Start with the basics:
1. Did you carry out all orders before change of shift? You said you didn't see any "now" orders and there were no other meds ordered other than Protocol-PRN meds.
2. Was pt. in acute respiratory distress? You said pt. had mild wheezing and some low sats and you took corrective steps (NC, Nebs).
3. When you handed off at shift change, were you comfortable with it? Pt. was relatively stable and oncoming nurse should be able to assume care.
3. and Check
I see nothing wrong.
The only think I'm slightly confused about is that you mention being worried about 'not informing the Doc' but you also mention 'standing protocol for Nebs for SoB in the ER'. Soooo, where were you working? On the floor or in the ED? If you were working in the ED, why would you need to 'call the Doc' - aren't they right there in the Department? If you were working on the floor, how can you use ER standing orders?
Just a little confused
Quote from RN-Cardiac
Then there is the whole issue of who is really caring for this pt now,.the ER doc or the admitting doc?
My understanding is that if admitting attending/hospitalist/resident has written orders for the pt., then they are now responsible for the pt's. care. If I need something or if there is a change in pt. condition, I have them paged.
I don't bother the ED doc unless it's a critical emergency (FDGB type scenario).