My facility is telling us that we must have a physician's order to start pushing ACLS drugs. They are telling us that it is a violation of the Nurse Practice Act to start ACLS without an order and that we are operating outside of our scope of practice because we are administering meds without an MD order. We have, in the past, just paged the MDs and started ACLS with high quality CPR, pushing whatever meds the patient's condition called for, following the algorithm. I work in a large teaching facility so there is always an MD somewhere close by so this problem isn't really that important specifically to me but what do smaller hospitals do when there isn't a doctor handy? Has anyone else ever heard of this? What do we need certification for if we can't do it without an order? Wouldn't any RN be able to administer these drugs with a physician present?