Doctors orders for the small stuff and third shift

[tsm007]

This is driving me crazy and I'm not sure how you deal with this. I am a new nurse and an agency nurse right now. I float to 4 different nursing homes so far and I have so much to learn. My question for you veteran nurses is how do you deal with requests for things that are not in the standing orders, but things I don't really want to wake up a doctor in the middle of the night for. Here's an example, resident asks for saline nasal spray because his nose is really dry. I asked the outgoing nurse about it and she said "I'd just write an order for it." Then of course when I was asking the unit manager for help with it I get "You can't just write an order for that. It's not in the standing orders." So what's a nurse to do? Do I really need to call a doctor at midnight because this guy's nose is dry? I also ran into this with needing to put on a dressing on weeping cellulitis. There are protocals for skin tears, but not other dressings. In this case I did just apply the dressing. She had cellulitis in another area with a dressing and I wasn't going to let her leg sit, but I'm really frustrated on writing orders. Some nurses say I just write the order (knowing the doc will sign off on it), but others tell me right the opposite - you have to call the doctor for everything. I've ran into requests for cough drops and other simple requests. Do I just start waking the doc up? Do I tell the resident, sorry suck it up buttercup until morning? Do I just give it to them anyway and not write an order like I've seen other nurses do?

[Larry3373]

At one facility I work at they have threatened to report us to the board of nursing if we write an order without talking to a doctor first. It doesn't matter if they would be ok with us writing the order or not. At the other facility I work it is kind of expected for us to write certain orders, but it depends in the doctor. Since I work in ICU, the types of calls I make could be emergent, so I may not care about waking the doctor up. That's why they get paid the big bucks!