RN_MishMish

Hi! What do we know about verbal/telephone orders 1. Do they need to be co-signed by the practitioner who ordered? 2. What type of orders can or can not be given via verbal order to an RN for signature. examples: standing order for diabetic supplies, eval & treat PT, orders for home health. All orders are either part of a standing orders protocol, or, if not than directly discussed with the provider. The question remains - would you initial or sign on it? Oy... I wish it would have been straight forward. maybe it is Any information is well appreciated, thanks in advance!

Dear classicdame! Thanks for your response. The nursing scope of practice in my state is determined by weather the nurse has been trained to perform the task which has to be a "reasonable and prudent" task to the standard of nursing. The tasks in question are straight forward document review for the purpose of triaging not treating or diagnosing (for example-a pathology report finding - does the patient need to follow up with the doc and within how long), so there is no hands-on or putting a patient at risk. Any finding that is not in the facility's written protocol is discussed directly with the provider. Also, do you know if any type of a nurse signature on verbal or telephone order (on rx refill for example) must be co-signed by the MD? I have discussed the issue with MD and was told co-signing all V.O's defetes the purpose of delegating in the first place when there is a protocol with standing orders. kind-of, sort-of makes sense from the physician's stand point, my problem is I am having difficulty coming up with accurate answers which cover the nursing stand point Thanks again and have a pleasant evening!

I was in a similar situation a few years back as a new grad with no hospital positions available. I took a LTC position and lasted a whole year. Yes you can gain good experience, skills and confidence but the nature of the work in LTC is physically and mentally very demanding... it is a lot of hard work and usually many patients to take care of. My advise-find out about the different LTC in your community-nurses turn over rates, pt to nurse ratio, how long has the administrator/DON are in the position. This type of information is a way to estimate how stable the work environment is which is so important especially at your first job!! Best of luck!!

This may or may not be the right forum to post this question:rolleyes: I'm giving it a try anyway... What would be the best source to contact with specific questions R/T tasks which can and can not be delegated to RN's by a physician in the ambulatory care setting? p.s.- the board of nursing's response is pretty broad - "anything the physician is comfortable with and the RN has been trained to do" Ha! can they be more specific ?? Thank you so much!!

Hang in there!!! you sound so much like me I have to say though, almost 3 months into the job and those "after shock" hours/days after the shifts happen less and less. I used to come home and worry and worry and worry some more, unable to sleep, torturing myself and wondering if all my patients are ok and and remember ALL those little things I forgot to pass in report or forgot to chart on... and yes I have filled an order that I forgot to technically write - so I made a late entry and took care of the documentation the next day. If it is really important I would call the nurse at work and ask her check on what it is I forgot to do or fill her on the info I neglected to mention at report. I can definatly relate to what you are going through, and there is some comfort in knowing most of us are going through similar experiences. It does get better - one day at a time :loveya: I made myself a rule - to leave work at work because there is nothing I can do about it now once my shift is over. It works, most of the time, and if not I leave myself notes to take care of it the next time I'm at work. Funny how we all react so similarly. You are doing wonderful, it sounds SOOOOOOO corney and I was told that a thousand times and still don't always follow but ---- don't beat yourself up, give yourself time to learn.

"How do you get organized?" Like mentioned in another post, knowing your residents, their meds, their needs is a great piece but even if you'll have to be a floater for a while, eventually you will develop YOUR system, and see what works and what doesn't(or what slows you down). My system: After getting report I take 10 minutes to quickly go over the MAR and mark on my list of residents t("the brains")the times of meds of each. I'd also mark on there if I have dsg changes, orders to take care of, skin checks etc. This way I know what needs to be done and when. Than I'll gather my supplies, anything I will need handy on the cart - I'll have ready and available - dressings, syringes, lotions, enteral bags. Anything I know is needed and is not located on the cart - this way I'll save mayself a few trips when it is really busy. The next hour I'll do my rounds - initially visit with and assess the residents. This way everyone is accounted for in terms of what they need for the evening and I have gathered the info to start documentation. I'll try to do most treatments before the big evening med pass. sometimes it works, sometimes I have leftovers for HS but at least I get a head start. And yet, every shift there is something else that takes a big chunk of your time - an admission, a dischargse, a set of new orders from the doc, a resident who is sicker than the usual. There is never a dull moment, as you know. you will eventually find what works the best for you. If management wants you to be successful they will help you find the conditions you grow best in. If this shift doesn't - by no means you are a bad or incapable nurse, you need to find your corner.... Hang it there, it's true what they say you know - it does get better. and if it doesn't after you've tried - it's ok to find something that works better for you Best of luck!

I agree. Stability, knowing your people and getting familiar with their needs and meds will be easier when you are work consistently with the same ressidents. As a floater is it so much more difficult to build up this knowledge because your residents change all the time. Talk to manegement and find out if they can place you on a certain pod rather than have you float at least for a few weeks. Time management takes a while to build up and a changing environment isn't very helpful. Best of luck! :redbeathe

:angryfire so sorry to hear. While I am truly not trying to discourage you usually a reputation of a nursing instructor has a good basis, coming from other students who have been thru the experience of "serving" under this instructor. Yet again, so many people are in the instructor's psotion for the power and control trips they get of it. what a shame what a shame.... yes you can read between the lines I am still bitter about what I have been through, and is sounds similar to what has happened to you. Please don't show fear, that is the worst you can do... poeple like that prey on your fear rather than teach, instruct, support and guide. Get whatever support from your classmates, friends anybody else and show you are in control, don't get intimidated. Yes you can do it, no it is not fair nurses with serious personallity issues are hired as nursing instructors and are given the daily opportunities to terorrize students. If it was a job you have a choice of quitting, as a student you don't. You are greater than this, you have done this before and faced a bad, controlling instructor - you will do it again :redbeathe Best of luck, think positively and you will make it!

Hi AniRN, I totaly agree with you - being a new grad stincks these days, and it wasn't this way only a short 5-6 months ago. I have also been looking in the Denver metro area and found the exact same responses you have....and yes I have heard this type of a situation is common in many areas not just in CO. I had also had 1 job offer at a skilled nursing facility which I have turned down about a month ago and now I regret doing that very much. The point is I didn't think the market is as bad and I thought I'd better wait for a job I am truly excited about. wrong. dead wrong. In this economy I would take anything just to get my foot at the door instead of letting my skills and knowledge become stale. The point is, dear AniRN (I like the name, how did you come up with it??) as frustrating as it is, :angryfire something will open up, even for new grads it is a matter of time. The hard lesson I learned is that this is not a good time to be picky. Even 6 months of experience in any type of nursing will open many more doors. I will give this 6 more months at the most and will consider relocating if won't find a job by then. try to stay positive (I advise and try this atitude myself it's hard, I know) I honestly believe this education and license will come to good work sometime... hang in there :redpinkhe

That sounds like a good floor you are working on... in many places you have to adjust to the 5-6 workload fast. That's great to hear there are hospitals out there which allow newgrads to feel comfortable and build good skills & confidence. Good for you !!

Very good points, thanks for the insight. Is a policy such as provided by NSO cocvers RN's off duty or between jobs as well? what happens if I act as a good sameritan in any public situations and somebody decided to come after my license?

5-6 pt. may be a decent load for an experienced RN and it definatly takes time to build up skills and time management abilities in order to safelt and effectively care for 6 pt. In nursing school, one of the requirements to pass the advanced med-surg course was to handle 5 pt at least once during the shift and it takes time and practice to do that... a good preceptor/clinical manager would be able to identify the areas which hold you back and give specific advice on how to improve in those area. Sure, putting a new grad RN down and making them feel like failures is easy... don't let it get to you. Everybody has a right fit and this med job wasn't yours. pick up the pieces and don't let it get to you!! :redpinkhe

who is your policy carrier? Most responses I read on the subject recommend NSO. Is there anything else out there that is worth checking?

Hello! As a fresh new RN, I was wondering what is your opinion on carrying additional insurance policies beyond what is provided by the employer. What is your take regarding the change in the "good sameritan law" and the obligation of nurses to help strangers while protecting their licenses? I was looking for previous threads on the subjects but couldn't find any. If you know of any please post a link to them. Thank you so very much!