I have been a RN for about 5 months now and still have the feeling I am not getting the answer I want (so like always I need to ask!). We have hospitalists and not residents (I guess thats what they are called). I am really not familiar with the term "residents" because we don't have those at our hospital. (So if someone can key me in as to what "residents" do that would be awesome; I do love to gain knowledge )
Anyways the "hospitalists" have standing orders for certain things, does this mean I can just take it without calling them and sign off "telephone order dr......." Since they won't want to be called for tylenol at 4 am? Now I have not been doing this because in nursing school we were always told to call the dr before administering something, but is a standing order different. I had one hospitalist tell me "don't call me, just give the order of novolog if they are on it".....now my license is on the line, and I want to protect my license and my butt!!! That is why I am asking you guys for your advice. I asked my manager and he really didn't help me out. I have seen other nurses just sign it off "telephone order dr....." without calling, but when it comes down to it, I am a very honest person and can't lie about anything. Help!!!!
So please tell me experience nurses what would you do?
My question though is that at the hospital I work at we have standing orders for the hospitalists (a sheet that states meds for bowel, bladder, blood cultures, etc), but they are not put on the chart when they come up. So in order for me to implement for every hospitalist pt, do I need to call the dr. Or can I just implement them since the hospitalists have standing orders?
I am getting both answers yes and no. In the end I guess I will save my rear end and call. Not the first time I have been yelled at lol.
When I first read this thread I thought that your unit may be in need of some clarification re: a true standing order vs. a protocol or known physician preference. But from this last post, it appears that these are truly standing orders that are available to you in printed form. The hang up seems to be that they do not magically appear in front of you and therefore you feel like you don't have an order.
If you know that these sheets of paper exist and what is on them, I'm not sure I understand why you feel that you need to call the doc for an additional order.
Is it expected that when you have a patient admitted to one of the hospitalists that *someone* (unit clerk, you, admissions/registration folks, etc.) will get the sheet that lists the standing orders and then voila - there it is on the chart? This is what you need to ask your supervisor. To continue to call the docs for situations covered in the standing orders will stir up unnecessary bad karma for you.
Is it expected that when you have a patient admitted to one of the hospitalists that *someone* (unit clerk, you, admissions/registration folks, etc.) will get the sheet that lists the standing orders and then voila - there it is on the chart? This is what you need to ask your supervisor. To continue to call the docs for situations covered in the standing orders will stir up unnecessary bad karma for you.
Well said. I don't understand why these orders don't come up with the patient on admission. How are they expected to admit a patient with no orders? And if the orders don't come up, why are they so difficult for the OP to get? How can a nurse possibly do her job under such circumstances. It just doesn't make sense. And then to say her manager was of no help clarifying things.... what the heck does that mean?!
Well said. I don't understand why these orders don't come up with the patient on admission. How are they expected to admit a patient with no orders? And if the orders don't come up, why are they so difficult for the OP to get? How can a nurse possibly do her job under such circumstances. It just doesn't make sense. And then to say her manager was of no help clarifying things.... what the heck does that mean?!
Well, that wasn't quite what I meant. OP has not given any indication, that I can see, that patients are admitted without orders.
OP has discussed her reluctance to implement standing orders for certain typically encountered situations because the orders weren't in black & white right in front of her. But she has now clarified that they do in fact exist in written form, but there is some issue with a piece of paper getting on the chart.
I suspect these papers are in a drawer at the nurses station or at the unit clerk/secretary's area.
Just my , but if I had a situation covered by the standing orders, and I knew what the order was, and that it did exist on paper -- I would implement the order for the patient and find out how to get that pesky piece of paper on the chart. I would not call the doc.
Well, that wasn't quite what I meant. OP has not given any indication, that I can see, that patients are admitted without orders.
OP has discussed her reluctance to implement standing orders for certain typically encountered situations because the orders weren't in black & white right in front of her. But she has now clarified that they do in fact exist in written form, but there is some issue with a piece of paper getting on the chart.
I suspect these papers are in a drawer at the nurses station or at the unit clerk/secretary's area.
Just my , but if I had a situation covered by the standing orders, and I knew what the order was, and that it did exist on paper -- I would implement the order for the patient and find out how to get that pesky piece of paper on the chart. I would not call the doc.
Every place I've ever worked had standing orders come up with the patient along with the regular orders. That's if standing orders were ordered by the physician for that patient. Nurses don't assume that a standing order exists w/o that order from the physician as not all patients are automatically candidates. That's the part I don't understand - that the OP wasn't sure about these orders because she couldn't find them on the chart. Then how did she know standing orders were, in fact, ordered for this patient? I would never call the physician to ask about orders that were never ordered in the first place. It sounds like her hospital is in serious need of some revamping of some best practice guidelines to make that place even remotely safe for nursing practice and patient care.
In order to use 'standing orders' you must have this signed by the MD, either a paper in the chart or EMR. Don't assume that you can use any set of standing orders just because they exist somewhere for some other patient or because there is a form in the secretary's drawer.
I'm glad OP you received some clarification from your manager as all the advice you've gotten has been good but can vary from your facility's practice and land you in deep water.
Do you have any of these protocols you could share? I am trying to get several in place for my organization.
Thank you.
Example: Pt complains of chest pain and/or has a run of v-tach or something of that nature. Per protocol, I can put an order in for a stat EKG for the doctor to sign later. I can also put in an order for sublingual nitro.
) 
, but if I had a situation covered by the standing orders, and I knew what the order was, and that it did exist on paper -- I would implement the order for the patient and find out how to get that pesky piece of paper on the chart. I would not call the doc.
Altra, BSN, RN
6,255 Posts
When I first read this thread I thought that your unit may be in need of some clarification re: a true standing order vs. a protocol or known physician preference. But from this last post, it appears that these are truly standing orders that are available to you in printed form. The hang up seems to be that they do not magically appear in front of you and therefore you feel like you don't have an order.
If you know that these sheets of paper exist and what is on them, I'm not sure I understand why you feel that you need to call the doc for an additional order.
Is it expected that when you have a patient admitted to one of the hospitalists that *someone* (unit clerk, you, admissions/registration folks, etc.) will get the sheet that lists the standing orders and then voila - there it is on the chart? This is what you need to ask your supervisor. To continue to call the docs for situations covered in the standing orders will stir up unnecessary bad karma for you.