Administering meds (like Pitocin) without medical indication

nurse.sandi · Apr 28, 2011

Your question makes sense but I am sensing there must be more to the story of this patient. If there is not, my best guess would be that someone and I will not state who is in a hurry. I do not think it would be the floor nurse as they are paid hourly. I think as a new nurse you should ask questions in a gentle yet assertive way. Meaning, do not tell anyone they are wrong. You do have an absolute right not to push or give any drug you think is inappropriate. More advice, do not do it because your peer does it. This could lead to more problems. In some cases, if you do not understand...take the time to read up or google it and see what the lit review shows you. Good Luck. One last thought you can always just ask the nurse and Dr. why they are doing that. But not in front of the patient. If the hospital is a teaching hospital, they will be glad to share their knowledge.

meandragonbrett · Apr 28, 2011

II feel as if to do otherwise would be to compromise the Hippocratic oath of "first do no harm."

You, as a nurse, took the hippocratic oath?

mindlor · Apr 28, 2011

damnit mean you stole my thunder...

DebblesRN, ASN, BSN, RN · Apr 28, 2011

No nurse should administer Pitocin without a doctor's order. The nurse stating she was giving it to "get things going" probably had an order. We don't act on our own like that. I have NEVER worked a facility that allowed nurses to decide when pitocin (or any med for that matter) was needed to induce labor. Sounds like the nurse had info you didn't--because a lot of doctors will have a standing order for pitocin if labor is stalled, or membranes are ruptured for a period of time with no contractions or irregular ones.

Word of advice. NEVER GIVE A MED without a doctor's orders. CYA.

nurse2033, MSN, RN · Apr 28, 2011

You two kill me lol... Back to the OP, yes you can refuse to administer a drug, and your employer can refuse to continue to employ you. I disagree with your assertion that there was no medical indication. It's not like they're giving Pit to men or children. I do get the idea that YOU don't think they should be giving it. Questioning authority, convention, and tradition is awesome! Do it! But do it in a responsible and informed way. A nursing student or new grad is not going to be listened to by anyone. Learn the business and educate yourself. Once you have been accepted into the fold, then you may question practice, and hell- do your own research. You are right, there are way too many operative deliveries, but changing that is battle that has been underway for a long time. As I understand it, there is less chance of a bad outcome for the baby. People will do a lot to avoid that happening. And by people I mean doctors, who have to pay malpractice insurance. Good luck.

serenity729 · Apr 28, 2011

Haha, no, I know the Hippocratic Oath is a doc's thing, but I figure it could apply to nurses too...

You're right, there was probably more going on that I don't understand. I know I have a lot to learn...and as someone just essentially said, my best action is to watch and learn, which I will do because yes, nobody will listen to me, hehe. My own bias is probably playing a role in how I look at the situation. I'm just really surprised at how often pitocin is used. And another thing that put me off about this particular situation is that the nurse I was with didn't tell the patient any more than she told me about why she was giving the pit, nor did she tell the patient of any potential risks or side effects. So I think it was more than just the pitocin that was concerning.

Thanks everyone

fromtheseaRN, BSN, RN · Apr 28, 2011

my OB instructor told us flat out that she will stand in front of her pt's and physically block the dr from performing interventions(meds, episiotomies, etc) that she knows would not benefit her pt. she's the manager of her l&d unit, and says it is her job to advocate for her pt's, not for the dr's schedule. needless to say, i loved her, as did her pt's (she admits the dr's could care less for her).

nurse2033, MSN, RN · Apr 28, 2011

my OB instructor told us flat out that she will stand in front of her pt's and physically block the dr from performing interventions(meds, episiotomies, etc) that she knows would not benefit her pt. she's the manager of her l&d unit, and says it is her job to advocate for her pt's, not for the dr's schedule. needless to say, i loved her, as did her pt's (she admits the dr's could care less for her).

wish we had more nursing managers like her!

Esme12, ASN, BSN, RN · Apr 28, 2011

Haha, no, I know the Hippocratic Oath is a doc's thing, but I figure it could apply to nurses too...
You're right, there was probably more going on that I don't understand. I know I have a lot to learn...and as someone just essentially said, my best action is to watch and learn, which I will do because yes, nobody will listen to me, hehe. My own bias is probably playing a role in how I look at the situation. I'm just really surprised at how often pitocin is used. And another thing that put me off about this particular situation is that the nurse I was with didn't tell the patient any more than she told me about why she was giving the pit, nor did she tell the patient of any potential risks or side effects. So I think it was more than just the pitocin that was concerning.
Thanks everyone

Before you can enforce your own bias you need to gain exprience at the bedside irst. If you are going to refuse to perform or carry out an order....you better have the chutzpah and experience to back it up. You also realize that you cannot force your personal biases on the patient......you need to respect the patients beliefs and biases. Were you there when the MD told the patient the plan? Are you sure no one explained the risks ans benefits. Prolonged rupture of membranes has it's own set of complications........if your own convictions are sooooo against intervention perhaps you should look for an outlying birthing center.

Just remember when you graduate......you still have plenty to learn. Pay attention and don't criticize those around you....learn and grow.......good luck

CrazziiRN913, ADN, BSN · Apr 28, 2011

I know a l&d unit on the hospital where I had my daughter give pitocin to everyone in labor....I mean everyone I only know that because I did my OB rotation there.

linearthinker, DNP, RN · Apr 28, 2011

Is there any other field of nursing in which medications are administered to patients without a medical indication? I'm thinking, first and foremost, about Pitocin. I know there are situations in which Pitocin should be administered. While on my OB rotation, however, I saw the nurse administer it to patients just to "get things moving."
I am about to start working as a Labor and Delivery nurse myself. It is my goal for my practice to be based on evidence, not on convenience or tradition. Can I refuse to administer a medication without a demonstrated medical benefit to the patient? I feel as if to do otherwise would be to compromise the Hippocratic oath of "first do no harm." It seems that Pitocin increases the chance of operative delivery, so why would you give it to a healthy patient who doesn't have any problems yet?
I would appreciate hearing your thoughts/experiences. Thank you.

Well "to get things moving" is the medical indication, lol. No, you cannot really refuse unless it represents a danger tot he patient, or unless you don't mind being fired. It is not the nurses responsibility to discuss the plan with the patient, including the risk benefit ratio, etc., it is the PCPs. However, if the patient ASKED her a direct question and she blew it off, that is inappropriate. To respond to the heart of your question, are meds used for off label purposes in other areas, yes all the time.