Interventions without MD orders

[Novo]

So today I learned that when I graduate I can do zero pretty in the way of medical interventions without a Drs orders, not including protocols/standing orders. I'm not sure why but I just kinda assumed that RNs were allowed to minimally invasive things like giving tylenol, maybe even start an IV (with rationale). So essentially does this mean nurses are pretty much limited to a hospital setting and can only really function with a M.D nearby for medical interventions that is. For example, lets say a palliative patients family hired you and you found they needed an IV started a home do you need to get an order from an MD?

Just wondering what the reasoning behind this is? Do Drs not trust nursing judgement? I just didn't realize what people refer to as "autonomy" is actually just protocols.

[Sassy5d]

What was that facility's protocol for hypoglycemia?

I'm going to guess the issue was more along the lines of them being upset that you didn't follow the established policy, ie maybe in that particular case the standing orders for low blood sugar dictated you should have given IM glucagon rather than the insta glucose.

I'll give you the benefit of the doubt and assume you deviated from the established policy because your nursing judgement told you the insta glucose was a better option than whatever the real standing order was.

I have deviated from my work's protocol in such cases when experience tells me it's okay to do so. But our doctor is okay with such minor deviations, provided he trusts the nurse in question's judgement. Just make sure you know what the "score" is at your facility before you do anything like that. When you deviate from standing orders you're potentially wandering into dangerous territory without any protection.

How about there was no protocol in place for hypoglycemia? I gave it without an order. I didn't call the doctor to ask before I gave it. I charted what happened, and the response.

Along came my next shift nurse. Although I did give the person something to eat, and the nurse knew I gave the instant glucose, she took their sugar, covered the reading with insulin and dropped their sugar down to eh, 20ish. Now there is a standing order for all diabetics to have instant glucose. I don't work there anymore and it's a lesson learned that you can't do much without an order.

[KelRN215, BSN, RN]

In home care you must call the doctor anytime there is a change of condition and document the change and any new orders. Nurse must obtain a doctor order for a social work referral. How long have you been in home care? Have you been through a chart review? Have you been through a state visit? Doctor offices document these calls. It sounds like your supervisor is not paying attention. In any event, i wish you well.

Well I AM a supervisor and yes, we had a state review recently and everyone who reviewed my documentation found no issues with it. A child's central line dressing becoming non-occlusive before a week is over is not "a change in condition." It's called your patient being a child and it's standard of care to change said dressing if it's soiled/non-occlusive. I wasn't making a Social Work referral. Medicaid does not pay for Social Work through a home nursing agency. Most of the time when I'm getting Social Work involved, it's through the state and I definitely do NOT need a Physician's order to call the state CPS as I am a mandated reporter independent of the child's physician. In the case I was referring to, I didn't say I was initiating a new referral for Social Work, I said I determined that a call to the child's existing Social Worker was warranted and the MD has nothing to do with that.

[hiddencatRN, BSN, RN]

I'm confused as to how you've managed to get through 2 years of nursing school before realizing that you will be practicing as a nurse when you graduate.