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I'm an RN who works at a telephone nursing call center that provides after-hours triage for a local internal medicine practice and independent practitioners who subscribe to our service. We often get calls from home health care RNs and LPNs requesting new orders for patients whose physicians use our service.

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Some of the physicians don't want to speak directly to a home health care nurse. Rather, they want one of the nurses in the triage center to relay the home care nurse's request to them, take the order, then relay the order back to the home health care nurse.


As triage nurses, we're not comfortable being in the middle. Do we have reason to worry?-L.W., ARK.


Yes, according to our consultant, an attorney for a large facility with a busy call center. Although each state regulates the scope of practice for nurses in that state, some principles are uniform. One of them is that only a practitioner with legal authority to issue medical orders may do so. Besides physicians, this generally includes dentists, advanced practice nurses, and physician assistants (when granted this authority by the delegating physician). In no state does this list include RNs or LPNs.


Because of this standard, it's not legally acceptable for a call center nurse to communicate a physician's order to another nurse. In effect, she'd be giving another nurse an order, which is beyond her scope of practice.


Patient safety is another concern. Because of the high risk of misunderstanding and error, orders that are given over the phone should be written down, then read back and verified by the prescribing practitioner. This isn't possible when orders are issued secondhand.


A nurse receiving an order from someone who has no authority to issue medical orders is jeopardizing patients and putting her license at risk, and the same is true of the nurse relaying the order. To protect everyone involved, insist that the call center's managers and administrators draw up an appropriate policy and enforce it. The call center's medical director should communicate the change to all prescribing practitioners.