Maybe I just don't know... - page 2

by Kdids520

1,707 Views | 17 Comments

A little background on myself: I've been an LPN for 5 years and am almost done with my RN. I expect to graduate in December. I took a per diem job working in a Level II ER. There is so much to learn and I'm doing my best to ask... Read More


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    Also wanted to add, in most EDs (here at least) the nurse usually will tell the doc whats going on and for the sake of saving time and taking care of the patient will just double check and put in the orders themselves and the doctor will sign off later on. I've even seen this on MedSurg floors.
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    Tylenol, no. Fluids, as long as the guy didn't have a hx of CHF, yes. In my dept, we have standing orders that RN's can initiate without the docs telling us to...then they go back and sign the orders. But if you weren't comfortable doing either, you are right to refuse. The RN you were working with, although she seemed overwhelmed, should know better than to get upset with you for not doing something without an order when you are new. I'm sorry that happened. It's sucky and situations like that can really make you feel down. You did the right thing.
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    Quote from Esme12
    Trendelenburg??? I know it's no longer recommended but I am not sure what this has to do with the post.
    Esme, I was replying to a prior post without using the quote feature....so it didn't indicate the link. Libran1984 indicated that she/he uses it for low BP.... sorry for any confusion.
    Esme12 likes this.
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    I thought what????? I missed that completely. Thanks.....
    Last edit by Esme12 on Jul 23, '12
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    As the others have said, it all depends upon the protocols at your facility. In the ED where I worked, we would have been expected to hang the fluids and give the Tylenol if indicated. We had Nurse Initiated Protocols in place, which were standing orders from the ED Medical Director. To not initiate treatments per protocol based upon the chief complaint/patient condition, instead waiting for an MD order, would have resulted in a delay in treatment and irritated docs. It's possible that your ED is different, but it would be worthwhile for you to check into this.
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    As other people have mentioned, different ERs will have different protocols....but they'll also have different cultures and expectations. One place I've worked, unless it's a respiratory issue, we're expected to be pretty conservative in what we initiate. We don't slap lines in patients without a doctors order unless the patient is REALLY sick (I work in peds so we try to minimize IVs). Another place I work, you'd be considered a weak nurse to not anticipate the basic orders and get that going while the patient is waiting to be seen.

    I don't think it's fair to expect a nurse new to the facility and that specialty though to be comfortable giving medications without an order in place.
    canoehead likes this.
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    As has been said, it certainly depends on the facility/department protocols. My ED is very liberal on protocols and what our docs will let us do. I toss in all sorts of orders for meds, labs, etc. I don't throw in orders for narcs, but Tylenol, Zofran, ASA, Toradol, and NS.. Yeah, not a big deal at all.

    But it's whatever you're comfortable with. It's your license, not hers.
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    Like stated before, I think you did the right thing. It all depends on the policies in your ER, if there are standing orders for things like Tylenol, etc. I put lines and get labs on people all the time to get things going-- that's just what we have in place for our triage/ambulance triage, etc. Depending on vitals (and labs if they've been lingering in the WR forever) I might have started fluids, and if I need more I just go talk to a doc. Ad long as there is reason for what you are doing, and it's within your scope... and in the ER policy, you're golden. Sounds like that nurse was just a bit sauced up because she was busy. No worries... send her an anonymous candy bar with a smiley face on it


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