McCullum Legal Nurse Consulting

Officially triple board-certified: CEN, CPEN, and now TCRN!

My head hurts, but I'm absolutely thrilled with this accomplishment.

Medical record entry: patient stated chest pain is a 10/10 and, "I feel like I'm dying."

Those are scare quotes. Scare quotes are quotation marks used around a word or phrase when they are not required, thereby eliciting doubts or disbelief towards the statement in quotations.

There's no need to document using scare quotes. Keep it clean, neutral, and fact-based.

I got asked on a consultation call recently if nurses can advocate for certain tests to be ordered, like imaging scans. After all, nurses can't order tests, so can they request orders? Should they?

Absolutely.

Nurses are highly educated and have honed their training in their respective disciplines. If a nurse feels strongly that a certain test or medication should be ordered for the safety or wellbeing of the patient, they should certainly speak with the provider about it.

Most of the time, the providers either have a reasonable rationale for not ordering it (waiting on a consult) or they simply order it when asked (the amount of providers who forgot to place an order is astonishing).

But occasionally, there is a disagreement.

At this point, the chain of command 🔗 factors in.

The chain of command is a step or ladder escalation process that directs employees how to consult and report with figures of authority. It is designed to eliminate confusion or having to decide which authority figure to go to when proceeding with a task. It's used in organizations such as the military, police departments, and civil organizations like hospitals.

Every facility with this process should have the chain of command organization chart available to their employees. My facility had it posted in the nursing stations and bathrooms, for example.

Utilizing the chain of command appropriately can assist in ensuring the best care for patients.

Have you ever utilized the chain of command?