I work in long term care. This morning I had a resident complaining of constipation. She had been on several bowel meds prn before going to the hospital but she had been back from the hospital for 5 days and when she was readmitted none were ordered. I went back to the nurse's station and paged her doctor to get orders. He called back about 20 mins later and I got the order for her meds and was filling out the paperwork, faxing to pharmacy, etc. It was about 30 mins after she was complaining to me that she fell out of her chair (the other shift had taken over by now, she told me about the constipation on my last med round and I was wrapping this up before I left, instead of leaving it for the next shift like many do). She said she was so uncomfortable because of her constipation that she had to get up (and instead of calling for help like she usually does decided to do so by herself).
My unit manager was talking about me like I was a dog in front of everyone, saying it was nursing judgement to go ahead and give her some medication first and then call the doctor for the orders. She has fussed at me for the same thing before, because I have waited to get orders from a doctor before doing procedures that we need an order for (such as putting in a catheter). I was taught that we are supposed to get an order before giving any medication, even a tylenol but I see many nurses give unordered medication and either call later or more often forget to call and then I have to call in the middle of the night to get an order. I am not trying to give a medication with no order and be charged with practicing medicine without a license. What if you give the medicine and something happens, then the doctor says "I didn't give the order for that medication"--you know he is going to protect himself.
Do you consider it nursing judgement to give medication without an order before calling the doctor? (by the way, I would usually try prune juice, etc but this lady says prune juice, milk of mag, and even laxatives don't help, she wants suppositories and enemas when she is constipated.
thanks for your feedback.
Quote from pagandeva2000
I'll tell you one thing. though...and I am sorry to say it. But, if the need should ever arise where you really think that you have to, don't document it until the order is covered. Things like this are issues that really place the nurse's rear end on the line. Just like that time with that aspirin...I saw a clinical need to give it, but believe me, I was not going to document it until it was covered FIRST.
Please don't go down that road. We all know that we need orders to administer medications. With no order (and no protocol), we are practicing medicine without a license if we choose, dose and administer a medication, regardless of the setting (LTC, acute care, ICU, etc.)
The only way I can imagine to step deeper in **** is to give a medication without an order and then fail to document it, so that the on-coming nurse has no way of knowing that the medication was given. S/he may then obtain a legitimate order for the very med that we just gave, and unwittingly double-dose the patient.
If one is to be so forward as to give a medication without an order, one must be professional enough to document it, for the sake of patient safety.
Last edit by donsterRN on Jun 4, '08
: Reason: Edited disguised profanity