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Discussion

Scope of RN license

There is a nurse who works in a nephrologist's office. Every time I call (from a dialysis unit) the nephrologist to notify about the patient's condition or to ask for orders, this nurse at the office demands to know the details about the patient first and then starts giving the order. There have been multiple incidents, this is among one of them-

I called the office because one of my patient's dialysis access (CVC) was infected, and I needed to notify the doctor. The office nurse initially asked so many questions about this patient which is none of her business, and then starts giving the order- Draw blood for culture, I will look the dose and will call you back with vancomycin order". I said," Mam, I need to speak to the nephrologist, and I don't accept orders from an RN". she demanded to talk to the charge nurse, and in response I told her that I was the charge nurse and was refusing to take orders from her. I know many nurses take orders from her, the nephrologist doesn't have any clue of what is going on with the patient. She reluctantly said, "Well then you will have to wait, I will let him know when he comes". I requested her to page the MD for me, and finally got to speak to him.

I have also noticed that she's been signing many orders for the MD. I haven't seen it with my eyes, but am sure it is not the MD's signature.

At one point, I was even thinking of reporting her actions to the BON, but I don't have any solid document or record. These are just telephone conversations....

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The doctor has probably given her protocol orders to give you over the phone to prevent himself from being interrupted so frequently.(not just by you but by everyone since HD patienst are notoriously noncompliant and the doc likely receives calls nonstop)

Whether your state allows this or not is another matter. You can report it but you will need more than just your suspicions. And unless you are willing to report it and sign your name, anonymous complaints are not given the same weight.

  • Experts

Is there an APN in this practice? If there are written protocols then you should be given a copy so that you can follow per protocol. I too wouldn't take orders from another RN. How are you documenting these orders? "Verbal order of Jane Doe, RN," or "Verbal order of Dr Joe Blow?" That will make a huge difference too.

  • Author
Is there an APN in this pran practice? If there are written protocols then you should be given a copy so that you can follow per protocol. I too wouldn't take orders from another RN. How are you documenting these orders? "Verbal order of Jane Doe, RN," or "Verbal order of Dr Joe Blow?" That will make a huge difference too.

There is no NP here. This nurse is an RN just like me. We are not aware of the written protocal that allows this nurse to give orders.

I have been refusing to take order from this nurse, therefore, I don't have to write "Verbal order Dr. So and So or RN Mary etc". If I transcribe the verbal order, it will directly come from the physician.

Illinois doesn't allow an RN to make medical decisions (I am talking about medical decisions like prescribing meds etc), and I just don't think it is appropriate for me to be taking order from another RN.

I spoke to my manager about it, and she told me that she will have conversation with the nephrologist and then they will figure out something.

that's interesting I would like to know the outcome of this.

  • Experts

I too live in IL and you are so right that this is not in the scope of practice here. The nephrologist needs to make some changes in his practice.

I got an email from my FA a few wks back stating that "Dr. Smith" wants me to give pt X vanco. The FA got a wound culture result off the fax machine on a day that we weren't open. He called and notified the MD and took the order.... He is a MSW, not RN. I let him know that I couldnt take that order... he was quite mad, but oh well.

  • Experts

Yep - you did the right thing.

  • Author
I got an email from my FA a few wks back stating that "Dr. Smith" wants me to give pt X vanco. The FA got a wound culture result off the fax machine on a day that we weren't open. He called and notified the MD and took the order.... He is a MSW, not RN. I let him know that I couldnt take that order... he was quite mad, but oh well.

BTW what does FA stand for?

I always wonder why these people love to do something that is beyond their scope. I wish they were just good enough to do the job they are supposed to, and leave others alone.

  • Experts

FA - facility administrator.

I am having the same problem, but my administrator says I should take the order. I still refuse. Also, if these are written protocols, I think the protocol should become part of the chart. The doc then has a certain amount of time to sign off, usually 24 hours. Bravo to you! You are doing the right thing by not taken these orders from this RN in my opinion. BTW, does anyone know where this is in the Virginia Nurse Practice act?

I am having the same problem, but my administrator says I should take the order. I still refuse. Also, if these are written protocols, I think the protocol should become part of the chart. The doc then has a certain amount of time to sign off, usually 24 hours. Bravo to you! You are doing the right thing by not taken these orders from this RN in my opinion. BTW, does anyone know where this is in the Virginia Nurse Practice act?

Your Board of Nursing should be able to provide the page, etc., that the information is on in the Nursing Practice Act. I find it interesting about taking orders from another RN. Scenerio: What if that RN did not give you the correct order that the nephrologist gave her? It still falls back on you for you, or whoever, carried out the order. RenalRuth :nurse:

This is one of the very reasons I left my previous dialysis job. Too many chiefs and not enough indians so to speak. The FA would give a verbal order for antibiotics etc and expect me to follow it. I refused as I dont take verbal orders from another nurse. If the nephrologist gives me a verbal or telephone order in the unit I am now the DON at I go write the order myself not give another verbal to the other nurse and expect her to follow it. What if he/she mistakens the order and follows something not intended and causes harm? Then it's thier tail on the line. What if I screw up and didnt get it right, then it's still his/her tail on the line for following it. No way and if you check I can bet you no matter what state you are in, it is not legal to follow another nurses verbals orders, short of it being the NP who is affliated with that particular Nephrologist with practicing priviledges. I also dont accept orders from any other doctor not on our clinic list with priviledges. This includes thier primary doctor or any other consulting MD.

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