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.
Personally, I am a nurse who has had a renal transplant. My veins are really precious, I would hate to have one blown just because it's protocal. Also, with nosocomial infections I would not want to risk a hospital infection, if I did not need it. Maybe this Dr. has similar concerns before placing an IV. What area of medicine is she in?
Personally, I am a nurse who has had a renal transplant. My veins are really precious, I would hate to have one blown just because it's protocal. Also, with nosocomial infections I would not want to risk a hospital infection, if I did not need it. Maybe this Dr. has similar concerns before placing an IV. What area of medicine is she in?
Angie you would be a special case having worked in an ED at a transplant facility you presenting to the ER for any complain even remotely related to your transplant are going to get a full work up. That is going to including a full array of blood work- requiring at least 2 sticks ie 2 sets of blood cultures, a cath urine specimin and a chest xray along with admission 100% of the time.
As busy as this hospital was- ie you might be waiting an hour or two after you were in a room it could potentially be deadly/organ endangering to you if we did wait for the doctor before any tests were done.
Now at other places ie non-transplant hospitals I would definately wait for the doctor and you would be placed at the head of the line as far as pts waiting to be seen.
Bottom line thats what protocols and critical thinking are for.
I've had my transplant 23 years. Numerous ER visits. I have only had one set of blood cultures drawn. Urine specimans are almost always cleancatch,
Chest xrays are diagnosis dependent. I have never had the extensive workup that you are describing, it has always been the least invasive as possible. The only times I remember automatically getting IV starts was dehydration and chest pain related.
the ed I work in has very specific protocols, such as "abdominal pain non-fertile female or fertile female, abdominal pain male, focal neuro deficit/cva, asthma, lady partsl bleeding, chest pain, sob, ams, ill adult with fever, diarrhea/vomiting-pediatric, etc...". If the particular patient does not fall under one of our many protocols, we usually have free reign whether to start an iv or not. We have one docter that orders ivs, or at least ints, on just about everyone that comes through the door. And of course, the patient that you think doesn't need an iv until a docter sees them is of course going to arrest. that is what makes the ed so challenging and exciting to most that work there. we also order outside of the protocols when needed. if someone comes in with c/o dropped tv on left foot, we order left foot xray before docter sees them. most of the time, they have their xray before they even leave the waiting room. this practice expediates care. of course, ct's are off limit, d/t expense, without a physicians order. we give a/a nebs and tylenol to adult and pediatric pts with fevers without physician orders. any pt that needs ntg, morphine or asa needs a physician assessment, or at least the nurse needs to speak to a doc about this pt. the docs and nurses in my ed have a very open relationship and it is very easy to get verbal orders for a pt if they do not fall under a protocol. legally, nurses cannot order or initiate care without protocols or md orders. that is called practicing medicine without a license. very serious. do not think/believe that the hospital/ed you work in will support you, the physicians will not back you, management will not back you. you will be on your own in court.
Unfortunately, I would take a court date on someone who lived over being right for someone who died. Our hospital has no protocols, not even for chest pain or hypoglycemia on the floor. We have one doc for the ER, and she/he can easily get tied up elsewhere, or be waking from sleep when that chest pain/syncope patient comes in.
I understand that my license allows me to only start IV's with an order- but I'm just saying I don't like it at all. Over the past 20 years I've been able to start a line just on RN instincts that the patient might go bad (keeping in mind the risks of an invasive procedure). I guess I'm just bucking the reins a little.
Angie2B
2 Posts
Personally, I am a nurse who has had a renal transplant. My veins are really precious, I would hate to have one blown just because it's protocal. Also, with nosocomial infections I would not want to risk a hospital infection, if I did not need it. Maybe this Dr. has similar concerns before placing an IV. What area of medicine is she in?