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Is OXYGENATION an INDEPENDENT Nursing function?

Im wondering if I can oxygenate my patient at will... using my own judgement.

Gompers, BSN, RN

Specializes in NICU.

Im wondering if I can oxygenate my patient at will... using my own judgement.

Nope. Oxygen is a medication and must be ordered by an MD or NP.

Nope. Oxygen is a medication and must be ordered by an MD or NP.

Thank you very much.

babynurselsa, RN

Specializes in ER, NICU, NSY and some other stuff.

You should check and see if you have standing orders in place. Most places do.

JaneyW

Specializes in Perinatal, Education.

Although O2 is a med and needs an order, I was taught that this is one of those sticky things. Yes, there should be standard orders in place. For those cases where there is not and there is a standard of care for the situation and a prudent nurse would know to give O2 you can be liable for not giving it. Another fun catch-22 for nurses.

For example, I am an L&D nurse. The standard response to certain types of decels of the fetal heart rate is to give the mom O2 by mask at 8-10 lpm. All L&D nurses should know this--it is standard of care. If I don't have a standing order, I would still start the O2 and stabilize the patients (mom and baby)before calling the doc. Because we work as a team, another nurse might be calling the doc for me as I am doing this. Get it? That is why critical thinking is so very important for nurses.

Gompers, BSN, RN

Specializes in NICU.

Although O2 is a med and needs an order, I was taught that this is one of those sticky things. Yes, there should be standard orders in place. For those cases where there is not and there is a standard of care for the situation and a prudent nurse would know to give O2 you can be liable for not giving it. Another fun catch-22 for nurses.

For example, I am an L&D nurse. The standard response to certain types of decels of the fetal heart rate is to give the mom O2 by mask at 8-10 lpm. All L&D nurses should know this--it is standard of care. If I don't have a standing order, I would still start the O2 and stabilize the patients (mom and baby)before calling the doc. Because we work as a team, another nurse might be calling the doc for me as I am doing this. Get it? That is why critical thinking is so very important for nurses.

Well, yeah, there is a difference between giving oxygen in an emergency (like in L&D, during a code, etc.) and just starting a patient on a nasal cannula or something like that. I thought the latter is what the OP was referring to.

Of course if your patient is going down, you can give the oxygen because a doctor is soon going to be aware of the situation and if the oxygen needs to be continuous, it can then be ordered. But just deciding your patient needs oxygen for low sat and starting it on your own, that's not right. If there is a standing order to start it then that's fine, of course.

starcandy

Specializes in tele stepdown unit.

But just deciding your patient needs oxygen for low sat and starting it on your own, that's not right.
There are no standing orders on my floor but if someone has low sats I have always started O2 to bring the sats up and then I would phone the Dr.

Hey Y'all

I vote for the 'standard of care' side of this discussion. I had to spend 45min trying to get a Pulmonologist to call me back at 0300 this past (holiday) weekend. It was not critical time--just very bad ABGs that didn't need instant orders (thank goodness). But we went from 2l/m to NonReBreather until we got the orders to Intubate. Not doing ANYTHING would have been below the expected behavior in this case.

Just the same--you've got to know what you're doing and (as always) DOCUMENT DOCUMENT DOCUMENT.

Papaw John

rpbear

Specializes in OB.

Although giving O2 is not an independent nursing function, promoting oxygenation is. You can possition for optimal oxygenation and instruct on coughing and deep breathing without a Dr order. These things are independent nursing functions.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

You should check and see if you have standing orders in place. Most places do.

We have a protocol in place where an RN can oxygenate up to 2L NC and can wean to room air based on pulse ox. levels.

So in this respect it's independently driven. The protocol is supported by the medical committee, so it is not nurse-written but MD written.

Oxygen indeed does follow under the medications. But same as a dopamine or heparin protocol RNs can make adjustments based on nursing assessments.

O2 does require an order, but come on....any nurse that works in a hospital (I don't know about other places) hopefully uses common sense. I seriously doubt 2L/min via NC ever HURT anyone and even if they need more or a mask, you don't let the patient crash on you because you're waiting for the doctor to call back. Put the O2 on and THEN call. If it's something like just needing a couple liters, just wait for the doctor to come in and get the official order. Also, call the RT. They need an order just like you but they also use their "independent" judgement and can help assess the situation.

AuntieRN

Specializes in Med/Surg.

I too was wondering this Dervid jungco...as we were taught in nsg 101 you needed an order for anything including O2...however...in my second semester we were told you did not need an order for O2..when I questioned my instructor she told me not to be rediculous...if O2 is neccessary you do not need to get an order that it's part of the ABCs...now my third semester instructor informed us we needed an order...and they wonder why students are confused...LOL....guess it would be a judgement call huh? I mean...what seems emergent to one may not to another right? Like what parameters would some of you seasoned nurses use? O2 sat

I have to add something here...I love all you nurses...yall are always so helpful and knowledgable....Thank you for your time and sharing your experiences with us....

Lisa CCU RN, RN

Specializes in Geriatrics, Cardiac, ICU.

:confused: So, what the heck is the answer? I guess we go by the facility we are working at. :confused: :confused:

Gompers, BSN, RN

Specializes in NICU.

The answer is...

If the patient is deteriorating and needs oxygen, of course you give it. You just need to contact the doc ASAP to get an order for it if there is not already a standing order for that patient since it is a medication.

It's not an independent nursing function because it does require a doctor's order. Whether that order is obtained before or after the oxygen is started, that is beside the point.

not now, RN

Specializes in LTC, med-surg, critial care.

What Gompers said. Just this evening we had a woman drop to 67% on RA and we threw her on 2 liters via nasal cannula until the MD called back (he notorious for taking his sweet time with LTC) she went back up to 94%. When he called back he ok'd the O2 and we wrote the TO.

Perhaps oxygenation falls under the category of "interdependent" functions- you need a physician order to initiate your facility's established protocols, but after that you can use the protocol to guide your actions- for example, weaning O2 based on pulse ox parameters. There are some aspects of oxygenation that are independent- positioning, cough and deep breathing, applying O2 during emergencies etc.

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