What have you done without a Dr. order???
- 0Sep 3, '10 by PureLifeRNSo what things have you done withOUT a doctor's order, for a patient?? I don't think I'm too bad, I'll send off a stool for c-diff if a patient has diarrhea, order a stat ABG for a pt in resp distress before calling the doc as well as an x-ray and will order a blood test or something if I think its necessary. I don't think I have ever given a med though, without an order (well, I have been known to give out a cepacol lozenge, but thats about it.) But I do know nurses that give out a maalox or robitussin without calling the doc. So I just wanna know, what kind of things do you feel comfortable doing without an order?
- 7Sep 3, '10 by elkparkI don't feel comfortable doing anything that requires a physician's order without that order, and the facilities in which I've worked don't permit that, anyway. It's been a long time since I've worked anywhere that one could get away with doing stuff like that -- i.e., computerized systems for entering orders that would require you to lie about having a physician's order in order to enter the order into the system, pharmacy systems that require you to scan the actual written physician's med order to the pharmacy, etc.
"I don't think I'm too bad" is a justification/rationale that makes me v. uncomfortable. I'm not saying this as a personal criticism of you, or anything, but I'm shooting for a higher professional standard than "not too bad." IMO, if people want to be able to order meds, procedures, etc. (outside of established, legitimate facility protocols, standing orders, etc.), there are educational/professional pathways to legitimately accomplish that -- pursue an advanced practice role that suits you. Otherwise, you are ultimately taking chances with your license. If a situation goes bad and comes back to bite you (even if it's just a matter of a physician taking offense and complaining), you won't have a leg to stand on -- is that a risk you want to take?
However, I'm v. "old school" when it comes to scope of practice, and I'm sure I'll turn out to be in the minority on this question (as I so often do on this site).Last edit by elkpark on Sep 3, '10
- 3Sep 3, '10 by nicole109I agree--I don't think that this is very smart--I will just say that I think that some of the things that the OP mentioned, you may actually have orders for and not even realize it. In the hospital that I came from, we had standing orders for a patient experiencing respiratory distress to get an ABG or for O2, etc...while we were notifying the MD. Because, a prudent nurse wouldn't watch a patient turn blue while they waited an hour for an MD to call them back to okay the ABG and resulting cascade of orders...
- 0Sep 3, '10 by noahsmamaI guess I'm wondering why you find it necessary to do these things without a doctor's order? Are the doctors that slow in responding that you can't get the order you need in a timely fashion? When I worked in a hospital (I'm in public health now), doctors were generally very good about responding to pages, especially since we had the option of sending a text page, in which I could explain exactly what I needed and why. If I had a pt in respiratory distress, I could get an order for a stat X-Ray and ABG within minutes. And nurses weren't allowed to enter an order for X-rays or labs -- there was no way I could enter it into the computer even if I wanted to, and the lab would not do any tests unless a doctor had ordered it.
I could see saving a stool sample without an MD's order, but I would ask for the order before submitting the sample to the lab. What if the doctors want to test for other things besides C-diff?
Since we weren't allowed to take verbal orders except in emergencies, I wouldn't even give a med, even if I had spoken to the doctor and they had assured me they would enter the written order, until the order actually came up -- if I had to call the doctor again to remind them to enter the order, so be it.
I only worked in a hospital for a short period (1.5 years), but I don't think I ever once during that time did anything that required a doctor's order without actually having the order. To do otherwise is to risk losing your license, and why in heavens name would you want to do that?
- 3Sep 3, '10 by StNeotserWe've all done things, such as giving o2 to a patient that has desatted without a doctors order. However, that's written in most standing orders anyway.
If anyone here admits to doing so, there'll be the holier-than-thou replies.
- 0Sep 3, '10 by MassED Guidelike you wrote, xrays (for a resp distress, febrile, productive cough) obvious fractures, etc. EKG's for cp, order labs, u/a's. I know some nurses give Zofran for nausea/vomiting without an order and go back for an order, but I never give meds without an order. I might pull it up and ask the doc "I have 4 of Zofran pulled up for the pt in such and such room for n/v - can I give it IV" ? I insert Foley's for hip fractures and ask after for an order, if the MD forgot.
I now work at a teaching hospital, so my autonomy has been stolen on what I might have done at "other" places.