Writing Telephone Orders/without calling doctor

[Nov2007_LPN]

Have any of you been asked by your DON and the doctor to write telephone orders for things like home health for wounds,Xrays for falls/injuries and UA's if you suspect a resident has a UTI without actually calling the doctor when these things occur and the doctor will sign the T.O when he makes rounds

No standing orders allowed at facility

[TazziRN, RN]

You mentioned home health as an example, but in home health it's almost standard to do so. The docs order us to go in and we develop the treatment plan. We write it up as an order and fax it to the doc, and s/he signs it. There are limits: we do it for wound care that does not require a med, obvious UTIs, and other things. In the scenario you mentioned, however, you were right to refuse. "Everybody does it" is the fastest way to get your license in trouble.

[caliotter3]

In long term care I noticed that other nurses would do this. When I asked about it, they said that they knew the doctors and knew who would sign off on what. I've done this in home health, but I am careful to never implement or put anything on the medsheet or tx sheet until I get the signed order back. However, both of my new agencies fail to return signed orders and one of them doesn't even bother to provide a copy of the 485 for the home. Therefore, I won't be taking any chances.

[husker_rn, RN]

I work in LTC and at this facility we have clear cut standing nursing orders that we can write for things like Tylenol, Imodium, etc. Anything else must have a doctor;s order; even things like UAs and stool specimens. If she wants you to write these orders they need to have a written policy and procedure to cover such things.

[barefootlady, ADN, RN]

I have written orders for emergencies that occured right in front of me and something had to be done. MI=02,ekg,abg & enzymes. Tele pack. Or when a patient was knocked down by surgery cart, had hip/back xrayed. Doctors did not bat an eye, signed them, and thanked me. But having said that, I never write for anything unless it is covered by standing orders. No way is my license going on the line for someone who wants the money but is too lazy to answer the phone.

[Dental Hygienist]

I'm not a nurse (yet) but I have to deal with issues of protecting my dental hygiene license even when dentists and office managers tell me to do things that are illegal. It is a tricky situation for sure...of course the obvious answer is "Don't do it!!!!" but in the meantime, while you're not doing it you have to find a way to smooth it over with your boss...because no one wants the living hell of having your boss mad at you. This is often when they start telling you things like "You're not a team player" and boy is that frustrating to hear when you're just following the practice act.

My first step is usually to explain to my superior that I am uncomfortable doing that and here is why...half the time they come back with a "everyone else is doing it" response which is hard to retort to without ticking them off and so then I usually tip toe around it and explain "well, perhaps they just aren't aware of the practice act etc. but I since I am, I cannot deviate from it. I have to sleep at night...ha ha" I try to lighten it up with a little joke or humor if I can....many times the humor is lost and my superior just scowls at me and drops the issue...because they know there is no logical argument for breaking the law.

Fact is...you won't be one of the favorites when you have a boss like that, but remember that they CANNOT fire you for following the practice act...sure they can go after you and try to find any little legitimate reason to fire you...such as 2 minutes late back from lunch etc...so you'll just basically have to have your guard up. It's tough to swallow that simply being ethical can put you on the chopping block at your own job...you have to weigh the risks and benefits of the job...if everything else is pretty good it might be worth putting up with...if the place is mediocre at best AND encourages you to be unethical....it may be time to start looking for something better.

It's a sticky situation for sure....best of luck to you. Remember, you are right and you have the law on your side.:nuke:

[Elektra6, ASN, BSN, RN]

We did it for treatments for skin tears, TAO & bandaid. We notified the MD ASAP, just an FYI message to the call service. This is in a LTCF. I should mention our MDs were part of one group and this was okay with all of them.