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I have been an LPN in pediatric homecare for many years. My new case manager is telling me something I've been doing routinely is illegal. I need some advice about this.

Thursday June 13, 2013
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Dear Donna,

I have been practicing in pediatric homecare as an LPN for many years. I am in Georgia, and I am affiliated with several agencies. If I need something for one of my patients, I call one of their physicians or state my need on the nurse advice line. They usually call me back after speaking with the physician. I write the order and send it to my agency. It is then faxed to the office for a signature. My new case manager told me this is illegal. I called my director who referred me to another nurse. I need an answer. Is this legal?

Frustrated and Confused

Dear Donna replies:

Dear Frustrated and Confused,

Matters such as taking phone orders by LPNs or RNs should be very clearly and explicitly written out in your agencies' policy and procedure manuals. If the case manager claims this is illegal, then he or she should provide you with the correct procedure. Was the case manager specific about which part of the procedure is deemed illegal?

You also should be able to obtain a copy of the policy for LPNs taking phone orders or obtaining physician or nurse practitioner orders from your immediate supervisor (if that is someone other than your director), human resources or the agency nurse educator. It is your responsibility to make sure you are following your agency's procedure on this and operating within your scope of practice in Georgia. You say you are working with several agencies, so you need to know the approved procedure for each one.

I cannot give you a direct answer to this question because there are many variables. But you should be determined to obtain written guidelines for this and other common procedures and protocols for each agency. Your license is on the line.

Best wishes,

Donna Cardillo, RN, MA, well-known career guru, is Nurse.com’s “Dear Donna” and author of “Your First Year as a Nurse: Making the Transition from Total Novice to Successful Professional” and “The ULTIMATE Career Guide for Nurses: Practical Advice for Thriving at Every Stage of Your Career.” Information about the books is available at www.Nurse.com/CE/7010 and www.Nurse.com/CE/7250, respectively. To ask Donna your question, go to www.Nurse.com/Asktheexperts/Deardonna. Find a “Dear Donna” seminar near you: Call 800-866-0919 or visit http://Events.nursingspectrum.com/Seminar.