I hate my supervisor

Part of critical thinking is making the decision to call the MD for these issues, and not to arbitrarily just hold 50 units of insulin from a very brittle diabetic because the sugar is low. Presumably the brittle diabetic is most likely an insulin dependant diabetic and at least needs some insulin, though maybe a different type or lower amount, ar a snack of a set amount of carbs before hand.

You can hold the digoxin for a lower heart rate, but if this is new situation for the pt, this may be an issue to notify the MD who may need to order a digoxin level. In addition, digoxin is presumably being given for a reason - perhaps the MD wishes to order a different med. Mag oxide is given for a reason - the pt still may need it, despite diarrhea. Are you going to let your pt suffer from a cardiac arrhythmia d/t serum mag of ohh, say 0.7, because they have diarrhea or you going to call the MD and maybe find a substitute med or get an IV dose ordered?

Recently I had a coworker that held a pt's stool softener because of loose stools. MD hits the ceiling the next day. Pt is very pancytopenic and has mucositis from stem to stern plus mucositis and we cannot risk this pt getting even small abrasions, or even minor bleeding. The MD is deliberately keeping the stools loose for that reason.

Current data shows that even NPO diabetic pts should get at least some insulin for proper management. Thus we are not supposed to just hold all insulin for the.

Yes, nurses are expected to have critical thinking. But we do not have prescribing rights and need to contact the prescriber when contemplating holding a med.

Following every Dr.’s order is not a guarantee to a lawsuit-free career in nursing. Remember that as a nurse, you also should lobby for your patients. If a dose or order is incorrect, do not give it…..you have to say something and have it corrected. If the order was erroneous and you carry it out and something bad happens to the patient-----guess what, it’s still your fault-----not just the Doctor’s (if he is at fault at all-----they'll probably grill you and say, why did you give it if you knew it was not right!?). I don't think answering: "Because there was no discontinue order and the Dr. that I paged didn't respond until three hours later, so instead of holding the med, I gave it because the order was active." will fly.

I agree with mauxtav8r. It's tough, but here you are open to constructive criticism ... kudos to you for that!

I never hold anything without calling the MD first. It's not my call to make. Nothing new in my response, just wanted to add my voice.

:jester:The right choice was made by the wrong person. That was totally the doctor's call. What has happened is we nurses protect the docs who don't want to be called instead of protecting the patient and our self. Next time call him, wake him up. At lease he has the balls to call you a fish to your face instead of writing you up behind your back and costing you your nursing license. In the long run you would be gratefull for the nasty attitude as oppose to the sweet face back stabber.

Now go and do the right thing.

So riddle me this batman...................

Standard orders include an order for heparin flush for CVL. CVL is running fluids, therefore I "HOLD" the heparin. Are you saying I have to call the MD for this? Get real your butt would never grow back. There are circumstances when you would hold a med without notifying the MD.

Per hospital policy I would have to call a doctor if I hold a medication or a patient refuses medication. I would say know your hospital policy and use common sense. You are not a doctor so can't just hold something because you think it's the right thing to do. Also the supervisor could have waited til you came to work to discuss the situation instead of ruining your night and waking you up at 2am.

I see both sides here...I too would have held that insulin. I have never been told where I work that we have to get an order to hold insulin on someone whos bs is 50...they tell us its nursing judgement. Now,if this pt is low 4 out of 5 am in a week...Id surely be on the phone or what not...telling the doc this is whats happening so far this week...what do we need to do about it? .....We give our insulins at 6 and 630 am....which I think is stupid since they dont eat breakfast til around 8am. But, again, where I work we have never ever been told that we cant hold a med, but we have been told that we have to document why we held it. Tough question. Good answers. Makes me want to question it at work also as we do not have nor have we ever had parameters on insulins to hold them.

Just found this post. I work on a stepdown floor and I would have held the insulin WITHOUT a dr. order also. Happens all the time on my floor. If I called the doctor about this, I work 7p-7a, I would get reamed from the dr. about calling this. We are expected to make our own judgement about this. I then would tell the dr. in the morning that insulin was held d/t low bs and he would then write or not write new order, whatever he decided.