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Taking orders from a medical student

Friend of mine who is an RN on a hospitalist service complained to me the other day. A med student who is on their service came up to her and asked her if she could check an orthostatic BP and give a patient a dose of a new antibiotic (apparently the attending had already talked with the med student and approved it). She got pissed, stating that med students have no role "ordering" nurses to do anything and that only the head attending doctor can do that.

HOw do you guys feel about that? Obviously if the med student is rude or whatever thats a totally different story, but I told her that as long as the med student is not making an unreasonable request or yelling/barking at her then I think its part of the job.

P_RN specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Unless the "med student" has MD, or DO or NP after his name NO WAY can she honor his order. It's up to the attending to make sure the student's orders are cosigned immediately. Now if the nurse is really nice and really gullible sometimes she can call the attending and get a verbal/phone order. If it's stat MAYBE it's ok. But if it's Stat shouldn't the attending be there anyway?

DR yes, NP yes MS NO NO NO NO NO

Friend of mine who is an RN on a hospitalist service complained to me the other day. A med student who is on their service came up to her and asked her if she could check an orthostatic BP and give a patient a dose of a new antibiotic (apparently the attending had already talked with the med student and approved it). She got pissed, stating that med students have no role "ordering" nurses to do anything and that only the head attending doctor can do that.

HOw do you guys feel about that? Obviously if the med student is rude or whatever thats a totally different story, but I told her that as long as the med student is not making an unreasonable request or yelling/barking at her then I think its part of the job.

I don't give any med that isn't prescribed by someone authorized to write prescriptions, be it an MD, NP, or whatever. Since when can a student prescribe??

Creamsoda specializes in ICU.

The rule at my hospital is...if they have a short lab coat...they cant write orders. If they have a long coat they can. Theres only a few residents on our unit anyway, and we all know who they are and we for the most part trust them, and they write orders all the time.

Cher

jmgrn65 specializes in cardiac/critical care/ informatics.

med students can't write orders! Therefore can't give orders!

Let me clarify. They use a computer order entry system, where the med student enters orders and its approved by the attending. The order for new abx was already approved and in the system, they ordered a stat dose. The med student was not giving a verbal order, he was telling them baout he change in abx and letting them know that it was a stat order.

Was it already approved by the attending? If yes, then what's the problem? He was letting you know of a change in orders.

Friend of mine who is an RN on a hospitalist service complained to me the other day. A med student who is on their service came up to her and asked her if she could check an orthostatic BP and give a patient a dose of a new antibiotic (apparently the attending had already talked with the med student and approved it). She got pissed, stating that med students have no role "ordering" nurses to do anything and that only the head attending doctor can do that.

HOw do you guys feel about that? Obviously if the med student is rude or whatever thats a totally different story, but I told her that as long as the med student is not making an unreasonable request or yelling/barking at her then I think its part of the job.

It is definitely not part of the job. Medical students do not have the authority to order anything, verbal, written or otherwise. The order is not valid unless and until it is cosigned by someone with the authority to do so (MD, NP, etc). I would certainly not take some medical student's word that the attending had already approved the order. What if the attending comes back later and states that he/she never approved the order? Would the nurse having given the med have a leg to stand on? Nope. It is the nurse's responsiblity to know who can and cannot write orders and to make sure that orders are valid before they are carried out.

MrChicagoRN specializes in Leadership, Psych, HomeCare, Amb. Care.

Was it already approved by the attending? If yes, then what's the problem? He was letting you know of a change in orders.

Right.

If it was electronically approved/signed off by the attending, the med student isn't giving the order, merely informing you of the attending's orders.

If it was..."I talked to the attending, and he said to give it." then that's an entirely different story. Hearsay orders conveyed through unlicensed personnel is never legal.

Dalzac specializes in CCU,ICU,ER retired.

If I was concerned I would have called his boss intern of resident, or I would call the attending and check with him.

chuck1234 specializes in Nurses who are mentally sicked.

Just tell him that you cannot take the verbal order from him.

And tell him that the order has be written in the MD order form and it has to be co-signed by an M.D.

loricatus specializes in ED, ICU, PACU.

Had this happen quite a few times. Sometimes the med student asks the nurse to do something because they have no idea how to do it and needs to observe in order to learn. So, when they ask for, let's say, orthostatics--I will escort them to the patient, point out the equipment and then ask if they need some assistance or are they OK on their own. If the student admits they don't know what they are doing, I will go out of my way to show them how to do it (including IV starts and blood draws). If they don't, I just leave them alone to figure it out. As for the Rx change, I would thank them for the info and verify the change myself.

swartzrn specializes in CCU/CVICU, Hemodialysis, ER, PALS Inst..

We have different gamet of students come through our ER. We not only have the occasional med student, we have PA students and also some 18D students (special forces medics.) They stick the 18D's with a PA or doc and therefore they sometimes think they can order the nurse's around. It irritates me sometimes b/c some of them can be a little arrogant about the whole thing but for the most part they are pretty cool--with that said, under no circumstances will I take an order like that from one of the students. They cannot give orders, therefore I do not FOLLOW OUT any orders they give. If the order is written and signed off by the preceptor they have who is a licensed provider, that's well and good. Everyone has to learn and there's no better way than a clinical setting but you just have to remember that they are students. I had a PA student one time worrying about giving Tylenol when the patient had a widening pulse pressure. We were both standing in the room and I was pointing it out to her and she was still harping on the Tylenol. I hadn't given the Tylenol b/c she was not licensed to order even Tylenol. I just went and got the PA she was working with and the widening pulse pressure got addressed appropriately. Case in point--they are students. They are there to learn. In that case, the PA had not ordered the Tylenol therefore I didn't give it!

jen123321 specializes in SICU; Just accepted to CRNA school!.

I think some people are getting confused between med students and residents...they are two different things. Med students cannot write orders, residents can.

If it was already approved and signed by a licensed MD, fine. Otherwise, no.

I wonder why your friend got angry.

Let me clarify. They use a computer order entry system, where the med student enters orders and its approved by the attending. The order for new abx was already approved and in the system, they ordered a stat dose. The med student was not giving a verbal order, he was telling them baout he change in abx and letting them know that it was a stat order.

But funny thing is that you left out key points, such as there was already a written order from a physician for this. You stated in your above post, that the nurse was given an order by the medical student. And failed to continue on. Medcial students cannot give orders, and that is what you wrote.

Faciliites has programs in place for stat orders in the first place. Even the order is stat, the ABX still needs to come from the pharmacy.

A med student who is on their service came up to her and asked her if she could check an orthostatic BP and give a patient a dose of a new antibiotic (apparently the attending had already talked with the med student and approved it).

I seem to have missed something in this statement. You say the med student "asked her..."

That is a question. Two answers to that one. Yes and no. She can give either.

Next you state that, "apparently the attending had already talked with the med student and approved it."

If the attending approved it, who is above him? Could your friend have gone to HIS boss? If he is the "last word", and your friend is still apprehensive about the med student doing this, she should document it in no ambiguous terms that she was against it.

However, (get your flamethrowers ready) IF the attending DID okay this, there is not much your friend can do...nurses are NOT doctors.

Just tell him that you cannot take the verbal order from him.

And tell him that the order has be written in the MD order form and it has to be co-signed by an M.D.

This is the route I would take if I was uncomfortable with the med student's request, or if I felt he had no authority to do it. This way, you CYA while protecting the patient and hospital to the best of your knowledge.

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