Dear Nancy,
At the hospital where I work, nurses write orders for patients returning back to the chronic center. Sometimes the orders are not reviewed until the NP comes in and sometimes days go by before the NP reviews the orders. We write it as a verbal order. This has been an ongoing practice for years. Our computers are not accessible for the NP outside of the center. I missed a medication. I wrote out all the medications from the discharge orders that I saw. Management and HR are having a meeting about me. They will take action. I have complained about the situation before but no one recollects it.
Bonnie
Dear Bonnie,
The practice you describe is not consistent with what should be done in this type of situation. To begin with, as an RN, and not an advanced practice nurse, you should not be writing orders, categorizing them as verbal orders, and then having the NP sign them days later. This could be seen as unprofessional conduct by your state board of nursing and the board could take disciplinary action against you. A better approach, based only on what you have included in your letter, might be for the NP to have standing orders in place for those returning to the center and then when the NP does review the specific orders from the discharge sheet, the NP then can write additional orders as needed. It should also be said that the NP's slowness in reviewing the discharge orders may present legal problems for her before the board as well. You did not indicate to whom you complained about this practice, but you may want to consider consulting with a nurse attorney or attorney to determine the best path to take to report your concerns internally again, and, if not heeded, to entities outside of the agency, such as the board of nursing and/or licensing agencies. Although there are no policies or procedures that can always prevent a nurse from missing a medication order, the current scheme of handling the orders certainly invites something like what happened to you to occur.
