Why do ED docs hate putting in orders?

[JennyAS, BSN, RN]

VENT

Why are some ED docs so averse to actually writing orders? I understand it's the ED, and they get spoiled by how much ED nurses are willing to do without a doctor's order (lines, labs, fluids, etc), but if you tell me to give Dilaudid, I'm gonna need an order for it. And if I come to you 15 minutes later and again ask you to please put the order in, don't get angry. It's your job.

Yes, you need to order that foley, as insignificant as it may seem, because when the patient gets a UTI 3 days later, I'm not going to lose my license over it. And yes, you need to order all those NS boluses, because there's no other way for me to document their intake. And yes, you have to place an order for some stupid Tylenol, because the almighty Pyxis won't let me pull it out until you do.

And no, I won't place a verbal order, because you are a resident whom I barely know, let alone trust. And also, I have enough sh*t to do.

What kills me is that it takes them 10 seconds to place an order electronically, while that same order may take me 30 minutes to actually complete.

woo! love to vent.

[Altra, BSN, RN]

You can always *update* the attending on the patient's status -- that you are awaiting orders for a Foley, pain meds, etc. I suspect you'll get the orders quickly after that.

[MADDOG70, BSN]

those are the Drs we all team up against and ask for orders on every little thing just to **** them off and put them in their place! LOL

[whichone'spink, BSN, RN]

ED doctors don't like to be slowed down by having to enter orders in the computer. It's all about throughput and seeing more patients at a time. At my hospital, the ED doctors have pretty much been forced to use the computer. They're not happy of course. They used to be able to have scribes (like me) do all the order entry stuff, but that changed this year. They have to put in for everything, including meds.

[Sehille4774]

Uhh Amen Sista!

Though my comment will apply to Dr's in general. I work in home care..Dr's give me the hardest time sometimes to give me the actual orders I need, written the right way, so that I can do my job..

It blows my mind that I feel I have to explain..."Hey...I really can't do very many things (even apply OTC lotion) unless you write me an order.....

Then their are the ones that insist on making the parents take off and drive over an hour to see the specialist...for silly things they could easily put in electronically.

I also hate when the wording of an order makes it basically useless for what we needed it for...AKA.".May remove NC 02 for 15-20 minutes, during baths: Ok well great now the only way I can remove it is if she is getting a bath...we asked so we could take it off while doing respiratory therapy such as the coffalator or neb tx, as tolerated.

OR Albuterol 0.083%, Neb, Give one vial every 4-6 hours, PRN for SOB....Now, this Dr's Intent that he told us was so we could give them for thinning increased congestion, rhonchi, wheezes, s/s cold, decreased spo2...But becasue he wrote it the way he did, I cant give it unless I can document or witness evidence of SOB...(at oleast according to my agency it works this way.

Lol. Why should I have to explain any of this to a DR...don't they know how HC scripts work yet? They are not real concerned about my license, esp. if they view your request as trivial..and a waste of their busy time.

But...I feel these little things ARE important to us...if they catch us (if it came to a court case or investigation) doing some small things outside of our scope, then that goes to our character...why wouldn't we do that with larger issues too?

[CapeCodMermaid, RN]

They are everywhere. In SNFs the orders have to be very specific but some of the docs don't seem to get it. We spend an extraordinary amount of time writing clarification orders. If the doc or NP writes "Give Lasix 20 mg qd" we have to write a clarification order to read "Give Lasix 20 mg daily." We're converting to EMR next month and the system doesn't allow for 'bad' orders. Can't wait!!

We had a doc who tried to titrate people from 2 to 1 liter of 02 or get rid of it altogether. He'd write "Discontinue all oxygen." I asked him if he wanted my to put a pillow over their face so ALL the oxygen was discontinued. He did have a great sense of humor. He asked me how he should write the order so it didn't look like he had written an order to smother someone. "Discontinue all SUPPLEMENTAL oxygen" worked.

[KelRN215, BSN, RN]

It's not just ED docs. Getting our residents to put in/update orders is like pulling teeth sometimes. Yesterday I had a patient who had been transferred out of the ICU several hours earlier who still had an order for an IA heparin drip. We do not use A-lines on the floor and they are always dc'd prior to the patient's transfer. Is it that hard to click "discontinue" on the order before the patient leaves the unit? Actually, the ICU docs are the ones that should be doing this since it's their order to begin with.

[Esme12, ASN, BSN, RN]

Mostly....they feel it is beneath them, they " Are NOT Secretaries". Second, they now have no one to blame but themselves.

[whichone'spink, BSN, RN]

Mostly....they feel it is beneath them, they " Are NOT Secretaries". Second, they now have no one to blame but themselves.

True story. But they have to get used to using the computer.

[Calabria, BSN, RN]

It depends on the resident, for us, regarding putting orders in. Some of them, it's really bad.

I've had to call the same resident multiple times for different patients before about missing orders... why? They were all fresh, post-op C-sections and had no pain medication orders put into the computer (none, nada, zilch). Ouch.

[psu_213, BSN, RN]

I guess we are lucky. For the most part, our docs enter all their own orders unless they are tied up in something (it would be kinda bad form to call a MD away from a code so that he can write an order for zofran...that one I'm willing to verbal). We actually have one doc who HATES it when nurses put in VOs under his name. He insists to enter every order himself--not sure if he got burned on this somehow in the past. Anyway, I digress. We have an excellent medical director for our ER, who is very big into using the computers and using CPOE as they were meant to be used. I think the other docs know that nurses would just have to go to him with the names of the docs refusing to put in their own orders and he would have something to say to them.

[VICEDRN, BSN, RN]

True story: Had a patient guppy breathing with a tanking bp sinking below 80s systolic and a resident I have never worked with but obviously completely sucks (as far as I could tell in the situation) tried to verbal me 4 mg Morphine (patient weighed about 80lbs too). When I told her there was a computer right behind her and she would have to put it in, she asked me if I was seriously going to make the patient wait till she wrote it and I said right in front of the patient, "yes." (Patients pain associated with respiratory effort). She complained to all of her little girlfriends that I wouldn't take a verbal for morphine on this patient.

Patient DIED like two hours later...after she had written it and after I have given it.

Gosh darn it but a part of me laughed and laughed and laughed. How unrealistic can these little residents get?