Have you ever given the 'Nurse Dose'???

Audreyfay · Oct 4, 2004

I would never and have never. If I question the MDs recommendations, I ask right away, or call. If the dose doesn't work, then I call. They're the expert and they have the license. I don't ever want to be convicted of practicing medicine without a license.

tmiller027 · Oct 4, 2004

Ive seen nurses do a form of this with milk of magnesia in a nursing home. It may be PRN..so according to the nurse, the patient needs it until they are exploding out their butts....guess a regular b/m just isn't good enough, especially when yoru not the one cleaning it LOL

ERNurse752, RN · Oct 4, 2004

Some of our docs will tell us to give whatever we want or however much of something we want (usually with pain meds or vent sedation.) They'll write an order to titrate, or we'll just write down orders for what was given and they'll sign off. But it's a little different in ER with the docs right there, and the fact that we also know them all so well. If I didn't know the doc, I'd make him/her write the order first.

Kudra · Oct 4, 2004

never done it... never heard of it... i wouldn't DREAM of giving more without an order because i wouldn't want my butt hung out to dry if something were to happen... luckily, the doctors where i work are pretty open to suggestion and increasing orders if needed...

beth

zambezi, BSN, RN · Oct 4, 2004

ERNurse752 said:
Some of our docs will tell us to give whatever we want or however much of something we want (usually with pain meds or vent sedation.) They'll write an order to titrate, or we'll just write down orders for what was given and they'll sign off. But it's a little different in ER with the docs right there, and the fact that we also know them all so well. If I didn't know the doc, I'd make him/her write the order first.

Our docs do this as well...We have quite a few standing orders: ie: 2-10 mg I'm MS q 3hrs, 1-2 mg IV q 1 hour, 2-5 mg MS q 15 mintues, LOC, AOC, restoril 12-30 mg, inapsine 1.25-2.5 mg q2 hours, xanex .25 mg q4--depending on which set of standing orders the doc chooses, we usually have multiple orders to choose from for the situation...we have a whole long and involved haldol protocol, but we can give haldol until the agitation ceases (especially if the patient is critical)...As for vent sedation, we usually just titrate propofol until the desired sedation...if we are using ativan usually it is 1-2 mq q 1 hour prn agitation (or whatever time frame/med the doc chooses)

if our docs want something inparticular of course they write for it...if we have questions or the ordered meds aren't working for the situation we call...if the doc forgets to order ms and the patient has cp we usually just give it ( I work in a CCU) and call with the results of the ekg/ms/ntg, etc...

CRNAsoon · Oct 4, 2004

I think there's a big difference between a drug titrated to effect and a nurse giving more than ordered. I've seen nurses give more than the ordered amount just because it was easier to compute or because they felt that the pt "deserved" the extra amount so their shift could be easier.

I always medicate within the dosage ordered by the doc. If I feel the pt needs more then I ask the doc. Sometimes they agree and sometimes they don't, but that is the chain of command that we're supposed to follow.

anndoodle · Oct 4, 2004

That's a new one for me, "nurse dose". However, I had never heard of a "slow-code" until lately, either. I just started working in LTC 3 years ago, and our docs are pretty good about ordering what we need for our residents. If there's a problem, or we think someone needs more/less, we just call the doc and they order x 1 or give a new prn order for the med. They're pretty good about it. I myself about freaked out when another nurse explained what a "slow-code" was.....couldn't believe it!!!

Tweety, BSN, RN · Oct 4, 2004

I've seen it done before a couple of times. Back before pixis the charge nurse would sign all these wastes at the end of the shift. Many of the wastes she wouldn't witness, so I've seen a few nurses doses given.

Also not long ago a nurse who floated up the the ER blatenly did it. As a nurse was signing her waste she said "I'm giving the whole thing, he needs it."

It's very tempting when a doc writes for .5 mg of Ativan q6h for someone in raging dt's to give a little extra and it only comes in a 2 mg syringe and you've made multiple calls to the MD. I plead the 5th.

Katnip, RN · Oct 4, 2004

No, I've never given a "nurse dose." Never even heard of it, and wouldn't think of it.

That 1mg Ativan or 4mg Haldol are a lot more than "a smidge" for a lot of people.

NurseKimmy · Oct 4, 2004

i'm guessing by "nurse dose" you mean.. giving the pt more than is ordered for him/her. why? i mean.. why would i do that? i enjoy keeping my job. if i feel the patient would be more comfortable with a bigger dose, i call the doc and explain the situation.. get an order for it. with many post ops having running epidurals and such.. i start on the low end and see what shakes loose. i like stable patients. not ones that are crashing b/c i was feeling "med generous".

chris_at_lucas_RN, RN · Oct 4, 2004

Dinith88 said:
Are any of you guilty of giving a 'nurses dose'?
Meaning do you ever give a 'smidge' more drug than the md orders?
As in,
Dr orders 1mg ativan iv, but there're 2mg in the vial (and pt is whacked out)...so you give 2
Or, pt in respiratory distress..doc wants 40 of lasix...you give 60..
Or, 1mg haldol(once again, pt is whacked out)...you give 5 (ouch!) ..
Or.. you catch my drift...
Is this a fairly common 'phenomenon', or do the majority of us stick to the straight and narrow?
Just curious....

I resent this being referred to as "the nurse dose."

I would not call giving 500% of the ordered dose a "smidge." I would call it criminal--it is, in fact, battery and practicing medicine without a license.

A nurse who does what you describe is not a nurse. S/he is an individual biding their time until they lose the license they obviously should not have.

If you know someone who is doing this, you are obligated to report it.

If the patient is "wacko," your obligation is to effectively convey that to the doc, and get a verbal order, not take it upon yourself to "prescribe" on your own.

Read the accounts of the nurses who have killed patients and been prosecuted, Most were doing what you describe. A smidge. Yeah, right!

Here's a question for you: how do you account for the missing medication? Do you have a partner in crime who joins your lies about how much you "waste?"

Trauma Columnist · Oct 4, 2004

No - never heard of it nor would I ever give it!