EKG order

[cepr4]

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. 

[DallasRN]

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!

[abbnurse]

d'cm said:

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

That's exactly what I was thinking !   

[feelix, RN]

Look at your unit standing orders. EKG or vital signs are non-invasive assessment tools and a prudent nurse can use them as many times as they consider appropriate. Yes, the hospital may feel you used their equipment unnecessarily, but that is their internal resource problem. You did a wonderful job by obtaining two EKGs that could be compared. Don't take the team member's comments to heart, but do report them to whatever group in your hospital protects nurses.

There is no board of nursing in US who would investigate a nurse for obtaining an EKG. They might for NOT obtaining one and if that caused harm.

[ikimmybee, RN]

Why are they fear-mongering you with your license? They should be supporting you. It's not like you inserted a catheter or something. But, I'm only a student so that is just my rookie opinion.

[vampiregirl, BSN, RN]

Another thought... if the patient was having an inferior wall MI an EKG could have made a huge difference due to the risk of hypotension with nitro.

[BeenThere2012, ASN, RN]

Never heard of this.  You didn't cause any harm.

[DallasRN]

BeenThere2012 said:

Never heard of this.  You didn't cause any harm.

Me either.  Some people just like to go off on a power trip.  I'm old now and can recognize that most of those types often feel the most "powerless" and inferior.  I couldn't recognize that in my younger career days.  It can wear a person down having to deal with that sort of nonsense.

Even if it was an issue, take the "offender" aside and have one of those teaching moments, explaining why it's an issue rather than bringing licensure into it.  If it's an issue that could cause harm, report it up the chain.  Certainly not the job of any peer or rapid response team member to wield threats involving licensure.

[ponderingDNP]

cepr4 said:

But the rapid team told me I could lose my license for getting the first EKG without an actual order. 

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B-?! The initials BS(n) can have more than one meaning...now you know. You won't even lose your job unless Mario is traveling up and down the complexes and charging your hospital by the step.? 

 

[FiremedicMike, BSN, RN, EMT-P]

d'cm said:

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

It's just that sort of thing that makes the OP's nursing job a crappy job.

In the ED I work in, we self-initiate and write in orders all the time.  This includes IV's, labs, fluids, EKGs, etc.  I just realized the other day that I can add orders for IV pain meds (only discovered it because the doc was in the room with me, I promise it was a legit "verbal with readback" or however that reads in epic).  I took and entered another verbal order over the phone to enter a GI consult for a newly discovered lower GI bleed. 

I guess this thread makes me appreciate that our providers put a lot of trust in us where I work.

[Aesopian]

That rapid team person needs to go pound sand. Total Jerk.

[feelix, RN]

ikimmybee said:

Why are they fear-mongering you with your license? They should be supporting you. It's not like you inserted a catheter or something. But, I'm only a student so that is just my rookie opinion.

This is a common sense opinion you don't need a license to have.

[delrionurse]

FiremedicMike said:

It's just that sort of thing that makes the OP's nursing job a crappy job.

In the ED I work in, we self-initiate and write in orders all the time.  This includes IV's, labs, fluids, EKGs, etc.  I just realized the other day that I can add orders for IV pain meds (only discovered it because the doc was in the room with me, I promise it was a legit "verbal with readback" or however that reads in epic). 

Aren't they all orders per protocol and not self-initiated? In many places providers are aware of orders per protocol and the nurse enters them in.