Without Orders

[Apollo8933]

Hey all! Have been reviewing multiple websites, state government and blogs and found that laws are very vague. I know this is to allow grey areas to occur to allow patient safety as well as protect nurses and other health professionals in emergencies but I was wondering...what are some of the things that you all can do without doctors orders? Obviously comfort is a consideration here but name some examples all responses welcome :)

[joanna73, BSN, RN]

OP perhaps you should review some of the guidelines outlined by your BON. Unless you have the knowledge, skill, and judgment to safely perform a nursing action, then you need to refrain from doing so.

We've all learned various skills in nursing school. However, unless you are competent in that area (ie delivering a baby), it isn't safe for you or anyone else involved. That means you would perform basic life saving measures only until the ambulance arrives.

To think that because we're nurses so this alone provides autonomy to act is false. You need to know what you're doing since you are liable.

[Apollo8933]

Firstly read what is written and respond please. Secondly there is a difference between what CAN be done legally and what people will do legally and be comfortable with cut the attitude people.

[Apollo8933]

Also I have clearly stated earlier that I ask for responses that are within legality and scope of practice. I am asking across the board interventions people can do without a doctor. And yes the fact that we are nurses do mean that we can act and work autonomously. That is actually written in my nurse practice act. I ask for answers to the question and not attitude that does not pertain to the actual question which I will restate: "what interesting, yet legal, interventions can you or have you done that does not need the order of the doctor because there may not be a doctor around?"

[joanna73, BSN, RN]

Your question has been addressed in a reasonable manner by many of us. You don't seem to appreciate the responses you're receiving. In a nutshell, there is very little a nurse can legally do safely without a standing order.

[BrandonLPN, LPN]

Yes, if there are significant "interesting and legal interventions" a RN can perform without so much as a standing order, I'd be interested in hearing about them, too. Who knows, maybe there are.

But the fact that most of the posts on this thread seem to reference instances where the nurse was, in actuality, utilizing pre established protocol..... Well that seems rather telling to me.

[Apollo8933]

Sorry for being short. I do appreciate the answers but so few answered the true question I suppose I was pushing people to search in their minds for things. I'm asking big or small....just interesting things they do without orders.

[BrandonLPN, LPN]

Well, "interesting" is relative.

I make independent interventions on a regular basis. Deciding to elevate the HOB, or apply a cool compress or check a set of vitals are independent decisions. They're important, but relatively dull. Anything along the lines of a medication or procedure usually involves a doctor's order in one form or another.

I've seen a lot of lip service to the idea of the RN being an "independent practitioner". But how many RNs, short of advanced practice RNs, actually operate independent of a facility and it's physicians?

[CodeteamB]

Sorry for being short. I do appreciate the answers but so few answered the true question I suppose I was pushing people to search in their minds for things. I'm asking big or small....just interesting things they do without orders.

Ok, let's turn it around! What are some things you would do without orders?

[PMFB-RN, RN]

I've seen a lot of lip service to the idea of the RN being an "independent practitioner". But how many RNs, short of advanced practice RNs, actually operate independent of a facility and it's physicians?

*** I feel pretty alone (independant) when intubating a farmer with a smashed face, laying in a barn with an 1800# dead holstein bull laying across his crushed pelvice 60 miles from the nearest hospital.

[BrandonLPN, LPN]

*** I feel pretty alone (independant) when intubating a farmer with a smashed face, laying in a barn with an 1800# dead holstein bull laying across his crushed pelvice 60 miles from the nearest hospital.

True. But this an exceedingly out of the ordinary experience.

I maintain that, like delivering a baby in a stalled elevator, intubating someone in a barn is something only a very small percentage of RNs have the experience to perform.

Plus, I'd argue that this is more of a "first responder" action than an "independent RN" action. You're responding to an emergency in the field much like a EMT or paramedic would. If this pt was brought to you in a ER, you'd almost certainly follow protocol.

For the vast, vast majority of nurses the most prudent and safe thing to do in this situation would be to provide basic first aid until an ambulance arrives.

[PMFB-RN, RN]

True. But this an exceedingly out of the ordinary experience.

*** Not as out of the ordinary as you might think. There are pre-hospital RN working all over the country.

If this pt was brought to you in a ER, you'd almost certainly follow protocol

*** I was following a protocol when I intubated him. My only point was it can often feel very independant despite the protocols and standing orders you are working under.

[PMFB-RN, RN]

If this pt was brought to you in a ER, you'd almost certainly follow protocol.

*** The physicans I work with pretty much follow protocols for treating nearly everything. Sepsis? Follow the protocal, Same for a large number of conditions and nobody argues physicians are not "independant".