Nurse pressured to admin IV lasix by DON w/o notifying MD

Lacie, BSN, RN · Sep 16, 2009

No way would I take a verbal order from another RN (DON or not)!! Is there standing orders for this by this MD? If not NO WAY! I've had this happen to me in Dialysis and told the Admin with Abx and I told her if she wanted something administered without an MD order she could write the order and give it herself! It's not worth your license. I would be contacting the BON to clarify this and get it in writing and challenge it. I know jobs are hard to come by right now but if you loose your license or end up in a malpractice suit you may never work again. That is no different then practicing medicine without a license and is considered prescribing. I learned my lesson 20 years ago over something as stupid as Mylanta and lost my license for 4 months for it. I didnt call the MD to ask if I could change it from Maalox to Mylanta and the pt wanted Mylanta. Working in Critical Care I wasnt going to wake up the doc at 4 am to ask. Wrote the order but MD forgot to sign it. Big mistake that cost me alot over something many of us take for granted. I wouldnt give a tylenol without the MD after my experience!!!! Not worth it. By the way I am in Florida also and this is unacceptable to the BON.

Katnip, RN · Sep 16, 2009

Unless the DON has prescriptive privileges or there are standing phsycian orders, no way. It's illegal. Document and report it to the BON and CMS. Same goes for the nurse pushing Lasix.

RN1982 · Sep 16, 2009

Katnip is correct. The nurse is wrong for administering the IV Lasix. The DON is wrong for ordering her to give the IV Lasix. Both, if reported would be in trouble and to be honest, they should be reported to the BON. No excusing either of their actions because they were both at fault. JCAHO and CMS need to be notified immediately. If people grew balls and did so more often, I'm sure more LTCs and their DONs wouldn't be getting away with their actions.

SpringerCab · Sep 16, 2009

20 years ago something similar happened to me in Texas. The administrator and owner of the LTC I worked in would call the doctor and get an order if their was a resident he felt was too "loud". He would then go to the DON and tell her what to write. I questioned it and said I don't mind taking an order if the DON talks to the doctor and writes the order but I will not take an order that the administrator received. I told him if he is allowed to by law I would take the order. I agree about not putting your license on the line for anyone, because it is your livelihood that is at risk.

lisamc1RN, LPN · Sep 16, 2009

Um, no. No way. No how. It's even hard for me to wrap my mind around a DON who writes her own orders for IV Lasix. It's just as easy to call the doctor and get a real order for it as it is to get an illegal one from the DON. Why would they risk it?

dizzejan · Sep 17, 2009

Yiikes!!!.....follow your scope of practice at all times....holy cow!!! :smackingf

SunnyAndrsn · Sep 17, 2009

Absolutely not! I would leave this facility ASAP.

It is completely out of the scope of practice for a RN to give an order to another RN telling them to give a medication. If it's not on the house standing orders, don't do it.

PERIOD.

I have only one time EVER followed an order from our DON. She told me not to wait to send a pt. to the hospital. I had already called the primary and could not get a call back. She told me, that per our medical director (an MD) she had the authority to send someone to the ER if in her clinical judegment she thought it was necessary.

I sent him, and was very glad I did, he almost died d/t blood loss.

I work in a nursing home rehab center in Florida. Administration has a policy, that nurses are to call the DON before we call the doctor or 911, if we feel a patient needs to be sent to the ER for any reason.
The DON instructs the nurse on how to treat the patient if possible, (like giving them Lasix IV if they're severely congested w/CHF or a COPDer), and the nurse has to write the order. It's a cost/revenue saving measure. The facility loses money for every day that person is in the hospital. A few days ago, close to change of shift, I overheard that the Nurse manager had given a resident IV push Lasix, because she had suddenly developed CHF; was extremely congested. She was fine the day before and her admit dx. was s/p suicide attempt, she also had COPD and HTN. She was at our facility for wound recovery and rehab. This elderly resident had voided > 2000 ml urine. Afterwards, according to the nurses notes, the resident was stable, alert and oriented.... A few hours later on the evening shift, she became unresponsive and with total lt. sided weakness. The evening nurse, called the DON first, and was then instructed to let the MD know and call 911. She had suffered a stroke. Is this the new trend among LTC facilities; for nurses to treat and take a chance?

PostOpPrincess, BSN, RN · Sep 17, 2009

NEVER take an order from someone who is going out of his/her scope of practice.

NEVER.

Morning-glory · Sep 17, 2009

In my experience, DONs knew less about nursing care than I did. I would never give a med that they wanted me to give without a doctors order.

Batman24 · Sep 17, 2009

NEVER take an order from someone who is going out of his/her scope of practice.
NEVER.

Yup. NEVER. This is illegal and could cost you your license. NEVER.

diane227, LPN, RN · Sep 17, 2009

Under the board rules in every state, it is clearly outlined that you cannot give medications without an order from a doctor, PA or an ARNP. Period. There are no exceptions. Nurses who give such orders should be reported immediately to the board and the nurse who followed these orders should be reported also. What they did is against the board rules for nursing practice. Don't ever let anyone talk you into doing something like this. This is a very sad situation. Did this poor woman have a hemorrhagic or embolic stroke?