ACLS requires a doctor's order?

Specialties Critical


My facility is telling us that we must have a physician's order to start pushing ACLS drugs. They are telling us that it is a violation of the Nurse Practice Act to start ACLS without an order and that we are operating outside of our scope of practice because we are administering meds without an MD order. We have, in the past, just paged the MDs and started ACLS with high quality CPR, pushing whatever meds the patient's condition called for, following the algorithm. I work in a large teaching facility so there is always an MD somewhere close by so this problem isn't really that important specifically to me but what do smaller hospitals do when there isn't a doctor handy? Has anyone else ever heard of this? What do we need certification for if we can't do it without an order? Wouldn't any RN be able to administer these drugs with a physician present?

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I am an RN ACLS provider/instructor at a large campus with subacute services. The acute care facility is across town. I'm on the front line in triaging and managing unexpected cardiac and neuro emergencies in an apparently healthy but high risk ambulatory setting (we stabilize and call 911). I don't have physician back up in an emergency or a code. Although there are physicians on the wards and in the clinics in other buildings. The institution has decided that a physician does not have to respond to a rapid response call or a code on our campus. There is a push to get the nurse managers ACLS certified here. Where does that leave me in an emergency? Am I allowed to push ACLS drugs per algorithm? Our medical director says yes - as long as we do it correctly (he is at the other campus). I have read our hospital policies, reviewed our state's nurse practice act (didn't address this type of thing), and briefly looked at ANA Scope of Practice (it looks like a text book). But I'm still unclear about my role and responsibilities and worry about the position I am being placed in. Can anyone help? I'm thinking of consulting an attorney. I don't feel communication is good at this institution at all.

*** I don't understand what your concern is? Lots of nurses run codes without a physician. There have even been times when I as an RN ran the codes and gave orders to physicians (interns and residents). Why is there any question of wether you can push meds in a code?

At the risk of " beating a dead horse" here...I think the general answer to your question is: Find out the specific protocols for YOUR facility.

At the facility I have worked at most of my nursing career, having worked on a cardiac stepdown unit and required for all nurses to be ACLS certified, they expect us to do as much for the patient per ACLS protocol as possible until the physician and code team arrive. When I had my first code, I was too afraid of pushing any meds or even shocking for that matter, until the physician was actually present in the room. Then I had a few physicians tell me over the years, as long as we follow the ACLS algorithm on medications that we were capable and able to do so without physicians present at the time of administration. They all agreed and said "if the patient is dead, they're not going to get any more dead-er than they are right then" Thanks to my years of experience in running codes, there have been times me and my team would code a patient, defib, administer medications, and achieve ROSC before the physician even actually stepped into the room. One time I had a physician swear up and down it was not a code blue but rather an "alert" or "rapid" in most other hospitals. Until he saw the patients rhythms and vitals. Then he thanked us for being a kick-*** team and bringing this patient back

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