This is a hypothetical scenario that has not happened in real life. Everything in this post is a pure fabrication. Thankfully, this hypothetical scenario did NOT happen directly to me - I would have only observed this scenario playing out had it been a real situation. I'm still fairly new at my facility and wouldn't want this looming over me, if it were real.
Now that that's out of the way...
Patient walks in with self-reported decreased level of consciousness/confusion. Speech is clear, mild unsteady gait but otherwise good mobility, equal and purposeful movement to all extremities, PERRL. General impression: patient looks stable. T/P/R/BP WNL.
Patient is a known frequent flier. Patient has been in the ED about 9 times in 6 months for various problems, including 3 times by ambulance for hypoglycemia. Patient has a hx of DM.
RN triages at the bedside and checks BG. 630. Rechecks BG immediately. 637. MD is busy with another patient. RN starts an IV, anticipating that this patient will need IV insulin and fluids. She draws labs but holds it until the MD makes the lab order, per protocol.
MD is FURIOUS that the RN took the BG. He had gotten a brief report when the patient was first starting to get triaged and had planned on streeting him due to him being a frequent flier (triage nurse's fault for even mentioning that, considering the chief complaint and hx). He flies off the handle and says that nurses are not to do anything invasive without an explicit MD order and that the RN was practicing outside of her scope of practice. Basically, MD is p****d off that he actually has to do something to treat this patient instead of clearing him off of the board, since it's 30 minutes prior to shift change and he has a tendency to discharge/admit everyone in the last hour.
I have never worked anywhere where a nurse could NOT start an IV if a patient was in danger of going downhill (except facilities that did not have the equipment; i.e. assisted living). I have never worked anywhere where a nurse could NOT check a BG on a diabetic, especially one presenting with a decreased level of consciousness.
If this patient was not a frequent flier, and presented with the same sx/sx, the MD would have been furious that BG had NOT been checked and IV was NOT started. This just seems crazy to me. Can't win for losing in this scenario.
Like I said, I'm just glad it didn't happen to me.
