Has any dr tried to get you to do something outside of your scope?

[NurseyPoo7]

Had a doctor call me out of another pts room when I'm attempting to give meds and do my assessment this morning - I come out and he tells me another pt of mine is going to need blood and I have to call the POA and get consent... Uh. I know we cant get surgical consent and all that but I wasnt sure about blood, but I was pretty sure the answer was no way.

I ask our RN care coordinator and she says no way - call our charge nurse and she wasn't sure. I called another nurse experienced on our unit (btw, I have to call these people b/c our unit is ridiculously large) and she said "If the dr was up here, he needs to get off his lazy butt and do it himself!"

I looked up our policy on blood admin and it only said to ensure consent was signed. Finally called the supervisor and she said No and told me to tell the MD if he had a problem with it, to call her!

I really think this Dr tried to pull a fast one on me from his laziness or maybe he honestly didn't know.

Has any dr tried to get you to do something outside of your scope?

[ohmeowzer RN, RN]

i've gotten consent for blood from a POA before on the phone, it has to be a 2 nurse consent to sign it, another RN and I called the POA and she gave consent for both of us. we both signed the consent and i gave the blood. no problem...

i have had dr's try to take advantage of me ... i had one dr try to tell me how to chart... i turned him into the dept manager...

some of them have the God complex ...

[queenjean]

We get consents for blood all the time. We always witness consents, but aren't the ones to introduce or explain whatever procedure is planned.

I used to work for a doc in an out of hospital setting for whom I have performed tasks that were technically outside of my scope of practice; but not outside of hers, and I was assisting her (so then I'm not sure if it really counts?), and the few times that these situations occurred it was pretty much a matter of life or death, or at least life or morbidity, so I didn't care whether I could technically perform the procedure or not.

[UM Review RN, ASN, RN]

Lots of times a doc will order something that's not appropriate for our unit -- for instance, IV Labetolol.

One doc wanted to scope a patient at bedside and ordered me to start giving Versed. I couldn't -- that was another no-no on our unit. We had to get an ICU nurse to help with the procedure.

I could see why the docs would get a little confused. Versed was OK on stepdown and ICU, but not tele.

[pagandeva2000, LPN]

I haven't had doctors tell me to do things out of my scope of practice, but have had plenty of nurses try.

I am an LPN in NY. Here, we cannot touch central lines for any reason. The state specifically says that all we can do is gather the equipment. The only IV pushes we can give are normal saline and Heparin. My first day working per diem on med-surg, there was a patient who had a central line. I didn't know it at the time, but after I set up the IV medications and went into the room, I searched for a peripheral line and didn't find it. Went to the RNs and asked them where it was, and they showed me the central line. It was totally unfamilar to me, because we don't even learn it at school (read about them, though). I told them that I was not shown this during orientation, and did not learn it in school, therefore, I did not feel safe giving it. I was told "Other LPNs do it" and I asked for the policy that stated this, and no one was able to produce it. I went home that night and emailed the BON of my state as well as one of my old professors. Both responded back and said "No way". In fact, the state sent me their policies and I promptly made copies and bring it with me each time I go in to work (because I've been asked a few times to do it).

I stated to them that I cannot control what other LPNs do with their licenses, but I don't want to take the blame for doing something out of my scope, because if something happens, both, the RN and myself will be in hot water-me even moreso, because it is my responsibility to know what, who and where to ask if I am not sure. It wasn't about not wanting to be a team player, but it is safer in the long run to follow policy when it comes to these things, because I cannot guarentee that any of them would have had my back if I went ahead and did it just because I wanted be requested to work with them.

[Burnt Out, ASN, RN]

Yes, several times.

One thing is doctors wanting us to give Versed on call to surgery or cath lab. We can't do it without being properly trained/certified. The only time we can give it is if an MD is in attendance and they are on a monitor.

One particular surgeon kept wanting us to irrigate a chest tube. We told him NO WAY!

Another is some doctors want us to run dopamine: per policy we can do dobutamine as long as they are on telemetry although we do not like to do it.

[sissiesmama, ASN, RN]

Hello - Good topic. While I was working on a med-surg unit, I actually had a surgeon call me from his cell phone. He actually told me he was on the golf course and his "tee time" had been delayed. He could have at least lied, "I'm in OR, ER, something, to make it sound a little better!

He had a patient going to OR the next AM for a BKA and actually told me that "I don't like the family and the patient is crazy, always asking uestions." Well, Gee. I'd be asking questions too if you were about to cut off my mom's leg!

But, anyway, he wanted me to explain the surgery and get the consent signed. Of course, he got POed when I said no.

I also had a MD place a central line at the patient's bedside and did not wait for cxr to confirm placement. The patient was on CVL TPN and Lipids and he went ahead and hooked all of it up and started them. When the CXR report came back, the radiologist called me and stated "Don't touch it. Call the MD and tell him he placed the CVL in the carotid artery. Make sure no one starts any IVF through the line." He freaked out when I told him the MD(who was notorious for bad line plmts anyweay) hooked up everything and left. Of course, when I called the MD, he was like, well, you can pull it. Just put a bandaid on it."

Oh, no I won't either!

Anne, RNC

[jlmb214rn, BSN, RN]

Of course, when I called the MD, he was like, well, you can pull it. Just put a bandaid on it."

Oh, no I won't either!

Anne, RNC

Holy Crap!!! Thats insane! Sure, just pull that big honkin tube out of his carotid ARTERY!!! And put a BANDAID on it??? It's hard to say what would be worse for the patient in that situation. Sure, you could refuse to do it, but if the doc was gonna put a Bandaid on it... you may have been better off doing it yourself! The right way!!! (I still wouldn't have done it tho. Just saying)

[jlmb214rn, BSN, RN]

Your profile information says that you are an RN. As an LPN, I know you are not authorized to handle blood transfusions, so I can see why you wouldn't be able to obtain a consent for one.

But unless is it just a facility policy wherever you work, an RN is legally authorized (at least in my state) to obtain and witness consents for most all procedures. As an RN in my facility, we are responsible for obtaining consents for blood transfusions. That includes educating the patient on the procedure and obtaining a signature. As far as surgical consents, we are responsible for obtaining the signature, but the MD initiates the education and explanation beforehand.

[Scrubby]

A surgeon once tried to get me to insert an laparoscopic instrument down a port during surgery because he had no assistant. I told him that I have not had the training of an RN first assist, and don't feel comfortable in case I was to perforate an organ.

[sissiesmama, ASN, RN]

Holy Crap!!! Thats insane! Sure, just pull that big honkin tube out of his carotid ARTERY!!! And put a BANDAID on it??? It's hard to say what would be worse for the patient in that situation. Sure, you could refuse to do it, but if the doc was gonna put a Bandaid on it... you may have been better off doing it yourself! The right way!!! (I still wouldn't have done it tho. Just saying)

My thoughts exactly!!! And I had never seen a CVL in the carotid artery before, thank goodness, but You could see the TPN and Lipids both just pulsating back and forth in the tubing!! And the way the doc sounded on the phone when I called him with the results. And yeah, like a bandaid would fix something like that?!!

Anne, RNC

[nerdtonurse?, BSN, RN]

I had a pt with a abdm surgery, heart that bounced between afib and a flutter all the time, 7 days post removal of half his large intestine, still on a rectal tube over a period of 3 days. The incision looks like it's going to dehisce to me -- staples down the midline and the skin is making "figure 8's" around the staples which "breathe" as he breathes. I call Dr. Wonderful at least 3 times during my 2nd shift with the patient, asking him he's come see the pt, who is now febrile, has had a LOC change and just looking like he's going septic to me.

Dr Wonderful comes in all PO'd because I've got my NM into the room, showed her what's up, and she's called the doc after he hasn't returned my call for 8 hours. He looks at the pt, never touches him, never palpates the abdm, and says, "oh, just take all the staples out" and leaves the room! I follow him out into the hallway, and I told him NO SIR, I'm worried the pt will dehisce and eviscerate (at this point, you could see tissue trying to herniate thru the spaces between the staples). I would get the supplies for him to do it, but I wasn't about to. He starts yelling and cursing at me, and I told him I didn't care how loud he screamed, I was not going to do it, and would document his request. He storms off, screaming he's going to get me fired. My NM is curiously unavailable (read: hiding).

Well, next shift, he calls in and tells the charge nurse he wants HER to pull the staples -- not the pt's nurse, his buddy that he cheats on his wife with. She does, and surprise! the pt dehisces, and then eviscerates about a 2 foot section of small intestine. He made sure nothing happened to her for doing it, but I know I would have been thrown under the bus if I'd done it.

BTW, the hospital severed his contract because he's got 4 outstanding lawsuits involving pt deaths. All we could think of was, "only 4?"