This is EXACTLY why I don't like taking Verbal orders

txredheadnurse, BSN, RN · Jul 7, 2012

Most facilities have a policy against taking verbal orders. If that is the case where you work the only quick comeback you need is that taking a verbal order is against policy. If the doc refuses to comply with policy then you take it up the chain of command and let the nurse manager, medical director, fill in the blank deal with the non compliant doctor. IMO it is best to follow your gut and stand firm even if the doctor turns nasty. Ultimately the nurse is held accountable to be a patient advocate and the final link in the chain to prevent harm or adverse outcomes.

roser13, ASN, RN · Jul 7, 2012

Unfortunately, it's sometimes a toss-up between verbal and written orders as to which is more difficult to decipher

DizzyLizzyNurse · Jul 7, 2012

Wow a dr too lazy to write an order? Although those can be difficult to read, too. Next month the hospital I work at is making the dr's write their own orders on the computer. Can't wait!

xoemmylouox, ASN, RN · Jul 7, 2012

This is where EMR is GREAT! Not only do they have to input the order, but you can read what is ordered.

Lynx25, LPN · Jul 7, 2012

We take many T.O., as we are a LTC and the docs are never in.

I'm no longer shy about demanding they speak up and repeat orders, better they be a little po'd then I get raked over the coals later.

KelRN215, BSN, RN · Jul 9, 2012

The doctor was THERE and refused to write an order? Your facility doesn't have any policies about this?

When I worked in the hospital, verbal orders were allowed during emergencies only. The MDs were required to write all their own orders (everything was in the computer). For services that didn't have someone in house 24-7 (like Endocrine or Plastic Surgery), the MDs all had remote access and still were required to write their own orders.

Christy1019, ASN, RN · Jul 10, 2012

Just out of curiosity.. What did you end up writing down that you thought he was ordering? And if you can give me a little more info about the patient (BP, meds already give etc), and ill tell you how I would've responded to him (I have a knack for witty comebacks to arrogant doctors lol)

Also, don't be afraid to question the doctor if you have ANY concerns about any ordered medication or treatment. Even though I'm pretty comfortable with the majority of meds/treatments that are frequently ordered in my ER, I'm notorious for asking the ordering physicians a bunch of questions. Generally I'm asking for my own education, like why the are using this med for something its not typically used for, or what we are looking for with a specific test they've ordered, and if you approach them like that, they'll be more than happy to explain.

When I'm questioning a physician's order b/c it doesn't make sense, or its not safe to be given (I.e. VS parameters/allergies etc), I make sure I have a legitimate concern and that I can back it up, and sometimes their reasoning makes sense and other times they weren't even aware of the issues causing my concerns and the orders will be changed.

Don't be intimidated by people like him b/c his badge says M.D. although they may disagree, being a doctor does not make them immune to mistakes nor does it grant them the right to have a god complex. If you bring him the chart and he still tells you to take a verbal instead, despite not understanding his accent, i'd say to him "Look, you have 2 choices.. you can write the orders b/c I'm sorry but I can't understand what you're saying due to your accent, or two; I will be calling the attending (or whoever would be his supervisor) and asking him for the order b/c you refuse to write them and my pt's BP needs to be treated. And when you were uncomfortable with the order you thought he said, I would've askd him about it, & if he laughs at you again tell him "what exactly are you laughing about? Is it the fact that I've spent all this time trying to get you to write a simple order instead of with my patients? Or is it that you're not really sure why you ordered this and can't think of anything else to say?"

I hate doctors like him and have no problem making them work just as hard as they are forcing me to with their laziness!

Sent from my SPH-D700 using allnurses.com

guest239592 · Jul 12, 2012

In this situation, the physician is not acting appropriately or in the best interest of his patient. As others have posted, check your hospital's policy because most are taking a hardline stance against this kind of behavior as it does lead to more medication errors. With EMRs now rapidly being employed in hospitals this is a lot easier for administrators to track.

I do want to mention and I'll probably get a lot of disagreement on this (this doesn't apply in this case) that there are times when taking a verbal in non-emergency situations is ok to help the doc out. Let me give an example

I worked in a high-risk CVICU for nearly 3 years, got to know the surgeons very well, and worked well with most of them. Many of them would come by early before their morning surgeries started and do a quick round through the unit (to see how the night went) before they more fully rounded with their NPs later in the day. When we had paper charts, it was easy for them to pull the chart out and write a few orders quickly. Most of these orders technically could have waited until their NPs initially rounded in the next few hours, but it was nice get started on some of them to get the patient transfer ready for example "40mg IV Lasix, then D/C foley" "D/C CTs" "D/C Swan" etc etc. Some were a little more urgent such as "Give 1 unit PRBC" or "Consult EP" Now I know EMR is the future, and I think it's a good thing (I was a superuser for 2 major transitions), but if the surgeon had to log into each patient's chart, put the orders in, log out, see the next pt, etc. that would delay surgery start time for the day which is definitely NOT a good thing esp since their pts were in the OR being getting prepped by anesthesia. Now I know, I know, you could argue "It's not my job to do that" or "Well then they should round earlier" but honestly there's also something called teamwork, and if this can help them get started with surgery on-time and get a little more sleep (since they really do get a lot of calls in the middle of the night and then are expected to perform a highly complex surgery) then I'm happy to help. I'm just glad they're taking the time to come at least a little early to see their patients. Helping them out honestly helped me develop a better rapport with them rather than always being at odds, which in the end having a good rapport I think leads to better patient care.

To summarize, in most situations (and certainly yours) the physician should put in their own orders because it is their job and it does lead to safer outcomes. But there times in non-emergency situations where I think it's ok and appropriate for us to help them out. Just my :twocents:

kindaquazie · Jul 12, 2012

Use the facility policy. If the physician still refuses to write his orders, invoke the disruptive physician policy. Do NOT rely on your charge nurse/director to handle this. Send an email to your chief medical officer stating the problem. The physician WILL be called in to answer the claim. If you are uncomfortable with that, contact the director of your quality department. He or she lives this stuff and is very familiar with the regulatory implications of the practice. TJC for example frowns on it, big time. The key is, you MUST do something about it because you have a responsibility to advocate for the lives of all people in your hospital, not just your patients for the day. This physician is a menace and is placing the hospital in legal jeopardy along with the patients. It is clear, your duty is to act and act fast.

kindaquazie · Jul 12, 2012

Dear Godfather RN:

I don't disagree with you because I too was an ICU nurse for a very long time. My primary surgical population was neurosurgery. It is very different when you work in ICU and in a specialty where there are few physicians and you get to know them well and there is an atmosphere of mutual trust, respect, and collaboration. What this RN is describing is very different. Even in the ICU we know which surgeons will "throw us under the bus" and we avoid taking verbal orders from them, right? Also, we frequently have very nice clinical pathways for ICU patients that allow us to ask things like, "do you want me to complete the pathway?" i.e. de-line, ambulate, prepare the patient for transfer...

So, while I agree with you whole-heartedly, I feel for our colleagues who work in Med/Surge and do not frequently experience this kind of collaboration with their physician team members.

merrywhiterose · Jul 12, 2012

I work in a LTC facility. The doctor comes about every 1-2 weeks. Most orders are taken verbally here. It's hard to understand the dr on his cell phone. I hate taking VO. I wish he was required to fax them to us!