On our ccu we get anything cv related now with our cv surg docs (ie cabg, valves...) for our patients we have about 120 different standing orders. Ie: Draw any labs any xrays, ekg's. Start amio for afib, start lopressor if needed, neo, nipride, mag, k, lasix, albumin, hespain, insulin gtt ntg, we can start/titrate/dc almost 40 different drugs (all without directly talking with the md first) dc aline, place or d/c f/c, d/c swan, d/c central lines, and the list goes on and on. All without talking with the md first the and god forbid you call them for one of these things esp at night unless the patient is dying b/c they will say you have a standing order for this and hang up. Pa's donot round in the ccu only on the step down units, often the cv surg docs make rounds by asking the rn's "how are they doing" then writing a 2 line note in the chart and moving on. I know this is not the best way to practice however we are ranked #1 in are state for overall cv surg outcomes. I just want to know if anyone else is exposed to this type of unit? Is this common?