I work in long term care. This morning I had a resident complaining of constipation. She had been on several bowel meds prn before going to the hospital but she had been back from the hospital for 5 days and when she was readmitted none were ordered. I went back to the nurse's station and paged her doctor to get orders. He called back about 20 mins later and I got the order for her meds and was filling out the paperwork, faxing to pharmacy, etc. It was about 30 mins after she was complaining to me that she fell out of her chair (the other shift had taken over by now, she told me about the constipation on my last med round and I was wrapping this up before I left, instead of leaving it for the next shift like many do). She said she was so uncomfortable because of her constipation that she had to get up (and instead of calling for help like she usually does decided to do so by herself).
My unit manager was talking about me like I was a dog in front of everyone, saying it was nursing judgement to go ahead and give her some medication first and then call the doctor for the orders. She has fussed at me for the same thing before, because I have waited to get orders from a doctor before doing procedures that we need an order for (such as putting in a catheter). I was taught that we are supposed to get an order before giving any medication, even a tylenol but I see many nurses give unordered medication and either call later or more often forget to call and then I have to call in the middle of the night to get an order. I am not trying to give a medication with no order and be charged with practicing medicine without a license. What if you give the medicine and something happens, then the doctor says "I didn't give the order for that medication"--you know he is going to protect himself.
Do you consider it nursing judgement to give medication without an order before calling the doctor? (by the way, I would usually try prune juice, etc but this lady says prune juice, milk of mag, and even laxatives don't help, she wants suppositories and enemas when she is constipated.
