[StacieRN]

Be honest, now. How many of you find a patient that you think has an emergent problem and actually call the doctor and get orders first?

Before ICU (where we have standing orders), when I worked on the floor, I would ask someone to page the MD but immediately start drawing needed labs, place O2, etc., while waiting for the MD to respond.

When the MD called, I would report the prob and say I drew this-and-that and did such-and such and what else do you want?

Of course, I had worked with the same MDs for years and could antipicate what they would want done. Technically wrong, but I felt waiting on a return page that could take up to 20 min or more was worse in an emergent situation.

What about the rest of you guys? What's your procedure?

[earle58]

yeah, i really do wait.
if i can't immediately get a hold of the doc, i'll call another one and another one, stating that i don't have the time to wait.

i know how tempting it is to start these interventions, but i just won't risk acting out of the scope of my license.

i have however, obtained standing orders for future emergencies.

leslie

[RNLisa]

I have to agree, I am still a new nurse, and I do wait and get ahold of the doc. In my case, the doc is usually the hospitalist and he is readily available if I need him. I will do O2, obviously if they need it; that is within our scope of practice. But, if there are not standing orders, I call first. I want to keep my license. LOL

[StacieRN]

Basically why I transfered to Critical Care (with standing orders). Was getting sicker and sicker pts on the floor, and working weekend night shift, It could take a long time to get a MD response while pt is spirialing down. I couldn't take it anymore!!! Those poor patients.

At on time, every weekend I worked for two and a half months I had to send a pt to the unit (usually BACK to the unit - had been dc'd to floor early due to lack of beds).

Since it has been seven years since I worked on the floor, I was wondering how thing were working now. They were getting progressively worse every year. I can't imagine being a floor nurse now. My hat of to you currently working med-surg.

[TazziRN]

Whenever I worked with an ER doc for the first time I would find out what his desires/expectations were of us. All but one wanted us to go ahead and start standard things like drawing blood, IV access if necessary (no fluids, just the access), EKG/X-ray, etc. Wheezers get a stat neb. In the meantime I'm on the phone saying "I got this and I've done this."

Med orders I always called first.

[icuwant2rn]

Have to admit there have been a couple of situations in which I started interventions before the doc called back. For example, I had a symptomatic diabetic pt c a BS of 20 that I started pushing D50% on before he called back. Another nurse finished pushing it while I was on the phone c him. He asked, "Is she symptomatic? Then give her some D50!"
I was sweating it some though. But her temp had dropped, she was lethargic, and becoming unresponsive. I didn't feel I really had much time to wait for a doc that may/ may not call back.

[TazziRN]

Addendum: a lot has to do with if the doc trusts the nurse, too.....if he doesn't he may not cover the nurse.

[Emmanuel Goldstein]

It depends.

I worked for over 17 years on an oncology unit with the same docs. They trusted me, and if there was an emergency, I took immediate actions I knew they expected while contacting them. I was able to anticipate most of their orders, and would notify the appropriate departments and give them a heads-up to have them ready while I awaited those orders. (our hospital never had a 'rapid response' team; I had discussed this with our DON shortly before I left. to my knowledge, they still don't have one) And our doctors always returned calls pronto, no matter what time of the night. As a traveler now, I'm more careful, but I will take action if necessary.

The gyn/onc told me a gazillion times to just write orders I needed (emergent or not), and he'd sign them ... I told HIM a gazillion times I couldn't just do that lol. He was a friend, and a great doctor and didn't mind one bit being called.

There are certain things I will do, such as O2, obtaining an EKG, and so on.

Just last night, had a patient's BP drop below 70's systolic. Initial thought was sepsis, but then he'd been cultured and covered and was asymptomatic otherwise. He had no IVF, so I put him on his head and hung NS IV and called the doc.

I guess the short answer is, it's on a case by case basis.

[MS._Jen_RN]

Wow- am glad that my facility has a lot of protocol/policy orders. For example to push D50 for hypoglycemia, and an urgent measure protocol that covers us for o2, labs, EKG, etc if the doc can't be reached.
~jen

[loricatus]

Originally Posted by StacieRN

Before ICU (where we have standing orders), when I worked on the floor, I would ask someone to page the MD but immediately start drawing needed labs, place O2, etc., while waiting for the MD to respond.

When the MD called, I would report the prob and say I drew this-and-that and did such-and such and what else do you want?

This is one of the reasons why I love ED nursing. We are expected to intervene. Labs are drawn, pt put on O2 and IVF (if needed) prior to the MD seeing the pt. If, in a critical situation, we must (& I emphasize MUST) give a med, the MD will write the order after-the-fact-----of course, this is a rare but sometimes necessary way to save a life. This is the only nursing specialty I have encountered where there has to be a team approach & the nurse is an integral part of that team IMHO.