Is OXYGENATION an INDEPENDENT Nursing function?

Gompers, BSN, RN · Dec 27, 2005

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.

Dervid Jungco · Dec 27, 2005

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

Thank you very much.

babynurselsa, RN · Dec 27, 2005

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

JaneyW · Dec 27, 2005

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 · Dec 27, 2005

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 · Dec 27, 2005

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.

papawjohn · Dec 27, 2005

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 · Dec 27, 2005

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 · Dec 27, 2005

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.

Undecided7 · Dec 27, 2005

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 · Dec 28, 2005

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....