Can ER doctors give dialysis orders?

[nursingisok]

I am so confused on this issue. I've been called in the middle of uckthe night only to find the er dr wrote an order for a pt to be dialysed and discharged. lucky for me i read the progress notes and it said the nephrologist was aware but i didnt see a consult on the pt. I called the nephrologist in the middle of the night (luckily i knew he was a nice one) and he gave me orders. So i dialyzed the pt. Other nurses h ave been in my situation and have fought with the staff saying it can wait till morning and that the nephrologist need to give clear orders and that the er dr cannot write dialysis order..only a nephrologist can. i know that is true but is what the hospital doing right? I'm so confused on this issue. The pts potassium was a bit high and thats why i proceeded to go ahead and call the dr. in the other cases of my coworkers..they have been called in the middle of the night for a fairly normal potassium of 5.3 (which is normal for a chronic kidney failure pt).

[Tish88]

good for you. like i said....i get my orders from a nephrologist. but an er dr CAN write stat dialysis. they are drs and we are not. but i obtain orders from the nephrologist when i arrive. i call trhem and bug them and i always get the orders because i look in the chart and see that the er physician discussed the case witht he nephrologist. i always look for that note. i think its good that u have 20 yrs in hemo.i myself however am applying to grad school. i dont want to do one thing for too long.

So basically you are saying the ER doctor is not writing the dialysis orders - you call the nephrologist for orders, based on the order from the ER doctor to consult nephrology for a dialysis.

I only do acute treatments per-diem now. I am currently an administrator for an outpatient surgical center.

Good Luck in grad school! :)

[diabo, RN]

Yeah, we get that all the time where I work too. When I ask for complete orders like QB, DF, heparin bolus and rate, uf target, bath, they usually back down call the nephrologist. We can't " make up" orders when they ask, "What do you normally do?"

That being said, when the patient has a potassium of 8 plus, and the nephrologist can't be reached, I will go out on a limb and write the verbal orders knowing that the Doc will back me up.