A Nursing Dilemma!!!

[Tolos]

I am an infusion nurse in a rheumatology clinic, one of my patients requests flu vaccine during infusion. Her Dr's nurse, an LVN said that the patient does not need an order because "they always recommend that their immunologic infusion patients get flu shots", she then drew the medication up in a syringe for me to administer. I felt totally uncomfortable and told her that in school of nursing I was taught to never admin medication drawn up by another nurse. To which she replied that the nurse manager permitted us to do it. I requested for an order from the Dr, she brought an unopened vial for me to use. My question is, will you administer medication drawn by another nurse and administer it without an order just to continue a good relationship with a coworker as opposed to protecting your license?

[Bluehair]

No, I wouldn't. I would ask to see the written policy that permitted the action she was recommending. Or she could give the vaccine herself and risk her own license. I wouldn't touch it.

[PICNICRN, BSN, RN]

I wouldn't have given it either, for the simple fact that you didn't even have an order. I think I would have just asked her to give it herself since she was the one who received the "verbal order" and drew it up. That way, it is all on her if some thing crazy happened like she did not really have an order, pt is actually allergic to eggs, drew up the wrong dose/med.... too many things to possibly go wrong! You did the right thing!!!!

[DusktilDawn]

It goes against standards of practice, regardless of what any written policy states, regardless of whether it meets with any supervisor's or manager's approval. You do not administer medication without an order, nor do you administer medication someone else draws up. Discuss the situation with your manager, he/she may not be aware of what this LPN is doing, despite the LPN's assurance otherwise. The fact that she was insisting that YOU give it makes me suspicious. She could also have gotten used to overstepping her role.

Recommending flu shots for patients is one thing, administering them without an order is practicing medicine without a license.

[lunden]

i'm not even a nurse yet, and i certainly would not have given it!!!

[Virgo_RN, BSN, RN]

At my facility, we have a protocol in place that allows certain vaccines to be given without a doctor's order. The order comes from pharmacy. I certainly would not give one of these vaccines without seeing the written order, and I do not give meds that I did not draw up myself. I think you did the right thing.

[everthesame, LPN, LVN]

I would not have given it without either an order or seeing the policy that states this can be given without a physician's order. I have worked at facilities that give flu vaccines without a physician order. However, these policies are approved by the medical director and as long as the nurse is following the proper procedure then the nurse is covered for giving the vaccine.

[MadisonsMomRN, BSN, RN]

I wouldn't have given it either. Just like someone else said... too many what if's (allergy to eggs, etc).

[IamVickiRN]

I would NOT have given it, I would have not allowed her to give it eitherwithout an order and esp without consulting the patient RE: consent, allergies, etc!! Just stepping back and allowing her to give it because thats "what she always does" doesn't make it right! Technically you would be just as guilty if something happened to the patient because the law would say a "Prudent Nurse" would have questioned the act. Sometimes you have to put your patients ahead of your relationships with your co-workers.

[wayunderpaid]

I would not have given it without either an order or seeing the policy that states this can be given without a physician's order. I have worked at facilities that give flu vaccines without a physician order. However, these policies are approved by the medical director and as long as the nurse is following the proper procedure then the nurse is covered for giving the vaccine.

Although I physician order may not be needed, if you are unfamiliar with a particular policy, it is best to err on the side of caution. Where I practice, we have lots of protocols that allow nurses to make independent decisions (e.g. electrolyte replacement) based on lab values, etc. These are delineated prescribed pre-written orders to make day to day decisions easier. I suspect that there may have been something similar written somewhere. If these is the case in your facility, there should be a copy in the chart or patient's folder for you to review.

I would also be suspect about giving a medication that I did not draw up, especially if it was not labeled. I have hanged medications drawn up by other rn's when I was present in the room and we were working together on a critically ill patient. Also on codes, pharmacy usually draws up the medications in the code cart (or another nurse if they are not available), and another nurse pushes it. The point is that it is ALWAYS labeled. One must not be so terminant with policies, but always use good judgment. Can you imagine having to draw all your meds during a code?? This isn't practical. There has to be an element of trust in the collaborative practice of nursing.

wayunderpaid

[DusktilDawn]

Although I physician order may not be needed, if you are unfamiliar with a particular policy, it is best to err on the side of caution. Where I practice, we have lots of protocols that allow nurses to make independent decisions (e.g. electrolyte replacement) based on lab values, etc. These are delineated prescribed pre-written orders to make day to day decisions easier. I suspect that there may have been something similar written somewhere. If these is the case in your facility, there should be a copy in the chart or patient's folder for you to review.

I would also be suspect about giving a medication that I did not draw up, especially if it was not labeled. I have hanged medications drawn up by other rn's when I was present in the room and we were working together on a critically ill patient. Also on codes, pharmacy usually draws up the medications in the code cart (or another nurse if they are not available), and another nurse pushes it. The point is that it is ALWAYS labeled. One must not be so terminant with policies, but always use good judgment. Can you imagine having to draw all your meds during a code?? This isn't practical. There has to be an element of trust in the collaborative practice of nursing.

wayunderpaid

It would have been one thing if the LPN pointed out standing orders that covered the situation and showed her where the vaccine was kept. That's not what she did, she prepared medication and attempted to hand off administration of that medication to another nurse. Hey, show me the standing orders, no problem, but don't buffalo me into doing something based solely on your say-so, which is how this LPN was coming across. Recommending vaccinations is not the same as a standing order. Also would it be contraindicated to be given at the same time the patient is receiving a particular infusion therapy, I know there are vaccines you can't give together on the same day. In this non-emergent situation why would the LPN draw up medication that she isn't going to administer, that's a violation of acceptable standards of practice. Giving medication with out verifying an order for it is also a violation of acceptable standards of practice.

Both nurses were also practicing in different settings in the same clinic, one with a physician and the other as an infusion nurse. The office setting is not the same as the setting the infusion nurse is in with patients from multiple physicians. What may be acceptable in one doesn't mean it's acceptable in the other simply because they occupy the same building.

[Babs0512]

There is a liability if you are an RN and the other nurse is an LPN, at least in the US. LPN's cannot take a verbal or telephone order, at least in NY. Therefore, allowing the LPN to give the med without an actual order, the RN who supervises the LPN could lose his/her license.