Without Orders - page 5

by Apollo8933

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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... Read More


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    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.
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    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.
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    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?
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    Quote from 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.
    Ok, let's turn it around! What are some things you would do without orders?
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    Quote from BrandonLPN
    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.
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    Quote from PMFB-RN
    *** 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.
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    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.
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    Quote from BrandonLPN
    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".
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    BTW, mothers deliver the babies. Doctors, nurses, midwives, etc assist in the delivery, but the women in labor are doing most of the work.

    C-sections, on the other hand, are different and I sure as heck hope an RN isn't doing THAT in an elevator.

    I think the OP is not agreeing that standing orders and protocols are orders. We may not have to call the doctor to do them, but they are orders all the same.
  10. 1
    Quote from Apollo8933
    Exactly the point of this thread. We are taught to be more than servants working on orders and in our world RNs are being given more and more rights and privileges. The idea of this was to help myself and others interested with what we can do without doctors in the hopes to learn and gain further autonomy.
    If you haven't read the ANA Scope and Standards of Nursing Practice you don't know jack. Says it all. The NANDA-I 2012-2014 gives you a huge amount of backup for autonomous nursing practice.

    Assuming you aren't just talking about tasks/psychomotor skills (you know, how some people get their epinephrine rush on intubation or cricothyrotomy, that kind of thing), there is a world of independent nursing action which is, sad to say, unknown to many RNs in active practice because they and their education focused more on "stuff" (lab check-off tasks, what some of them call "skills") than on real nursing skills and mandates of nursing licensure.

    PS: Just for the heck of it, the next time you find yourself saying "doctor's orders," remember that this is not a power-down structure where the superior rank issues orders to the inferior rank, it's a collaboration between independent and interdependent professional disciplines with their own sets of expertise, neither of which is subservient to the other. Call it "medical plan of care" and see how that makes it feel. Words matter; words shape our understanding of the world. More RNs need to take the world into their own professional hands, and this is a quick way to conceptualize it before beginning. Try it, you'll like it. And you'll never go back.
    Last edit by GrnTea on Mar 26, '13
    ObtundedRN likes this.


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