Ordering meds as ordered by doc

[Guest1141053]

So, I am fresh off orientation (5th day, week 3) and keep feeling like I am messing up every other day. The issue that is bothering me now is ordering meds for my doc. At my hospital, nurses are able to order meds as long as we are able to put in the docs name who gave the order. Albeit we cannot do any orders at all without a docs name.

Patient's creatinine was high so I called and was told via phone to replace the electrolytes that were low. For example, the potassium was 2.9 and the doc said to give 40 mEq of potassium. Two other electrolytes were low and the doc told me to put in orders to replace those as well. I asked the doc to input the orders herself but she told me to do it since she was in another chart. I documented that the doc had instructed me to do via phone order.

I was able to hang the potassium and one other electrolyte just before shift change. After I gave report and was leaving, I remembered one more thing to tell the oncoming nurse who took my patient. She informed me that the day team called her and said that with patients with creatinine that high that the docs are the ones who put in the orders.

Now I am freaking out because I feel scared that I strayed outside scope of practice. IDK. Putting in med orders for docs is something we do on my unit but now I feel like I should have not done so. What is your take?

[chare]

2 hours ago, Newbienurse said:

... At my hospital, nurses are able to order meds as long as we are able to put in the docs name who gave the order. Albeit we cannot do any orders at all without a docs name.

[...]

This would not be accepted at my facility. By policy, physicians are expected to place their own orders. The only exception is in an emergency setting, and even then this would be a rarity.

Quote

[...]

... I asked the doc to input the orders herself but she told me to do it since she was in another chart. I documented that the doc had instructed me to do via phone order.

[...]

This is not an acceptable reason for her not to enter the order herself. When I speak to the physician regarding orders I make it a point to tell her or him that I will hang the med, discontinue the catheter, etc. after they enter the order.

2 hours ago, Newbienurse said:

Now I am freaking out because I feel scared that I strayed outside scope of practice. IDK. Putting in med orders for docs is something we do on my unit but now I feel like I should have not done so. What is your take?

What does your facility's policies on physician order entry provide for taking a telephone order? If there are no restrictions then you should be fine; if the physician signed the orders. If this is specific to your unit then this should be addressed in unit specific practice guideline.

Best wishes.

[JKL33]

I agree with the above, this is not acceptable as a matter of routine in a lot of places now.

On 5/22/2020 at 9:41 AM, Guest1141053 said:

At my hospital, nurses are able to order meds as long as we are able to put in the docs name who gave the order. Albeit we cannot do any orders at all without a docs name.

The thing you need to do pronto is look up and review your facility's policies regarding verbal/telephone orders rather than going by word-of-mouth from coworkers at this point. I can't stress this enough. Your place sounds like it might be a little bit behind in its expectations with regard to this, and with your coworkers telling you arbitrary things like "with patients with creatinine that high that the docs are the ones who put in the orders," you must know what the actual policies are. I can't stress this enough.

When you are newer you have to rely somewhat on guidance from more experienced coworkers, but you lack the honed nursing judgment to understand which coworkers are knowledgeable and reliable sources of advice. You can get in over your head quickly and make serious mistakes by taking everything coworkers say as truth/reasonable. Compare everything you are told to the basic principles you were taught, and consult the policies.

I agree with @chare - being in another chart is no excuse for not entering one's own orders whenever possible. Unfortunately plenty of people are going to see how far they can push you/how much of their work they can get you to do for them. This is worse for newer nurses because they sometimes don't know any better (no fault of their own).

When you know what your policies actually are, you will be able to respond in a pleasantly assertive manner.