Problem with charge nurse& MD's order

[L. Swanson]

Hi, new on-line. I hope somebody can help. A charge nurse wrote a different order for Pavulon because she disagreed with the dose. She did question the MD, but he said toi give what he ordered. the nurse looked it up in the PDR, & decided not to administer the Pavulon. the pt. was on a vent., very heavy, with an overdose. the MD wrote the nurse up, & wants this handled ASAP! Any suggestions? I have been on vacation & will approach this on 6/6/99. I will keep you posted. What is the critical care nurse to do legally in this situation. I have my own theory, but would like yours.

Thanks Lu949

[Canrckid]

WOW! Is this nurse in deep do-do! And rightly so! Where did she go to medical school? All sarcasm aside, she cannot "order" a medication.......if she so strongly disagreed with the MD's ordered dosage, then she should have refused to give it, or had him administer it himself. If the dosage was so incorrect, she could have had the pharmacist speak to him about the consequenses of that particular dose....DOes your hospital have a P & P regarding the use/titration of neuromuscular blocking agents? Maybe you should have one....Since the patient was intubated, the likelihood of any negative effects was probably small, as long as the dosage was given relatively slowly........ What dose was requested? I've given as much as 10mg at one time, was the dose higher?

[shariann]

Actually, this issue should go to your state board of nursing, (unfortunatley). The charge nurse completely acted out of the scope of nursing practice. She had no right to change the dose of the med. That is for a physician only. If she had a problem with the dose, she needed to go through the proper channels to get it changed. Usually this means going to the head of the medical dept. She could definately lose her license for this!