I'm an RN who works at a small-town nursing home, owned by a large, multi-state company; I work nights--1745 to 0615 (or until the day is done--you know how it is). So here's the situation: geriatric pt with increasing edema. We attempt to contact the doctor but get his PA instead. The PA orders an increase in Lasix to 40mg po qDay x 3 days and a BMP with f/u with the doctor. The blood work gets drawn and sent to the lab the next morning and the first dose of Lasix 40mg is given. The BMP reveals a critical low potassium (2.9); results are faxed to the Dr. with a request for further instructions, which don't come that day. During the noc shift, I put the next dose of lasix on hold pending further instructions from the doctor and I fax him again and pass this on to the on-coming shift via verbal report. My DON comes in later, can't figure out why I would have held the lasix when it was a brand-new order, goes into a tizzy fit and COMES TO MY HOUSE!!! She pounds on my door, waking me up from a sound sleep, to demand to understand why I thought I could put a one-dose hold on that Lasix. She tells me that it was an inappropriate action on my part and orders the day shift LPN to give the Lasix anyway, apologizing to the doctor for my actions.
Here's my question: was I really out of line in holding one dose of lasix while waiting for further instructions on a critical low potassium? Did I overstep my legal authority as an RN? I did not d/c the order, only put it on hold pending further instructions. Is what I did so far from logical thought that it warranted her coming to my home and waking me up?
