EKG order

I doubt you would lose your license over obtaining a 12 lead ECG without an order?

Did you have orders for the O2 and nitroglycerin?

chare said:

I doubt you would lose your license over obtaining a 12 lead ECG without an order?

Did you have orders for the O2 and nitroglycerin?

Yep!!

In my experience a PRN order for an ECG has always been  included in the acute chest pain order set.  If it isn't, have you considered taking this to your facility's practice council?  It sounds as if the rapid response team could have done a better job in providing education, and the definately didn't need to bring up losing your license.

cepr4 said:

  But the rapid team told me I could lose my license for getting the first EKG without an actual order. Has anyone heard of this? 

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OMG. Well that takes the cake. No. I think there is zero chance you will loose your license for getting an EKG on a patient with chest pain! Frankly in a lot of units it is a standing order and you more likely to be in hot water if you didn't get one.  

Who ever it was on the "rapid team" that told you this is a power tripping jerk. 

cepr4 said:

Hi, so I'm a new nurse and had a question about EKG's and orders. So I had a patient that was having chest pain and SOB. VSS. Still put her on 2l NC to be safe, even though her o2 was good just because she was having short of breath and gave two tablets of nitro. I stat paged out to the doctor and got no answer. At this point I grabbed a more experience nurse and he told me to get an EKG. The EKG showed AJR, so I paged again and messaged the cardiology doctor this time too, who told me to get an EKG, but the internal med doc needed to put the order in. Basically I got the EKG before an actual order was in since the doctor was taking so long to respond to my STAT page. Once an order was put in, I got another EKG that showed NSR with 1st AV block. Long story short I had rapid team come up to look at the patient and the rapid doctor came and looked at both EKG's. But the rapid team told me I could lose my license for getting the first EKG without an actual order. Has anyone heard of this? I totally understand grabbing an EKG for no reason, but I was just getting it proactively before the doctor put the actual order in since I knew it was gonna put in, and the cardiologist also said too. Feeling a little discouraged because I didn't know this and wonder what other things I could do in hopes to proactive and help my patient could actually get me in trouble. 

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I doubt you would lose your license, or even lose your job. An EKG is non invasive, just like a bladder scan, or pressure bag for low blood pressure. It sounds ridiculous. 

From a European perspective, I am shocked you need an order for an ECG.

If I have a patient with chest pain, thoracic oppression, palpitations etc. and I feel an ECG may be useful I do one. I have never (in France nor in the UK) needed an order for an ECG. They CAN be a medical order, but it can also be a nursing decision to perform one. Nobody questions that and nobody gets into trouble.    

It's just this sort of BS that makes nursing a uniquely crappy job. 

That is BS. They are bullies and liars. 

While every state is different, O2 is usually RN judgement, even EMTs can admin oxygen without an order. EKG is standard operating procedure for chest pain. Some places doc won't come until EKG is complete. Was the The MD trying to cover up their "delay of response, aka care"? 

If your DON is is a trusted professional, communicate to them that this happened. Ask for specific protocol on EKG and  how long you 'must wait'  for response before stat page. 

At places where the ekg machine syncs automatically into the chart - you usually need an order in place to be able to tie the ekg to their chart. 
Some places you can sync it up later if you needed a stat ekg - pretty common in ERs where the patient comes in and takes 85 years to get registered so you just do the ekg while you're waiting because heart attacks don't wait for the registration lady to finish scanning the insurance cards for the toe pain in the next bed LOL

But you're gonna be hard pressed to find a board of nursing that wouldn't side with you on getting an ekg in an appropriate situation.

And you DID have an order - you had a verbal order from the cardiologist, albeit after the fact...

The thing I'm surprised you didn't get jumped on for was involving a cardiologist - unless you had standing orders for that, it's a decision that should be up to the hospitalist. Accelerated junctional and 1st degree blocks aren't butt puckering rhythms that warrant a page to cardiology unless you have a specific order to notify of any rhythm changes - and you'll quickly learn that the readings on the tops of EKGs are wrong a good 30-50% of the time. Honestly there's not a single rhythm that would cause me as the nurse to involve a cardiologist without a specific order in place - from NSR to 3rd degree to asystole, I'm dealing with the hospitalist on the floors and the ER doc if I'm in the ER. It's THEIR job to consult other docs. 
Definitely get the EKGs - but leave the cards consult to the hospitalist in the future. 

time to look for a new job, there's enough work out there to not have to tolerate a toxic or threatening atmosphere and every day you work there your license is at risk due to administrative incompetence, if there's a bad outcome they will not hesitate to throw you under the bus

And this type of stuff is the exact reason I and many of us could never work in the hospital environment again.  Nurses are constantly told they are the first line of defense, advocate for the patient, complete all the required education and ongoing CEU's, and more.  Yet when this nurse did exactly what most of us think she should have done, she's chastised.  Most of us know the incredible stress a nurse is under when she/he is observing a patient having significant symptoms (or going down the tubes we may call it) and trying to do umpteen things at one time.  

When my day comes, as it will for all of us, I hope I have a proactive nurse like this OP,  So I say thank you, cepr4!