ordered to sign orders for previous 24 hours...for someone else

student987 · Jul 21, 2012

Do you mean you are being told to sign off that something was done (e.g. a med given or a dressing changed) or that orders are received?

I would think if it is the first NO if it is the second I do not see a problem with it but I only just graduated nursing school so may be missing something (saw it being done nurses who did not take to order signing off that they were received so i dont think it is an issue)

TheCommuter, BSN, RN · Jul 21, 2012

I would not sign for anyone else, especially if I was not in the building at the time the order was initially written.

I also wonder why your manager will not sign any 'unsigned' orders. After all, she's the one who is concerned, so why will she not 'woman up' and sign them? There's a good reason she's turfing this task off onto you.

brownbook · Jul 21, 2012

Doesn't sound right to me. We did 24 hour chart checks on the 11 pm to 7 am shift to confirm that orders had been carried out, and signed off that we had done so. If an order was not signed we left a note for the nurse taking care of that patient when the order was written to sign off the order.

Do-over, ASN, RN · Jul 21, 2012

I sign orders that are unsigned - I either verify that they were completed / carried out, or I take care of them myself. To me, this is what "signing off" on an order means. I am not sure what the issue would be with doing so. the only time I wouldn't sign is if I didn't agree or couldn't confirm that it had been/hadn't been done. In those cases I call the doc and clarify (then, instead of signing the original order I can write "see clarification order").

I don't agree with leaving the order until that nurse returns - the orders need to be carried out - unsigned usually means not complete where I am.

Of course, ideally, they are addressed and signed off at or near them time they are written.

NicuGal, MSN, RN · Jul 21, 2012

We always went back thru the chart with the off going nurse to make sure she had all the orders checked off. Is this something you do?

hopesgramcracker · Jul 21, 2012

Oh sorry student987, I meant orders that were written/received, I would never sign off for a med given or dressing change for someone else.

hopesgramcracker · Jul 21, 2012

NicuGal, we don't go throught the orders at change of shift, we just give report and do bedside rounds, but my last shift (the same day the manager told me this) I had charts with me and went over some of the orders with the oncoming nurse. I think from now on I will do this to protect my self. I think the problem on my floor is that we are over loaded with pts, and are overwhelmed and in all humaness we overlook things. Sometimes I wonder if I am cut out for nursing and how do other nurses overcome this without cutting corners?

KelRN215, BSN, RN · Jul 21, 2012

The orders are still valid on your time even though they were written on the previous shift. If an order is written for stat labs or a chest xray or whatever on the day shift and isn't signed off, then it hasn't been carried out. Those orders still need to be carried out. I don't understand why you would leave them there and not sign them even if you saw them. Signing off on an order means "I see this order and I acknowledge that I need to carry this out." I've had it happen many times that orders were missed on previous shifts and I would always sign off on them if it was something that the patient needed that would be my responsibility. Examples: labs that were ordered but never signed off, Chest Xrays/CAT scans/MRIs, meds that the patient needs etc. I did not sign off on orders that were meant for someone else... examples: orders for the OR (the surgeons always put them in the day before surgery) and orders for radiology (sedation and/or IV contrast).

hopesgramcracker · Jul 21, 2012

The orders are still valid on your time even though they were written on the previous shift. If an order is written for stat labs or a chest xray or whatever on the day shift and isn't signed off, then it hasn't been carried out. Those orders still need to be carried out. I don't understand why you would leave them there and not sign them even if you saw them.

KelRn215, Just to clarify, when an order is placed, our HUC inputs it into the system if its a lab, x-ray,ct, u/s or faxes the order to pharmacy if its a med then it goes on the MAR, I never said that the orders did not get carried out or that I would not carry it out, my concern is with signing for it, as I stated before I was taught in school that you do not sign anything you were not there for. I am new to the hospital setting and have been an LPN for 2 years and just looking for clarification not assumptions. The facility I worked for prior to the hospital setting I really did not see this problem.

KelRN215, BSN, RN · Jul 21, 2012

Give me an example of the kind of order you don't want to sign. I'm not really following what your issue is. When I worked in the hospital, when orders were on paper, the night shift did "24 hr checks" to make sure that no orders were missed. If there were unsigned orders, the night shift signed them off. It was also expected that one of the first things you did when you came on was to look at your orders to see if there was anything that needed to be signed. Once we were on the computer with everything, orders were supposed to be reviewed as they were entered. It did sometimes happen that an order was missed because you were so busy that you didn't look at the computer for hours. If that happened on a day shift and the night shift came in and saw the order, yes I would expect them to sign off on it and that's exactly what I would do when I found unsigned orders. If you say you don't have an issue carrying the order out, I don't understand why you'd have a problem signing it off. If the order was written at 2pm, but it's not signed off at 8pm, when you sign it you note that so it doesn't look like you were signing off orders when you weren't there.

hopesgramcracker · Jul 21, 2012

I was never told about a "24 hour check" in school or when I had my two weeks of training so it's new to me. I work days so maybe our midnight shift does it. It's not often I see unsigned orders from the previous shift or past 24 hours but it does happen. My issue is if it is legal or not for me to sign even if I date it as the day that I am there and not back dating it. Does that help you understand a little better?