An RN changing meds without a doctors order?

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A nurse I work with is continually changing patient's medications (cardiac, bp, etc.) without prior consent from the patient's physician. She is a complete "know it all" and doesn't even document the changes in writing. Well, one of the patients had some problems and ended up in her local ER, and after the patient told her doctor that "Sally" had changed this med and this med, and that med, the doc called "Sally" on it and "Sally" lied to the doc and stated she didn't change any meds, or doseages, just what time the med was taken. (NOT TRUE)...so now the family thinks the patient is losing her short term memory!

I am completely frustrated and did go to my administrator about it. "Sally" told the admin that "nosonew" didn't know what she was talking about! And because "Sally" brown-noses to the hilt, admin isn't going to do a thing about it.

Any suggestions?

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I would never think of jeopardizing my licence like that. I can't believe the administration has turned a blind eye to this. Well, all i can say is that this situation is a lawsuit waiting to happen. :uhoh3:

Also to save your own butt, document and record the time & dates that you spoke with admin. about this. Take care!

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Specializes in Neurology, Neurosurgerical & Trauma ICU.

Eeek! If this person is truly doing doing this, then this is not only dangerous, but unethical and illegal!

My only advice to you would be to document what you specifically witness and hear what she says. Then, present it again to mgt.

Good luck.

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Wow. I will change meds like give the Lopressor a couple hours early if the patient is hypertensive, or only give half a dose and wait to see how they react before giving the rest. I believe these are within the scope of practice, at least the second option. With the first option the pharmacy, not the doc, chose the scheduled times, and I doubt the doc cares if I give the BID med at 1800 instead of 2000.

But this nurse sounds really scary and dangerous. I'd keep watching her, and document date, time and details of every incident you witness. When you have a few more you can go to management. They might blow you off again, but less likely. Also, you could possibly tell the doc what happened -he/she would probably be livid and might be more likely to take action.

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Yep, I must start documenting better (I keep a log on my computer at home), and I guess the reason why this issue has me so bent out of shape is that she lied about it to the detriment of the patient. I know if the family tells me they are considering moving her to a nursing home, I am going to have no option but be the patient advocate and inform the family. **On a good note, the admin did tell this nurse to "let the family know of any changes" and that has to be documented...so I will keep an eye on that to see how she documents her future changes. Should be interesting.

**And absolutely NOTHING against ICU nurses (this nurse used to be one for over 10 years) but I think that is where all of this is coming from. She has stated numerous times that ICU nurses generally KNOW MORE THAN THE DOCS when it comes to meds and what is best for the patient! Yep, that is her motto. I guess she thinks she can adjust the "ICU" letters into "MD" to suit her needs. Not to mention she hates charting or documenting anything, stating "I hate writing". And admin, of course, does nothing about it. I write a nurses note for everything....I call it "CYA charting". LOL Thanks for your input...

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Here's another thought.... I believe you can report to the SBON anonymously. Let them know what's going on with this nurse and I'm sure they'll investigate. You cannot change meds or doses without a MD order - to do so is outside the scope of practice.

I agree with previous poster about say...1/2 Lopressor dose but, even then, if I give 1/2 the dose and pt wouldn't tolerate second 1/2 of dose, you better believe I'm calling the doc for a one-time order for the 1/2 dose I gave. If you don't get this order, you are practicing outside your scope. Better to not give the med due to "clinical judgement" than to change the dose without MD order.

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I agree with previous poster about say...1/2 Lopressor dose but, even then, if I give 1/2 the dose and pt wouldn't tolerate second 1/2 of dose, you better believe I'm calling the doc for a one-time order for the 1/2 dose I gave. If you don't get this order, you are practicing outside your scope. Better to not give the med due to "clinical judgement" than to change the dose without MD order.

What if it were morphine and the patient was ordered for say, 4 mg (not a range like 2-4), but they were little and frail so you started with 2? Would you get an order for that? Or would that be different because it's PRN?

I am an ICU nurse and sometimes we do do things without an order, in the patient's best interest. I had a 250-pound man (I'm 5'2 and 130) in raging DTs trying to climb out of bed and swing at me last week - he got 4 mg Ativan and THEN I got the order. You develop a certain rapport with the docs where you usually know what they'd be okay with and where they'd draw the line. In return, they trust you to know when you're in over your head and you need to call them. And of course we do titrate scary stuff like dopamine.

None of this is the same as manipulating a patient's meds, not telling the doc, not charting it, and lying about it. ICU nurses do tend to have more knowledge and confidence which can lead to arrogance, and some can be pretty obnoxious. But obnoxious doesn't hurt patients, poor care and lying does. I don't care if she used to be the Queen of Sheba, she still needs to stay within her scope of practice.

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Totally agree. I have at times had to make a judgement call regarding something I need a doctors order for, do what I know he/she will back me up on (due to good relationship) and then get the order. (Like holding a bp med due to low bp) I don't have an issue with that. It is about lying. And if the behavior continues, I will report her to the SBON...I won't have a choice will I?

I have always been a strong patient advocate since I graduated over 10 years ago...and this just disgusts me. Thanks for all the advice and support. I love this site...glad I found it!

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What if it were morphine and the patient was ordered for say, 4 mg (not a range like 2-4), but they were little and frail so you started with 2? Would you get an order for that? Or would that be different because it's PRN?

Absolutely, I would get an order for it. But, like you, I'm also an ICU nurse and know I can get the order later. You still can't change a dosage and not follow up by getting that MD order. Suppose you gave a 1/2 dose of say, Lopressor, and never got an order for the reduced dose -- and then the pt had a hypertensive episode resulting in a cerebral bleed...guess who's butt is on the line. Not the MD. All that is documented is that the doc ordered something and you didn't follow the order.

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Which is pretty much what happened in my situation. She changed the meds, patient was experiencing a hypertensive episode, went to ER...etc, etc. No doctors order for the change...and the ER doc and her reg doc didn't know what the heck she was taking or who ordered it/changed it, etc. Just amazes me how any RN (regardless of their specialty) can be so "above the law", kwim?

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If what you say is true I'd document it with copies to your facilities administration and your state board of nursing. Again, If what you say is true she's practicing medicine without a license and could hurt someone.

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You could always report it right up the chain of command. Report it to someone so that they can't ignore it.

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