Writing order and having Dr sign later..your thoughts?

elkpark · Jul 6, 2018

The more calls you make at $150 a shot, the more likely management pushes for reasonable protocols.

This was my thought, as well -- if the nurses start making $150 telephone calls because the regular physician overlooked something, management is either going to develop some standing orders/protocols or get after the regular physician to start being more thorough. Either way, problem solved! :)

For those who say they are comfortable writing "orders" if they know the physician and are comfortable with her/him, what if something goes wrong? I've known a lot of physicians over the years, some of them v. well, but I haven't known any physician that I would trust to take a fall to cover for me if something went sideways at work.

JKL33 · Jul 6, 2018

I'm asking because I also work at a LTC facility and I see nurses do this all the time and was just confused and wonder how many nurses actually do it.

This is where people go wrong though. You have been educated about the issue you're asking about, so why look to others' wrong behavior for guidance or look for a way to justify not following basic principles.

I understand it can be difficult to know which "adjustments in practice" are reasonable and which are absolute "NO"s - but you can start by picturing how you would justify your actions if something were to go wrong.

I would sure hate to have to explain that I did the wrong thing because of convenience, money, patient demand, or "we aren't allowed to do it [the right way]," "my charge nurse told me to," "my director said it would be okay," "the doctor gets angry if we call" etc., etc. These excuses (and many more) will all sound very ridiculous.

So. I think you have the tools to figure out things like this, and there will be more. We were all taught to do what a reasonably prudent nurse would do when a decision has to be made. This becomes a problem when one doesn't know exactly what a prudent nurse would do in a given situation, so sometimes it's better to think about what s/he would not do: illegal, immoral/unethical, violate a patient's rights, etc.

Doing something that is technically illegal vs. spending $150 of the company's money. It's pretty easy to guess which of these is considered the reasonably prudent action.

Jedrnurse, BSN, RN · Jul 6, 2018

If it's $150 a call, how much to text...? :eek:

Patient Safety Columnist / Educator · Jul 6, 2018

Do you think its dumb to call the Dr about this after hours?
.

You are an amazing person for trying to help your company "save money" - but please, I am begging you, don't put your license at risk! As others have said - that is what the on-call is for! You have to have an order. YOU HAVE TO HAVE AN ORDER!!! :) Think of all the money they will lose if the patient is harmed and sues the facility? How about the monetary value of you losing your license?

NurseBlaq · Jul 6, 2018

If the MD didn't say it, there's no order to write. Don't care how much it'll cost the facility, speak to the person who's going to have to sign that order. Protect your license, not the facility.

Kooky Korky, BSN, RN · Jul 7, 2018

The fact that you are asking must mean that this is a practice where you work. But, as you know, there are rules against making stuff up. So, no, it is not OK to just fabricate an order. (You must already know this.) The fact that nurses actually do this is what keeps the docs and management from creating a protocol that would allow you to take certain actions.
The more calls you make at $150 a shot, the more likely management pushes for reasonable protocols.

And the more they should push to get the doctor to get herself in gear in the first place. It is one of my biggest peeves that doctors just so often do not write the necessary orders without prompts from the nurses.

kbrn2002, ADN, RN · Jul 8, 2018

It depends on the provider and the order I guess. I would never write an order for a med and expect a provider to sign off on it unless it's a med covered in our standing orders that just needs to be activated. I would and have written orders for therapy to eval and treat but our rounding provider has made it clear that is OK to do. Not all providers would be ok with that though, so before you start writing an order just to avoid calling an on-call provider it should be very clear that the primary MD is going to be OK with it. I don't get why you would avoid calling the on-call provider though, after all it's not like any money you save the facility is going in your pocket.

_firefly, BSN, RN, EMT-B · Jul 8, 2018

From my own experience I have called every time. If it can wait for either the next batched call or more reasonable hours, etc then I make a note and wait. I know some nurses have that pre-established relationship with docs and play that game, but they are typically also the very experienced nurses and are putting in low risk orders. I personally think this is enabling poor order writing and/ or a broken order set or ordering system. Never trade money for safety.

Kooky Korky, BSN, RN · Aug 8, 2018

Normally that's completely reasonable to not be OK with that, but if you're charging $150 per call then I don't think you can really complain when someone avoids making a call.

You have got to be kidding, Muno. I can hardly believe you are encouraging this new nurse to care about saving the employer money by lying.

OP - NEVER and I mean NEVER follow the herd when you know full good and well that what they are doing is illegal. That is NEVER. Envision NEVER in Bold, font 490, neon lights.