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

[Dinith88]

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....

[oramar]

I have heard of it, I have heard of it and have had people urge me to do it. I didn't do it but I sure has heck made sure the Ativan was not on the light side. It is just as easy to draw up a little less than ordered than a little more if you are not giving it all you attention.

[mattsmom81]

I will ask for a range of doses depending on the situation. In ICU most of our docs work this way so we don't have to ask. Such as 1-4 mg Ativan IV prn agitation, use smallest dose effective. They count on us to be cautious. A little foresight helps too, such as asking for a 'may repeat x 1' order for anxiolytics, sedatives, etc. Nurses need to be careful about practicing medicine without a license. Its a real slippery slope.

There was a sad case last year where ICU nurses got in serious trouble for routinely administering 'bolus' doses of Diprivan ordered as a drip. This is a good reminder not to overstep into prescribing.

[missmercy]

This "nurse dose" you referr sounds a bitl illegal to me, and dangerous, and unethical and wrong. Sure, as nurses we can exercise our crithiacl thinking skills and good judgement WITHIN OUR SCOPE OF PRACTICE -- which does NOT include prescriptive authority in most cases!!! Meds can only be given within the parameters the physician ( or other licensed pratctitioner with the correct training and accreditation) sets! A nurse can choose which dose best fits the situation and patient's condition ONLY if the order leaves room for that --ie: range orders. Outside of that, He/she would be opening themselves up for lawsuits, and tremendous grief and guilt -- not to mention termination and losing one's license to practice!!

I too find the term "NURSE DOSE" a bit offensive. A "Nurse Dose" should be considered the dose specified within the parameters set by the physician!! What you refer to should most definately labeled something else..."malpractice dose" perhaps.....

[laughingfairy]

When my mother was working in a psych facility a nurse was fired and lost her license over something like this.

They used stock meds instead fo unit doses...so (by the way this was a geriatric forensic psych ward) when every one would start getting wild she would dose everyone with liquid risperdal. No one paid any attention because it didn't happen every day or even every week, the bottles weren't counted, the bottles were huge and frequently got spilled.

My mom said she understood sometimes and that sometimes it was real bad. She would joke that it would have been easier and safer just to fill a water gun with the stuff and shoot at everyone from the nurses station. But it was just that, a joke. She always would speak of the dangers involved and taht it was illegal.

[CCU NRS]

I agree this would be practicing medicine, I didn't think you would get anybody to say they were doing this, I had never heard it refered to as "Nurses Dose" although I have heard some stories about some of these things. Ativan ordered 1mg in a 2mg vial is I beleive the most frequently heard tale.

I have also heard some of the more veteran nurses speak of giving a drink concerning IV gtt's like the pressures were really low and the Dopamine wasn't really touching it so I gave a little drink (meaning W/O very briefly) to help bring it down, also drink of Diprivan to get treatment started, I too work I/CCU where our orders are titrate so we have some autonomy

[CRNAsoon]

mattsmom81 said:

There was a sad case last year where ICU nurses got in serious trouble for routinely administering 'bolus' doses of Diprivan ordered as a drip. This is a good reminder not to overstep into prescribing.

I've seen this done many, many times and have been encouraged to participate.

[P_RN, ADN, RN]

Have I? No no no no no no no no no NO!

Would I? No no no no no no no no no NO!

Nurses administer, Nurses do NOT dispense!

[TiffyRN, BSN, PhD]

I've never heard this as "nurse dose". I've seen slight "fudging" that would be something like 10% more than ordered amt. I never saw things like giving 2x to 5x the prescribed dose. Much better to deal with the doctor and get an increased dose. I know some docs just can't be reasoned with but I wouldn't want to open myself up to risk over something like that.

Now that I work NICU there is absolutely no room for fudging any at all, all doses MUST be given exactly to the last 0.01ml.

[Jolie, BSN]

This whole discussion makes me sick to my stomach! In 11 years, I never heard of or saw this done, thank Goodness. It seems to me that the difference between giving a "nurse dose" and outright euthanizing a patient would be just a few mcgs.

It is this type of action on the part of a few bad apples that casts a pall on our entire profession.

[Marie_LPN, RN, LPN, RN]

Heck NO i don't! Not only do i lack the knowledge to do that, i lack the licensing required. It is NOT up to me to 'fix' something like that.

Edited to add: "NURSE DOSE" offends me as well, what it SHOULD be called is ILLEGAL

[leslie :-D]

they're nothing but nursing doseholes.

[TracyB,RN, RN]

WOW!!! I have also never heard of this... fortunately.

Only a few times have I had to even call a doc to get a repeat order for something.

Sorry, I need my license & wouldn't even consider doing something sooooo stupid.