Drawing Labs without an order

[umnurs]

I work in a Level 1 trauma center in NYC. I only started a few months ago. We generally have anywhere from 4-12 patients at a time, so as soon as I get a new patient I try and line and lab them to expedite things (as do my coworkers). We recently heard a story from management that at another nearby hospital 3 nurses were suspended for "inserting an IV and drawing labs without a MD order." This was related to a lawsuit from a patient who ended up not needing an IV, but was "lined and lab'd" by the RN and went home to develop a staph infection at the site resulting in hospitalizattion, IV abx, and an I&D. The other 2 nurses were suspended when management did an "investigation" and found that they had done the same thing (as i'm sure EVERY nurse in that ED does). I dont know all the details or the "full story"...

So we were reminded that inserting an IV and drawing labs are "not in an RN''s scope of practice". We dont have standing protocols except for true "emergencies". i make the judgement call every day regarding which patients I out Iv's in and which one's i wait for the MD to see first. But sometimes it can take HOURS for a MD or resident to see a pt., and if i feel that the pt will need an IV and labs or may go bad-- i do it.

Anyone ever heard of this happening? What do you guys do in your hospital?

(and yes i know the ratio is bad but thats how it is everywhere in this crazy city!!)

[HonestRN]

Now that the whole post is there I really don't have an answer for you since I don't work ED. Sorry

[bjaeram]

We do it all the time. Obviously we do it on critical patients but we also do it on anyone we know will need one. Anyone with Chest Pain, ect...

I'm not exactly sure what our policy says about it or the exact criteria but I do know we have a standing order. Also our Physicians will always back us with an order. They are very good about that!

[fins]

There's a scene in the movie Casablanca, when the police captain closes Rick's bar. When asked why he replies that he was "shocked to find out that there is gambling going on at Rick's." Just then, one of the waiters brings him his gambling winnings for the day.

I always think of that scene when some administration "discovers" during an "investigation" something that they d@mn well knew was going on, and were fine with until they had to have someone to throw under the bus.

Before that BS "investigation" I guarantee you that any nurse who insisted on waiting for a doctor's order for all lab draws would have been run out the ED as not a team player.

[umnurs]

I totally agree.....

[wooh, BSN, RN]

Yep, be a team player, but don't get caught.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Wow,..would love to know where this happened and the "real" story. There are very, very few pts that come to the ER that don't need an IV or labs. We do have protocols that we often start in triage, most times if I'm drawing labs I put in a HL to avoid another stick later, et if I'm starting a line I draw labs, even if nothing ends up being ordered, I have them just in case. We have so many protocols that as a nurse I am completely within my scope of practice to follow a protocol and start a line. I'm not sure what you mean by "true emergencies", in the trauma center where I work, if you took the time to come to the ER you are treated as a "true emergency" until we prove otherwise. We have protocols for suspected pneumonia, abd pain, renal colic, chest pain, HA, extremity injury, pediatric vs adult fever etc, it is up to the nurse to chose the correct protocol for the pt and use it.

[nuangel1, BSN, RN]

we as nurses do this every day in my er gets the ball rolling .drs trust us its part of our protocol.of course we also use our judgement in not lining and drawing everyone.

[JBudd, MSN]

My docs would be asking why we didn't already have a line in.

[iluvivt, BSN, RN]

Technically yes but in the future have a minimum ER order set that can be based on admitting complaint.........Mds will be made aware and they can quickly sign it b/f nursing care proceeds. How far would nursing get behind if we waited for every little thing.....can you imagine patients waiting longer than they already do.

[canoehead, BSN, RN]

Administration can solve that problem if they choose to by adding a heplock prn to whatever protocols you already have. If they don't they are setting you up to catch their mistakes.

[RedSox33RN]

Yup.....damned if you do, damned if you don't. Don't start a line and get labs and they'll be wondering why you didn't, and if you do, you'll get the doc that says "I haven't made any assessment of the pt yet, so why did you??"

I will continue to draw meds and start a line for *almost* every acuity level 3, because that's what I was taught, and only one time has a doc ever said "why", but the pt ended up getting NS anyway.

I think it's ridiculous that we cannot use our assessment skills as we've been taught.