Was this such an unreasonable request?

[verene]

Yesterday at work I had a call from an RN from another clinic call to say that MD wanted to make changes to one of our resident's insulin dose. Perfectly fine. I asked her to fax me a written copy of the order (per our facility policy we MUST have a written order for all med changes) and she pretty much told me off and asked why I couldn't take a verbal order. I told her it was facility policy, and for liability reasons we have to have a written copy. She again refused to fax the order and said when she changed the Rx with the pharmacy she'd make them clarify the information for us.

She made it sound like we were a substandard facility for not taking a verbal order, and that I was asking for way too much work on her end. Is it really that weird to ask for a written order for med changes? I thought it was pretty standard and don't understand why I got chewed out.

[Nurse SMS, MSN, RN]

I have had nurses get irritable with me as well for not accepting a verbal order from them. Oh well. I don't back down. It isn't worth the liability. The fact that you are not licensed makes your actions even more correct. Shame on that "nurse".

[BuckyBadgerRN, ASN, RN]

No... I can answer the phone but I can NOT take verbal orders. Another reason why I needed the order faxed.

That is probably what irritated her. If she was talking to a nurse, that would have saved her the step of sending over the written order instead of giving just the verbal. In my state as well the cna absolutely cannot accept verbal orders and they have no license to protect.

[BuckyBadgerRN, ASN, RN]

How do you even know the person on the other end is a nurse??? I have had secretaries give verbal orders for a MD. You did the right thing, apparently she just did not want to hear it. I would never take a verbal order for medication changes from anyone other than an MD. The rest can fax the order signed by the MD. It made more work for her, but too bad!!!

How do you know you're really talking to an md on the other end of the phone?

[Nibbles1]

Did you tell her you were a CNA? Did you attempt to get a LPN/LVN or RN? Did you relay the message to the LPN or RN?

[jadelpn, LPN, EMT-B]

I am confused. This is like the game "telephone". If you are a CNA, you should not be put in this position to begin with. "Hold on, let me get the nurse for you"--and then let the nurse deal with her issues.

To which the nurse in your facility would have hopefully said, "fax the order". The only one who can give telephone orders are providers. A less than ethical nurse could say that they gave an order to "who they thought was a nurse" or whatever (and that nurse should KNOW better).

But do be mindful and careful. Any and all phone calls that have to do with medication changes should be given to the nurse. A CNA scope of practice, in general, doesn't include communication regarding orders. Did you let the nurse on duty know about this? What did this nurse say? As now, it COULD (and just COULD) turn into a "but I told nurse verene that resident such and so needed an insulin change, and she said OK, sooooo....." Which is a complete falsehood in how you answered her (and again, you should never, ever get into an answer regarding orders) and the fact that you are not licensed, (BUT she NEVER said THAT says the less than ethical nurse) therefore, any fall out from this would be on the nurse on duty (hence why the nurse needs to know and field these calls). There are nurses who will "feel out" other staff to see if they can have a friend/ally/cohort that is willing to do dirty deeds dirt cheap. And even more facilities who are "testing" (and usually when there's an inspection coming up) "what would the CNA do?" Ain't no one got time for that stuff, but if there's complaints of CNA's overstepping, not giving nurses the messages, attempting to be helpful by dealing with stuff, but no matter how well intended is still incorrect procedure. Respectfully decline to take these calls in the future. Stay out of the mess. If you are told you "must" take these calls, have them show you the policy that says you are able to.

Because as much as I appreciate and trust the CNA's that I have been responsible for, anything that results in a med error is on me. And that "the CNA took the call and did not inform me" is not an ideal answer.

So, bottom line, make sure that you tell the nurse that this conversation occurred. Also be sure that as soon as a nurse calls regarding orders you say immediately "I can not take this phone call, as I am a CNA. Let me get the nurse for you" and put the call on hold and go get the nurse.

[nurse4ever08]

At least you know your scope of practice. Keep it up. You were right.

[RosesrReder, BSN, MSN, RN]

Verbal order? That's obsolete in many places with reason and unless it's an emergent situation, they should be avoided like the plague.

[BuckyBadgerRN, ASN, RN]

Verbal order? That's obsolete in many places with reason and unless it's an emergent situation, they should be avoided like the plague.

When I worked rehab/LTC we would have many instances where a blood sugar would be out of parameters and we'd get a verbal order for insulin coverage. We'd write the order, fax it where it was needed to go and the MD would sign off on it later. I worked weekend nights---how available do you think an MD is for signing an insulin order at HS for a patient?

[caliotter3]

One of my RN colleagues on an extended care case (she was the primary nurse) would take orders from the office RN. She was comfortable in this, one reason being that the office RN was the physician's spouse, and she knew that they were in complete agreement with everything.

[jadelpn, LPN, EMT-B]

In my neck of the woods, verbal orders and telephone orders are two different things. A verbal order is and order that a provider gives a nurse and they are standing right there. Those are obsolete in most cases, and most facilities are not too keen on them unless an emergency.

A telephone order is when a provider has telephone communication about an order to a nurse who is able to take said order. And not every LPN can even take telephone orders--depending on scope. A CNA should not be getting into asking anyone to fax anything. There are some LPN's who couldn't take that call. (although acute care is different than a LTC situation).

With all due respect the OP, as a CNA, was absolutely in the wrong for even engaging in conversation about this to begin with. It is a call that is the nurse's responsibility, therefore, should need to hear it first hand--and then the nurse be the one who asks that it be faxed, or take the order from the MD themselves.

And to the pp about the office nurse being the spouse and "they agree on everything"....yup, until the office nurse gets it wrong--and I would not want to be the nurse who has to answer to "well, I received the telephone order from the office nurse, but that's OK, as she was speaking for her husband, the MD".

To the OP: Do not ever put yourself into the situation of discussing orders with a nurse, a nurse who believes they are a practitioner, or anyone who wants to give a telephone order. Immediately get the responsible nurse. Otherwise, the nurse on duty can get into a real mess. And if the nurse gives the wrong dose because he/she is in the dark about this discussion that you had with the other nurse, it won't matter one bit when she is disciplined for it. It is just not the right thing to do, regardless of your good intent.

[verene, MSN]

To those saying I should have gotten the nurse on duty. This other RN called late enough in the day that we do not have any RNs on staff. Late evening and overnight is just CNAs at my facility as patients are very low acuity. We are essentially a group boarding home, but are licensed as ALF for various reasons that are longer than worth explaining. Most residents receive any routine medical care they need at our agency's clinical facility rather than in the residence except for those few who refuse to leave, in which case there is an RN who comes in during the day to handle their medications and injections. While I do have access to an on-call RN should an issue arise during late shift, there isn't an RN available for me to hand the phone to. So I used by best judgement an asked for a faxed order for RN to later clarify. The RN who called is well aware of the fact that I am a CNA as I have had many previous interactions with her and have always clarified my position as such, I also told her when she called that {RN} had already gone home for the day and that I could take a message for {RN} to call back. She insisted she wanted to give me the order. (Med change to start during day, next day). I asked that it be faxed so that I could leave written copy for RN. She refused to fax the order, and said that I should just take a verbal/phone order so that change could start next AM. I again told her that facility policy is for written orders only, and she got in a huff, told me off, and said that she would call the pharmacy so that one of the pharmacists could call and explain the order to me and if I still needed a written order they could be the one's dealing with the hassle of faxing it to us. (Despite it being well after pharmacy closing).

I left a note in the log for the RN to read when she gets in in morning stating that I'd had conversation with this other RN regarding resident, did not receive written orders, and to f/u with RN and/or resident's doctor ASAP as clinic RN stated she wanted change to implement at morning med pass.

I'm not really sure what else I could have done that both protected me and still relayed that some one needs to f/u on this change with the MD/Pharm/RN, and that it needed to be an early priority in the day. So that hopefully RN can get a written order in time for the verbally stated time of dose change. I don't want her to get in trouble for not making that change when she is supposed to.

When I get back to work I will have a discussion with my supervisor about this situation. Hopefully she will be able to tell me how I ought to have handled it as I really felt like this RN was pushing me around by insisting I should just take the telephone order despite me telling her that 1) I'm not authorized to take telephone or verbal orders and 2) it is against facility policy. Even an RN can't take telephone orders in our facility.

[RosesrReder, BSN, MSN, RN]

BuckyBadgerRN, exactly in the PAST. Welcome to the world of CPOE lol

I know it's different at the nursing homes perhaps. My comment was in surprise that people still take down verbals or phone orders in non-emergent situations. Thought it was standard practice to get rid of all that but I may be wrong.

I still take phone orders because of the nature of my job (ambulance). Not in the hospital setting. Last few places I've worked within the last few yrs have done away with verbal/phone orders or anything written down. That's why my comment.