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

Nurses General Nursing

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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? :rolleyes:

Just curious....

Interesting that no one admits to it. I would bet it's a lot more common than expected. I know I've been places where it's routine.

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Even if the larger dose is effective, not only is it illegal, it seems really unfair to the next nurse who comes on, thinking that 1 mg of Ativan was effective, when actually the first lazy nurse just passed on the mess to the next shift! I guess I don't understand why anyone would do that.

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apaisRN said:
Interesting that no one admits to it. I would bet it's a lot more common than expected. I know I've been places where it's routine.

In one sense I'm not the least bit surprised noone admits to doing wrong, but on the other hand, I'd bet many who insist they never would could, can, will, ect, in fact have in one form or another. When it comes to an I'm or IV med, I can say I haven't intentionally messed with the dosage. But let's use a PO as an example. A patient is ordered ambien 5 mg PO QHS; MRx1 in 1 hr if no results from first dose. Now let's say all your hospital stocks are the 10 mg tabs, so naturally you have to break it. More than likely you are not going to get a clean 50/50 break 100% of the time. So do you throw away the larger piece and give the smaller dose, or do you waste both and give it another try for that 5 mg dose? While this isn't as blatantly obvious (and illegal) as the OPs example, it is giving the incorrect dose, nonetheless. I'll go with 3rdShiftGuy on this one: I plead the 5th.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
AndyLyn said:
Even if the larger dose is effective, not only is it illegal, it seems really unfair to the next nurse who comes on, thinking that 1 mg of Ativan was effective, when actually the first lazy nurse just passed on the mess to the next shift! I guess I don't understand why anyone would do that.

Very well said.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
apaisRN said:
Interesting that no one admits to it. I would bet it's a lot more common than expected. I know I've been places where it's routine.

I don't know too many people who would shoot themselves in the foot. (I.e. ratting themselves out.)

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The BON might have something to say about "the nurse dose".

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Specializes in Neurology, Neurosurgerical & Trauma ICU.
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.

You've peaked my curiousity....can you tell us a little about what happened here?

We're not supposed to bolus either.

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NeuroICURN said:
You've peaked my curiousity....can you tell us a little about what happened here?

We're not supposed to bolus either.

The situation mattsmom alluded to was a very interesting one indeed. I was considering bringing this thread back up to see if there were any updates. I encourage you to read each post. This thread is almost like a novel with the reader gaining a bit more insight with each post.

https://allnurses.com/forums/showthread.php?t=48470

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Marie_LPN said:
I don't know too many people who would shoot themselves in the foot. (I.e. ratting themselves out.)

There's a certain degree of anonymity here, but you're right, I wouldn't admit to illegal and suspension-worthy actions either.

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Specializes in Neurology, Neurosurgerical & Trauma ICU.
psychrn03 said:
The situation mattsmom alluded to was a very interesting one indeed. I was considering bringing this thread back up to see if there were any updates. I encourage you to read each post. This thread is almost like a novel with the reader gaining a bit more insight with each post.

https://allnurses.com/forums/showthread.php?t=48470

Thanks for the link. I went to it, read it, and then posted at the end to bring it up to current. Still, I don't know what the REAL story was or even why they were fired? Administering without an order? Bolusing?

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Thanks for the link...I was looking for it too and couldn't find it. These can be complex matters...ie we have a titrate order but this may not include bolus doses. I have seen nurses get in trouble for this type thing , some don't recognize the 'slippery slope' they're on...specially with Diprivan, paralytics, and other drugs used in anesthesia which is a hot button these days.

I'm very careful to start first with policy. I've had situations where I've refused to do something because I was uncomfortable with the policy in place, whether written or 'word of mouth'. I have to make the best decision I can. Today my state has Safe Harbor for these situations.

Hard to balance sometimes....specially when we have a patient trying to die.

This is dangerous ground, but I will admit to increasing (or decreasing or holding completely) a dose/drug AT A CRTITICAL MOMENT. My goal is to cover it later with a specific doctor's order...as soon as I have a moment to call ...and I will only risk this if I felt it necessary AT A CRITICAL MOMENT. Should the doc NOT cover me, I have risked my license. So this practice also involves a lot of comfort levels, and anticipating what his order would be 'if he were there.' Again, a risky practice and not to be taken lightly, but part of the 'art' of my particular specialty, for sure.TV shows make the public think docs are around every corner and easily reached by phone, but we know better.

Written policies and orders including a range of doses or 'hold if's' are indeed the safest way to go and we should always strive for them.

Certainly some nurses will choose to NEVER do what I described above. This involves our own personal decision...how much risk will be assume? Varies from facility to unit to patient to doctor to nurse.

Interesting topic and comments from all on this thread. I will share this: I got in trouble once with a peer review committee (instigated by a coworker with a grudge). I was unable to follow a policy to the letter cuz it clashed with my sense of duty and it may have resulted in harm had I followed policy to the letter. Luckily, my BON sided with me but I lost my job. Sometimes we face hard choices and we follow our conscience. :)

Whoever thinks nursing is an easy job either hasn't been doing it long or hasn't been immersed in it fully, IMHO. I realize this is an uncomfortable topic for some. In the end we all have to sleep at night don't we.

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