mannurse65

I too, was involved in creating the Pre-printed Orders and Practice Guidelines, with our physician group. The intention is the same as protocols except that a protocol allows the nurse to initiate care regardless of what the doctor decides after the fact. The protocol should be considered a direct doctors order, or it is non-binding and you are not protected. I use the trust issue because I think it is foolish to base your future on the hope that, if it all goes to hell, your physician will choose to protect your licence over her/his own. Even if you had such an angel, doesn't anyone feel like this is a big step backwards? Mother may I?

It is a very difficult situation, and I feel for you. There should be agencies/people to help: Sexual Assault Nurses, Child Protective Services, Councilors, Patient advocates. I agree that every thing you chart needs to be clear, correct, and without bias. Do not underestimate your presence as a healing/comforting element, but I would also be sensitive to the patients perception of physical contact.

So, I'm guessing you have never had a doctor denie that they gave a verbal order, or change a written order or the time of an order? How about writing "I did not order this!" on a protocol order? It only takes one patient complaining to the right person to leave you high and dry. I am suprised that no one has had a personal experience with the frailty of Doctor - Nurse Trust.

The preprinted carepaths are individualized by just adding the sheet with the pt name to the chart and the doc signs them. No big deal, the orders were things the docs had already decided on some time ago. Before we had these protocols nurses did line and lab patients but now we are covered legally as well. So, if you have to have the MD sign them, then do you wait to start care? How do you handle the critical patient that needs immediate intervention? What happens if the physician refuses to sign the paper? We all get along with our docs until there is a problem, like the patient complaining, or suffers one of the risks associated with IV starts. It will happen, It has happened in our department several times in the 12 years I have work there. If there is no protocol, there is no protection. I still take care of the patient first, but I know I am at risk.

I am currently attempting to get a clear answer from Joint Commission, but their latest attempt to screw up ED practice is that a protocol is fine as long as it is signed off on by the patient's MD. So, every IV you start, med you give, under the protection of a protocol is medicine without a license unless the patient's doctor approves. This includes ACLS. Do you want to bet your license on which doctor you get for that patient, that day? I will continue to do what is best for the patient, within the scope of my training, but I know the risks, and many nurses out there do not.

A state senator walks into our ED. Management rushes in to ensure the pt gets in ahead of all others. all the beds are full to hall 8. Our charge nurse says no, I am in charge during her lunch and say no. Management takes the patient to cath lab to be seen and we go on about our bussiness. The next day they charge the Charge RN with insubordination. Does any one have any experience with the legalities of this situation?