do you actually wait?

yeah, i really do wait.

if i can't immediately get a hold of the doc, i'll call another one and another one, stating that i don't have the time to wait.

i know how tempting it is to start these interventions, but i just won't risk acting out of the scope of my license.

i have however, obtained standing orders for future emergencies.

leslie

I have to agree, I am still a new nurse, and I do wait and get ahold of the doc. In my case, the doc is usually the hospitalist and he is readily available if I need him. I will do O2, obviously if they need it; that is within our scope of practice. But, if there are not standing orders, I call first. I want to keep my license. LOL

basically why i transfered to critical care (with standing orders). was getting sicker and sicker pts on the floor, and working weekend night shift, it could take a long time to get a md response while pt is spirialing down. i couldn't take it anymore!!! those poor patients.

at on time, every weekend i worked for two and a half months i had to send a pt to the unit (usually back to the unit - had been dc'd to floor early due to lack of beds). :angryfire

since it has been seven years since i worked on the floor, i was wondering how thing were working now. they were getting progressively worse every year. i can't imagine being a floor nurse now. my hat of to you currently working med-surg.

Whenever I worked with an ER doc for the first time I would find out what his desires/expectations were of us. All but one wanted us to go ahead and start standard things like drawing blood, IV access if necessary (no fluids, just the access), EKG/X-ray, etc. Wheezers get a stat neb. In the meantime I'm on the phone saying "I got this and I've done this."

Med orders I always called first.

Have to admit there have been a couple of situations in which I started interventions before the doc called back. For example, I had a symptomatic diabetic pt c a BS of 20 that I started pushing D50% on before he called back. Another nurse finished pushing it while I was on the phone c him. He asked, "Is she symptomatic? Then give her some D50!"

I was sweating it some though. But her temp had dropped, she was lethargic, and becoming unresponsive. I didn't feel I really had much time to wait for a doc that may/ may not call back.

Addendum: a lot has to do with if the doc trusts the nurse, too.....if he doesn't he may not cover the nurse.

It depends.

I worked for over 17 years on an oncology unit with the same docs. They trusted me, and if there was an emergency, I took immediate actions I knew they expected while contacting them. I was able to anticipate most of their orders, and would notify the appropriate departments and give them a heads-up to have them ready while I awaited those orders. (our hospital never had a 'rapid response' team; I had discussed this with our DON shortly before I left. to my knowledge, they still don't have one) And our doctors always returned calls pronto, no matter what time of the night. As a traveler now, I'm more careful, but I will take action if necessary.

The gyn/onc told me a gazillion times to just write orders I needed (emergent or not), and he'd sign them ... I told HIM a gazillion times I couldn't just do that lol. He was a friend, and a great doctor and didn't mind one bit being called.

There are certain things I will do, such as O2, obtaining an EKG, and so on.

Just last night, had a patient's BP drop below 70's systolic. Initial thought was sepsis, but then he'd been cultured and covered and was asymptomatic otherwise. He had no IVF, so I put him on his head and hung NS IV and called the doc.

I guess the short answer is, it's on a case by case basis.

Wow- am glad that my facility has a lot of protocol/policy orders. For example to push D50 for hypoglycemia, and an urgent measure protocol that covers us for o2, labs, EKG, etc if the doc can't be reached.

~jen

before icu (where we have standing orders), when i worked on the floor, i would ask someone to page the md but immediately start drawing needed labs, place o2, etc., while waiting for the md to respond.

when the md called, i would report the prob and say i drew this-and-that and did such-and such and what else do you want?

this is one of the reasons why i love ed nursing. we are expected to intervene. labs are drawn, pt put on o2 and ivf (if needed) prior to the md seeing the pt. if, in a critical situation, we must (& i emphasize must) give a med, the md will write the order after-the-fact-----of course, this is a rare but sometimes necessary way to save a life. this is the only nursing specialty i have encountered where there has to be a team approach & the nurse is an integral part of that team imho.

Nope...I have no problem drawing for appropriate labs, dipping a urine, doing an EKG, starting O2 or a neb. I don't always order and send the labs, but they're available. I figure if the doctor says no, I can just pitch the specimen or rip up the EKG. A lot of the doctors I've worked with are more annoyed if you do nothing than if you jump in and start working the patient up. We also have a lot of great protocols that will back us up.

Wow!

You all have me wishing for more protocols. As it is, we have one for hypoglycemia and that's about it.

As for most of the privates I have learned where to draw the line. I will start a line and draw pre-eclamptic labs on a preggo with super high pressures, or start a line and draw CBC/TNS on a pt who is screaming along in labor and says she has a section scheduled in 4 days because her baby is breech. But would not hang Magnesium or ask a pt to swallow her Bicitra without an order.

On the other hand. I would do only the very basic stuff before calling the intern in July, August or September. That intern needs to learn what needs to be done in that kind of situation and having the nurse do it all really doesn't help.

(IMHO)

Prior to RRT's on the cardiac units we did a lot of things we just KNEW the doctors would order. You get to know which docs order what for each situation. Even had one tear me a new one because I called him without the RESULTS to the interventions he just assumed would be done. Once, I called with EKG, SPO2 and was waiting on ABG results. The cardiologist THANKED me, because he knew what needed done without having to wait for the orders to be carried out. Other docs, I wouldn't put on O2 without an order;)