Receiving verbal and telephone orders

[Serotonin2]

Hello, I recently started a new position and have several concerns regarding the way orders are received on the mental health and addictions floor I am working on. I brought my concerns to the director who took them seriously and is trying to initiate change,  but the process has been an uphill battle.  I'm concerned about the following:  1. Nurses giving a med they think the patient needs without getting an order, verbal or otherwise,  before administering and asking for the order after.  (example: a RN gave Ativan without an order because the pt was getting anxious and agitated.  She asked for the order after. ) 2. The behavioral health liasons, who are not nurses, will often receive "orders" from the physician,  and will write "Standards,  CIWA, H, T" on top of our intake form. The nurses will then throw in orders based on this. The problem is. They are selecting other items in the standard order set that aren't preselected,  will use another physicians standard order set rather than the admitting physicians order sets, will assume the doses of the meds even though the only info they received regarding meds were the letters H and T. Basically,  there is rarely communication between the doc and the nurse regarding admission orders, nurses are assuming the doses of the meds without verifying,  and independently selecting other items within the order sets that were not preselected  by the physicians.  The physicians also don't know what is in their own order sets. Some will order "Standards " but they don't have their own standard order set and the standard admission order set has not been standardized. When working with my preceptor,  she became angry that I wanted to talk with the physician first before entering orders. I'm not going to accept the letter "h" as a med order LOL. How do I navigate this?

[JKL33]

Do not take orders that have been received by assistive personnel.

I know it must be incredibly uncomfortable to be exposed to your preceptor's completely inappropriate desires, but you do have to hold your ground on this. "I can't do that. I will need to call the physician." She will get over it. Even if she complains about you, there is no defense for what is going on. In fact my first thought when reading your post was that somebody needs to call the compliance line about this (if they have one), but then you have already reported it appropriately to your superior. This is terrible and unsafe patient care.

There is no reason for this to be an "uphill battle" process for your supervisor. It is putting everyone at risk.

Do what you know is right.  Others' activities are your supervisor's responsibility.

[Serotonin2]

47 minutes ago, JKL33 said:

Do not take orders that have been received by assistive personnel.

I know it must be incredibly uncomfortable to be exposed to your preceptor's completely inappropriate desires, but you do have to hold your ground on this. "I can't do that. I will need to call the physician." She will get over it. Even if she complains about you, there is no defense for what is going on. In fact my first thought when reading your post was that somebody needs to call the compliance line about this (if they have one), but then you have already reported it appropriately to your superior. This is terrible and unsafe patient care.

There is no reason for this to be an "uphill battle" process for your supervisor. It is putting everyone at risk.

Do what you know is right.  Others' activities are your supervisor's responsibility.

Thank you. I do stand my ground but I end up working outside of and around my preceptor. It's super stressful.  All the nurses, and I mean all, are practicing this way. 

[JKL33]

I'm sorry.

Did your supervisor offer support, as in does s/he understand that you won't be practicing this way?

Hang in there. (Or possibly don't hang in there if you have other options...)

[Serotonin2]

47 minutes ago, JKL33 said:

I'm sorry.

Did your supervisor offer support, as in does s/he understand that you won't be practicing this way?

Hang in there. (Or possibly don't hang in there if you have other options...)

My director is very supportive and plans on initiating education for everyone including the physicians.  He's getting push-back too though,  even from the physicians.