[SDS_RN]

That was a struggle for me too was getting used to just doing things w/out notifying the doc first because on the floor you can do absolutly nothing w/out an order first. I sort of know now what the ED docs prefer now and if I don't I just ask my more experienced nurses what they do.
Does your facility have a CP protocol? All of our CP get put on the monitor, cardaic lab panel, CXR, EKG, O2 4L. I guess I haven't given any meds for CP w/out the docs permission though and our docs are pretty good about seeing a CP almost immediatly.
I like to think that the more I see and do the better I will get at it and will feel more confident when I have to do it. You will catch on just hang in there and keep learning.

[northshore08]

Every new place you have to learn the docs and what they want/allow you to do. That just takes time. It's especially hard if you come from a place that is more aggressive; sounds like the first doc took you for granted, then got upset that you did not do "everything." I bet if you had done "everything," then he would have grilled you as to why you did this, why you did that....Just do the protocols for now. If you do not have them, your hands are tied, just document that you reminded the doctor of the pt and their condition.

I had a doc once years ago---we got a trauma pt from MVC with obvious steering wheel mark on his chest and c/o chest pain. I got an EKG, and suffered the consequences for the rest of the shift. I stood up for myself and advocated the standard of care for my patient, but that doc was self-absorbed and not used to having a CEN taking care of business. I worked with this doctor for many years and ended up having a good relationship, but I will never forget that incident.

Good luck to you...I am orienting in a new ED now as a matter of fact, and currently backing off and "following the protocols."