BUNightingale

That is what assumption I have always worked under and now they are trying to tell us they will report us to the board if we do this. The people above my pay grade tell us that they have contacted "large" hospitals all over the country and they have always required an order to start ACLS.

My facility is telling us that we must have a physician's order to start pushing ACLS drugs. They are telling us that it is a violation of the Nurse Practice Act to start ACLS without an order and that we are operating outside of our scope of practice because we are administering meds without an MD order. We have, in the past, just paged the MDs and started ACLS with high quality CPR, pushing whatever meds the patient's condition called for, following the algorithm. I work in a large teaching facility so there is always an MD somewhere close by so this problem isn't really that important specifically to me but what do smaller hospitals do when there isn't a doctor handy? Has anyone else ever heard of this? What do we need certification for if we can't do it without an order? Wouldn't any RN be able to administer these drugs with a physician present?

This is a tough one. Resusitation is one of my passions in nursing so my gut instinct is to say that charge nurses should be "experts" but I know this is not usually the case. I think they should be experts at CPR at least. CPR includes AED training so a lethal arrhythmia could at least be shocked prior to our arrival. My building is tall and maze-like depending on the floor you are on so our code team can take vital minutes to arrive. I would be happy to see the patient on the monitor, CPR in progress and the crash cart at the bedside.

For Bluegrass RN I understand that is seems to be overdoing it to wake a patient up everytime. I have seen pt's who have become unresponsive with just 1mg of morphine or 1 lortab. Yes, these patients usually have comorbidities that probably have contributed to their enhanced response to narcotics. I have never been fired or punched because I woke up a patient. I can just see it now speaking to a family after a code "I'm sorry, I thought he was just sleeping". I would never accept this if I was the family member. I am not here to make friends, I am here to make sure you are kept safe and get better under my care.

We also have computer charting at my hospital and "sleeping" is an option for pain and level of consciousness. I think it is something we as nurses need to have changed in our standards of practice. I was actually told by our CNO that we cannot wake everyone up all the time to check on their pain status. I disagreed with her infront of a lot of people and got kudos for it. If a patient receives a narcotic in a procedure area or PACU, they never use sleeping because they need to assess neuro status. How can you check neuro status after a narcotic UNLESS you wake them up. If your patient dies and you have to defend your charting and assessment in court, how do you defend the fact that your did not want to disturb them by waking them up? If that was my family member, I would say it is negliegence on the nurse's part because they did not do an actual assessment.

I work in a large urban teaching hospital as a member of the Rapid Response Team. I don't know how many codes I have responded to over the years where the primary nurse tells me "They were fine 15 minutes ago. They were sleeping." Endless chart reviews have shown me that many nurses chart "sleeping" for neurological assessments and pain assessments after narcotics. Narcotics are CNS depressants and a side effect is respiratory depression which can lead to unresponsiveness and death! I am not asking that we wake everyone up for hourly bedchecks but please, wake up your patients when it is time for any assessment. I have seen nurses chart sleeping next to a set of vital signs. You mean to tell me that this patient slept through a BP measurment and did not wake up at all and this seems normal to you? Research has shown that a change in neuro status usually predicts a CPA event within 24 hours. I know it seems rude to wake people up from a deep sleep to ask them questions but to me, the only way to tell the difference between an asleep pt and an unconscious pt is to wake them up. I won't make us any new friends but it could save your license.