I'm having issues with a doc. She does not want IV's started on her patients-not even saline locks-unless she gives the OK. Most of our docs have no problem with it if someone is orthostatic, or if they just look sick, if we put in a lock and draw blood while awaiting orders. If I wait for her to finish with what she's doing it can take up to 20 minutes, and in the meantime the patient could be treated, and feel like they are being taken care of, even if no meds are given.
The last ER I worked in they had no problem with RN's starting a line, and in most cases if the patient needed one the MD would be annoyed if it wasn't already in and running when he/she got there.
If anyone has a link to ENA material that states their position I'd love to see it. I have their triage manual and it doesn't address the issue.
I am not sure if we have protocols or not, but have yet to have a doc get upset about us starting an IV. I like to go ahead, get my line in and get my blood drawn. That way if they order some meds (pain meds/zofran) or order some blood work, it's a quick thing to do. My biggest problem is forgetting to get a set of blood cultures if I think I will need them, but I'm getting better at that one!
If our patient didnt have a line and bloods drawn and sent before the MD sees them we would be in trouble! The only patients we dont put lines in is fast track type patients, and in peds unless they state they want the IV. My ER is too busy to wait for the MD to see the patient, and sometimes the wait time is like 2 hours to be seen. We have had new attendings try to pull that crap about no line before seen, but after a week of working there and them realizing that they are the only one who is falling behind, they changed thier tune pretty quickly If I were you, I would abide by her wishes, dont start the IV and when something happens to the patient, its her fault. Document up the butt that doctor refused IV before patient evaluation.
Excellent idea. I hate having patients brought back emergently and then waiting......for the doc before I can start their care. But documenting she declines the IV until pt seen, that is good for me, plus may prompt her to look at how long the patient waited.
Check and see what your dept's policy is regarding IV starts. Some places have standing orders allowing RNs to start IVs on patients presenting with CP, CVA symptoms, CHF symptoms, or abdominal pain.
If this doc is new, she will soon learn that her orders pile up and her patients stay longer in the ER than other patients. If she brings this up, let her know how you feel.
Meanwhile, these patients may have to wait. Depending on how your facility is run, you could get written up for performing an invasive procedure without a doctor's order especially if the doc ends up not ordering it.
I've never had an ER doc NOT want me to start a line. In our busy season, the wait to be seen is crazy...its not uncommon to have all the labs resulted and on the chart before the doc even sees the pt.
We don't have protocols for IV's but none of the docs I work with have a problem with the RN's getting stuff started before they see the pt, except for one. If there is no written, approved protocol, he won't let us do it.
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
I'd let Risk Mgmnt know about this, too. Maybe they can sort this out for you, and at least you'll be on record as having questioned this doc's policy.
This is one of those situations where we should not even have to ask the question. Starting a line is an invasive procedure and should be ordered by a doc. If, given the pace/wait time in our department, it is in the patients' best interests to have a line placed before the doc sees them, then the department should decide that and issue a protocol. If a certain doc has a problem with the protocol, then he/she can take it up with the hospital and the nurse doesn't have to get in the middle.
This is one of those situations where we should not even have to ask the question. Starting a line is an invasive procedure and should be ordered by a doc. If, given the pace/wait time in our department, it is in the patients' best interests to have a line placed before the doc sees them, then the department should decide that and issue a protocol. If a certain doc has a problem with the protocol, then he/she can take it up with the hospital and the nurse doesn't have to get in the middle.
I know when I worked at LUMC in the ER, we just line and labbed everyone. Drew a rainbow off of the IV catheter and had them ready. Everyone had either a lock or a 0.9 tko. The only ones we didn't touch were the obvious walking "wounded" who were looking for a note to get out of work or had some of the "simple" complaints...STD's, Colds, hands and feet. Our docs appreciated being able to work through the patients faster. Some considered it an afront that we were not using our critical thinking and assessment skills if we didn't have this done by the time they got to see the patient.
Specializes in Alittle of everything but mostly ER.
It sounds like this doc has power issues. Unfortunately, by the time this doc orders a lock or an IV the patient may be more compromised and the IV insertion may be more difficult. It only hurts the patient in the long run. The ER I work in uses standing protocols. I've seen more docs get bit in the butt by not giving up some of their "power" from not allowing nurses some slack to start IV's. I'm curious, is this doctor new?
If I were you, I would abide by her wishes, dont start the IV and when something happens to the patient, its her fault. Document up the butt that doctor refused IV before patient evaluation.
Aneroo, LPN
1,518 Posts
I am not sure if we have protocols or not, but have yet to have a doc get upset about us starting an IV. I like to go ahead, get my line in and get my blood drawn. That way if they order some meds (pain meds/zofran) or order some blood work, it's a quick thing to do. My biggest problem is forgetting to get a set of blood cultures if I think I will need them, but I'm getting better at that one!