Nurses discretion to hold Tx?

[Unitedlife]

Hello! Fairly new nurse here, I have been working at a LTC facility on overnights for the past 3ish months. Loving it so far!

One of my residents has a 3x4 cm blood blister on her shin, it is intact with an opsite dressing covering it. I didn't want to irritate the site, and decided to hold her ACE wraps.

The morning nurse came in and said I should have put them on...

It's something minor but it got me thinking, when do I have the discretion to hold a Tx?

[amoLucia]

OP, you're a newbie with a newish job in LTC. Having been a long-time NOC nurse, I know the job well and can speak from experience.

I'm guessing the orders for the ACEs are 'to rewrap in AM'. Without doubt, they have to be applied while you,the nurse, struggle to complete last med pass, MUCHO fingersticks, neb txs, GT flushes, IV flushes and any IV PICC line labs,(like vanco peaks & troughs & PT/INRs), send out any early dialysis & MD appts, finish up charting, clear the medcart and start the count with 7-3. All the while hoping no one had any emergency/incident/crisis.

I hated, H-A-T-E-D, putting on those blasted ACEs/TEDs! They would just slooooooow down the end of the shift. Let me tell you, if I could have found ANY plausible reason to avoid applying those ACEs/TEDs, I would have done so. So OP, might you have been trying to stretch the limit to avoid that order?

I'm smiling as I say this, but I wouldn't blame you one little iota bit!! Not one little bit! After those wretched ACEs, my next worst hated job was putting on those CPM machines for post knees exercises.

Nsg discretion is permissible but there needs to be a reason and all the appropriate notifications, Plan Bs, and documentation.

Curious - is there a senior nurse or supervisor on duty with you that you could have consulted?

[ComeTogether, LPN]

All answers are correct, but the reality, are you going to call a physician at midnight to ask if you need to put ace wrap over the opsite? Or get an e-mail? Certainly no policy is going to cover it. There is no easy answer..

My facility has created a policy so that we can communicate this kind of thing to the MD by leaving them a note in a designated notebook. This way they're informed and we're able to still chart "MD notified per protocol".

I've been told so many different things in terms of being allowed to hold treatments, meds, etc. and I have just decided to use my judgement and do what I think is best for the patient while covering my bum and leaving word for the doc and documenting.