActName=Nurse+Practice+Act%2E

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Specializes in Psych, M/S, Ortho, Float..

I ran into the same situation here once. I defaulted to my "when in doubt ship them out" stand. And dealt with the doctor who was too busy to answer the phone the next day. I will not take an order from a receptionist even if she tells me that that is what the doctor has said to do. I need to let the doctor understand the situation and to help me go through what is happening with them. I will make the call to sent them out, with family consent. I'm in a different country, but it all boils down to the chain of command, and goes ripping through my licence. I would call the family and explain the situation and take it from there. If they don't want their relative to go to the hospital, then we would do what we can to stabalize them over night and call the Doc in the AM. We have medical directives to cover most eventualities and so we can use our own judgement for most things. But it is sometimes the PT or RT that try to order stuff. The new staff get caught off guard with these orders. They will get them sorted out eventually, but it does cause some discontent all around...

I would have serious issues with a non-doctor giving me verbal orders based on projected medical problems. Just seems like a cop out of on call procedure.

I hope you get this figured out. I would be very upset and annoyed at this situation. To say the least. Residents are at risk, especially if it is serious enough to want to call the on-call in the first place. RNs should not have to deal with this kind of ambiguity of authority.

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Specializes in Onco, palliative care, PCU, HH, hospice.

How can this possibly be legal? Since the person giving you orders is not an APRN, PA, or MD then I would think that following through with the orders puts the staff nurse at risk as well.

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Specializes in LTAC, Med/Surg..

Hey Trauma - I hate to say this because I'm NOT trying to turn this into another awful old LPN/RN thing, and i'm sure you weren't either - but isn't it irrelevant that the nurse issuing the order was an LPN? I don't see how it would be any more appropriate if it were an RN - the bottom line is that it's not an MD, PA, or APN. Right? Have I missed something?

I too live in IL and doubt that RNs can take orders from LPNs. This MD is in serious hot water over allowing this to occur. Found this at the IDPH site:

"Communicating and collaborating with other

health care professionals as delegated."

http://ilga.gov/legislation/ilcs/ilcs4.asp?DocName=022500650HArt%2E+55&ActID=1312&ChapAct=225%A0ILCS%A065%2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&SectionID=75382&SeqStart=14800000&SeqEnd=15600000&ActName=Nurse+Practice+Act%2E

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Specializes in Nephrology, Cardiology, ER, ICU.

I addressed the issue as an LPN issuing orders because that is what the OP stated, nothing more. If she had said it was a receptionist or RN giving the orders, I would have tried to find something germaine to that topic.

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Specializes in LTAC, Med/Surg..
I addressed the issue as an LPN issuing orders because that is what the OP stated, nothing more. If she had said it was a receptionist or RN giving the orders, I would have tried to find something germaine to that topic.

Well sure - wasn't implying that you were trying to do anything but that. :)

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Specializes in Gerontological, cardiac, med-surg, peds.
How can this possibly be legal? Since the person giving you orders is not an APRN, PA, or MD then I would think that following through with the orders puts the staff nurse at risk as well.

Encountered a similar situation in a large teaching hospital, in which some cardiac doctors were using their private office RN's to write admitting orders and do rounds on their patients in the hospitals. These RNs were not advance practice and did not have prescriptive authority, so were operating out of their scope. This dubious practice put everyone at risk - the nurses taking the orders, the RNs giving the orders, and, most importantly, the patients.

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Specializes in Med/Surg.

I don't know IL law, but maybe she's just reading off orders he signed off on and has approveD?

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Specializes in Neonatal ICU, Pediatrics, ER, LTC.

You've all been very helpful. The website provided was great!

A reply about the LPN/RN thing. It does make a difference by state law. A LPN can never supervise or delegate to a RN. You cannot delegate up-- only down. Illinois state law states that a LPN can only work under the direction of a RN or physician.

As far as the LPN working off of something the doctor signed -- it is true the doctor has signed it. The problem is that the nurse is giving the order NOT the doctor. The order that was given to my RN was completely inappropriate and had the order been followed, the resident would have gone into diabetic shock.

I really don't feel as if we should accept a verbal/telephone order from anyone other than the doctor.

Thanks everyone for your help!

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Specializes in LTAC, Med/Surg..

I really don't feel as if we should accept a verbal/telephone order from anyone other than the doctor.

My point exactly. I don't care what role you are in, I'm not following an order if it's out of your scope - as it wou be for ANY nurse without an advanced practice credential, LPN or RN notwithstanding. I don't particularly care if by law an RN is able to delegate to me as an LPN - in this case the delgation would be beyond his or her scope and I would be obligated to question and/or refuse that delegation.

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Specializes in Med-surg; OB/Well baby; pulmonology; RTS.

We have a problem with calling doctor's offices and their nurses wanting to give us orders. If I had a dollar for every time they tried to give me an order and I told them it is against our hospital policy (as well as the BON), I would be rich. They get really mad about it too. Oh well, it is my license, not theirs.

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