Without Orders - page 6
by Apollo8933 7,799 Views | 54 Comments
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
- 1Mar 26, '13 by ObtundedRNQuote from GrnTeaHaha, thank you. I always say the doctor has "prescribed" this XYZ treatment, and it is up to me to ensure it is appropriate to carry out.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.
- 0Mar 27, '13 by TerpGal02No, we don't do anything without an order, but we as nurses enter the orders (usually just admission orders or anything the doc was not physically there for). Some of our docs are more trusting (read: don't want to be bothered at 2am) than others. For something like a Tylenol or Motrin outside business hours, none of our docs want to be bothered for. When our medical director is on call and we have a ton of admissions all at once during evening or night shift, he doesn't want to be called until they're all done. So labs and orders for home meds can be entered and he will ask you when you call, "tell me what I ordered this time". I work in a psych hospital and we have NO standing orders. Makes for a good bit of trouble when you have to go hands on with a of. We can initiate restraint and send someone to the quiet room in an emergency, but the doc has to be made aware when the situation allows for it. Where we run into big problems like this are when we do have an emergency, there are no standing orders for prns. Some docs are ok with us just giving it and being notified after the fact, others aren't. This weekend we had a child that had to he put in holds and escorted to the quiet room . He was a BIG kid and once we got him there, he was swinging on staff and after we were all outta there he was throwing himself against the door, hard. We had to call this particular doc for a PRN and she did not want to order one. Obviously if he just wouldn't calm down we could call her back and ask again, but thankfully the kid ended up wearing himself out. I REALLY wish we had standing orders for agitation. Or for EPS for that matter.
- 0Mar 27, '13 by PRNketamineI work in an ICU and if the pt is on sedation and waking up we will bolus the sedation to maintain their safety with out an order, and get it after.
Also, if the pt needs O2, I would apply or increase what they are getting and get the order later.
In terms of a code, obviously no one is sitting and writing the orders while its going on. There is almost always a doctor there staying verbal orders and after they will write a note and say all medications or interventions given under my direction. Instead if writing up everything that was administered. If there isn't a md present a nurse who is ACLS/PALS certified can run the code.
- 1Mar 28, '13 by Esme12 Senior ModeratorQuote from Apollo8933What you seem to be misunderstanding is that there is very little to nothing that a nurse does without a MD order or protocol. Nurses have varied rolls in different areas of nursing that are covered by protocols and physician approved protocols but the bottom line is......they are physician driven. Have you had ethics/legalities in school yet? What semester are you?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.
Pre-hospital nurses/Flight nurses do many things that a floor nurse cannot. What is usual and customary for the flight nurse isn't for the floor nurse. What you are covered to do while you are employed at the hospital doesn't mean you are supposed to perform them at Walmart.
Many malpractice insurances do not cover heroic acts at the scene of accidents and will not protect you civilly when the family sues. Some states do have good Samaritan laws but the is not the intent to give you carte blanche for everything you have ever read in your nursing books....and perform on an unsuspecting public....for reading about it does not give you the level of competence to perform them on another human being.
I am an ER nurse not an OB nurse. I know how to intubate...but that doesn't meant I carry a ETT tube in my trunk. I am very good at IV's but I don't start them on random people if I think they need one.
I have assisted with cracked chests....I have done internal massage, I have inserted arterial lines at one hospital but I am not allowed at another......but I wouldn't do one at the scene of an accident because I can. I have done many things on the job.....but not off duty just because I can.
We are govern by our state nurse practice acts and individual facility policy and that is influenced by physicians. It is up to each nurse to know her limitations within her state and facility.
Your question is answered even if it isn't what you want to hear.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.
If you want stories about crazy things that have happened to you outside the hospital...is another question.
As far a the legalities of the Good Samaritan laws and what you are legally obligated or can perform again varies state to state. You need to justify to a court of law that you were competent and capable to perform...what ever it is you performed.... outside the hospital setting and that the patient would have suffered irreversible injury or death....like the cars on fire and going to blow but you moved the patient and now they are paralyzed. But that will not absolve you civil lawsuit that your malpractice will not cover.
Nurses of advanced degrees (Nurse Practioners, CRNA) do all kinds of things without physician orders.....but that still doesn't mean they have carte blanche in the public at large.....they too are bound by the usual and customary clause and what another reasonable competence professional would do.
The first rule of medicine...do no harm
- 0Mar 28, '13 by Esme12 Senior ModeratorQuote from Apollo8933The things that nurses do without a physician "around" are protocol driven and performed by nurse with training and documented competence ....and coverd by hospital policy that was approved by the MDs. Any unusual things we do are covered by policies and procedures.You would only help a woman in labor that much? Right in my nursing textbook it tells you how to deliver a baby we an do that without a doctor if no one is around...? And yes we have chainsaw wounds come into my urgent care because people hate the ER and the treatment they receive there. I did not call the ambulance right away rather I assessed first rather than ignorantly called 911 first and I cleaned the wound and checked vitals and called for the doctor who would've stitched it herself if it wasn't so busy so I placed a pressure dressing and sent him to the ER. To simply call 911 or depend on only the ER is a waste of our skills. And nursing practice acts are actually uninformative simply because they are vague; reason being to help us when we are in emergency situations so that we can still be protected AND to also give additional aid to the patient. This thread is meant to be progressive I suppose, not latent. What I want to do was written earlier...the point of this is to find unusual or interesting interventions people have done that are legal and without doctors orders because there is no doctor around; NOT meaning standing orders or protocols.
Are you looking for stories about "the craziest things" that ever happened to you"?