No provider for orders

Personally? I'd send their happy butts out. (But I'm rather salty like that.)

Generally I call the on-call MD several times, then the non-OC MD. If I get no response, I'm sending the pt. to the ER. If it's a legitimate urgent/emergent issue and there's no provider to give orders, the only thing within my scope that I can do at that point is send the person to someone who can.

That's really the only reasonable course of action at that point.

And paying a nice ER bill tends to make the inability to contact an on-call provider show up loud and clear on management's radar, especially if it's a chronic sort of issue.

Regardless of the setting, RNs are trained and expected to be patient advocates.

I agree with the suggestion that if the MD does not respond after repeated attempts to contact that the RN must advocate for other treatment options for the patient.

If it were me, I'd do whatever I needed to in order to ensure the patient was stabilized, up to and including sending someone out to the ER, and then worry about squaring up paperwork with the Doctor later.

I'm alot more comfortable with being called out onto the carpet for taking matters into my own hands in order to ensure patient safety than explaining why a patient coded while I waited for a Doctor to give me appropriate guidance.

If it were me, I'd do whatever I needed to in order to ensure the patient was stabilized, up to and including sending someone out to the ER, and then worry about squaring up paperwork with the Doctor later.

I'm alot more comfortable with being called out onto the carpet for taking matters into my own hands in order to ensure patient safety than explaining why a patient coded while I waited for a Doctor to give me appropriate guidance.

Ditto!!!

My motto is "Better to be in trouble for doing too much than for not doing enough."

I feel like a genuine, good faith correct intervention through potentially unorthodox channels that results in a positive outcome is preferable to a "by the book" one that ends badly.

The key word here is "correct". What you are proposing is acting out of the scope of an RN practice, which has repercussions beyond a hand-slap by the boss. You could lose your license. And if your intervention is not correct (entirely possible considering it is an RN acting as an MD) you are in a legally indefensible position: Did you know you were acting out of your scope? Yes. And you did it anyway? Yes. And why is it you think you are the exception to the rules every other RN is bound by? Uh...the doc wouldn't answer the phone. And you didn't think there was any alternative other than to play doctor yourself? Have you heard of 911?

Where is the line? (outside of established protocols) Is it OK to give IV Zofran to someone vomiting? A CBG of 500 insulin who doesn't and hasn't ever had a script for it? How about an HTN med if their BP is sky high? You think they have a DVT, are you going to give them coumadin? Or perform an emergency trach or chest tube if someone can't breathe?

Nope, if I act within my scope, which includes passing off care to someone licensed to handle the situation, and there is a bad outcome, I'll have a clear conscious and a legal defense.

I would do what was within my scope of practice, and if there was no answer or return call from the on-call provider, have the inmate transferred out in a timely manner. What I consider a timely manner is based on the circumstances, it may be immediately. I wI'll not put my license on the line because I am unable to communicate with a provider.

I apologize if I'm wrong, but I don't believe I ever recommended stepping outside my scope of practice. I merely said that if the situation warranted, I would do what I had to to ensure a good outcome, e.g. send the pt to the ER. That's basically the only thing we're equipped to do in a serious-type situation anyway, and I fully acknowledge having a low "send 'em out" threshold compared to some at my facility. Obviously I'm not advocating initiating serious interventions on my own.