Nursing Dose

Nurses Medications

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  1. Have you ever given a nursing dose?

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On orientation, at a previous facility, I was told about nursing doses. Normally it involves giving extra narcotic to a person in severe pain. This occurred in a emergent setting where patients would have been ordered Morphine 1mg IV and the dose comes in 2mg vials. The extra 1mg was to be wasted and witnessed. However, if a nurse determined that may not be enough due to the severity of pain, weight, past history, etc., they may decide to give 1.5mg and waste the .5, etc.. I have not heard about it outside the emergent setting, but I'm guessing it occurs in other areas.

Have you ever heard the term "nursing dose"? How do you feel about it? Have you ever given a "nursing dose"?

Specializes in ED RN, PEDS RN, IV NURSE.

I've heard it in the ED as a joke.

"You should nurse dose that (annoying ) patient"

It was the first time i heard it. But OBVIOUSLY it's not legal and out of our scope of practice. Explain THAT one in court..."oh no your honor, he was ordered 1mg of Ativan and I gave him 2! I mean HELLO, he obviously needed more...."

1 Votes
Specializes in Critical Care.
cardiacqueen said:
No, this is outside of our scope of practice. Unless you have parameters. One of our surgeons, for example, will put 3 different orders for morphine - eg. 2 mg for mild pain, 4 mg for moderate pain, and 6 mg for severe pain.

Generally you shouldn't have multiple orders for the same med, it should be one order with a range for that order.

Set doses based on a 1-10 pain scale is not good practice and is specifically advised against in practice guidelines.

1 Votes
MunoRN said:
Generally you shouldn't have multiple orders for the same med, it should be one order with a range for that order.

Set doses based on a 1-10 pain scale is not good practice and is specifically advised against in practice guidelines.

Interesting...what do you mean by one order with a range? I know that our docs have been criticized, for example, by pharmacy for putting in range orders such as "1-2 tabs for pain." Not sure if this is what you meant though.

I have had that thought that specified doses for certain levels of pain has some issues. Mainly related to patients having different pain tolerances and perception, as well as varying tolerances for certain medications. But what is the alternative?

Say for example I have a patient who is 2 hours post op, not tolerating PO intake, and says they are beginning to have pain, 4/10. I have orders for Percocet and Morphine. I am concerned about giving a larger dose of morphine (say 6 mg is my only order option) to patient who is drowsy and whose pain is at a level in which the risks may outweigh the benefits.

Sorry for the long post! Just curious as to what you guys think!

1 Votes
Specializes in Critical Care.
calivianya said:
To my knowledge, I have never worked with anyone who didn't do this. I have never seen anyone actually witness a waste either - except for when we are taking down narc/benzo drips and charting how much was left of the drip. In addition to "nursing dose," I've heard "wasting into the patient."

I have been told that we waste "in the vein, not the drain..."

1 Votes
Tex. said:
I have been told that we waste "in the vein, not the drain..."

I've heard that too! "Nursing dose" flies around my ED every shift. People may or may not actually be doing it, but the thought is always nice... Especially with screamers.

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Specializes in Emergency.

Ahh, a baker's milligram...

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Specializes in Critical Care.

I haven't heard about the nursing dose, but I HAVE heard about the Catholic Dose.

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Specializes in CVICU.

You can't leave us hanging...what's the "Catholic dose"?

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Specializes in Critical Care.
deflowerkidRN said:
You can't leave us hanging...what's the "Catholic dose"?

Well, I'm not entirely sure. In the context I heard it, I took it to mean something along the lines of.....suicide is a sin, so this extra hefty dose of morphine at the nurse's hands could help the patient move on to the other spiritual plane... I was a brand spankin' new nurse, so I wasn't sure what to make of it at the time.

1 Votes
Specializes in Critical Care.
emtb2rn said:
Ahh, a baker's milligram...

I like that even better than the Texas sized dose.

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Specializes in ER.

*Wink Wink*

I've never done it personally. Not worth it. However, I know of those who have. I also know those who run around with morphine vials in their pockets to use just in case the doctor orders a 2nd dose (ER). I don't agree with that either because it sets the nurse up to forget or the other nurse could potentially just steal the morphine in the vial and replace it with NS. In all honesty, I don't get wasting at all unless you go to the bedside and witness a waste on a computer after the nurse gives the medication but all wastes I know of are at the med machine.

Hence why it is almost a waste of time. What is to stop a nurse from then swapping that vial/syringe out with normal saline?

1 Votes

I know this is an old thread, but I'd just like to comment. I understand wanting to always follow the doctor's orders, but there are certain situations in which there isn't time to wait for a new order. Susie2310, sometimes you have no choice but to give a nurse's dose or you really risk a central line being pulled, the patient falling, or worse.

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