RN Functions

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In the ER, do the RNs have more independent functions that they normally wouldn't have on other floors? (ie what you would normally need a signature for)

I think like you it is a problem;

thanks.

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In the ER where I work, we have protocols in place that are signed by the EMS Director, an MD. So, technically, our protocols for certain symptoms are standing orders and we are expected to perform them.

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In the ER where I work, we have protocols in place that are signed by the EMS Director, an MD. So, technically, our protocols for certain symptoms are standing orders and we are expected to perform them.

I think so; protocol is a good way to solve these problems.

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Be very careful. Remember, no one is as concerned about your license as you. I believe there is more autonomy in the ER than some other areas, but this may give you a false security and lead to stepping over the line. Know when to say, "sorry, this is not within my scope of practice". I have heard physicians say, "well, I thought she knew what she could and could not do. It's her license".

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Can any one provide some protocols?. To discuss about functions it will very usefull to report specific protocols.

Can any one?. Some protocols can not publish by author rights.

Do not forget the question about the copy right, please.

kind regars.:)

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In the ER where I work, we have protocols in place that are signed by the EMS Director, an MD. So, technically, our protocols for certain symptoms are standing orders and we are expected to perform them.

I'm working in a hospital-based, outpatient, pediatric clinic with urgent care. The pediatricians and I are trying to establish standing orders for some of our sick patients. We are meeting resistance from nursing administration. Administration is insisting on a separate order sheet for each patient that comes into the clinic (as opposed to our system of writing the treatments and medications on our urgent care forms). I am trying to show that standing orders are an acceptable practice. Do you know of any resources for establishing protocols and standing orders?

[email protected]

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alanpe

Chest Pain Protocol in our ER: verify: med history, aspirin today? copd? allergies? full complaint (time frame in case thrombolytics indicated)

if no contraindications it is automatic to: place on monitor, obtain EKG (compare with prior if available)- and show to any MD, give ASA (if none today), sl ntg x3 -1" ntg paste if effective, IV access (with labs of troponin, cbc, bmp, pt, ptt, dig if prescribed, bnp if hx chf & edema) start oxygen, portable chest xray (if painful - pa & lat if not), morphine (2-4), obviously ... if monitor or EKG look bad, lungs sound bad, patient looks bad ... be get a doc in ASAP - otherwise, when one is available we already are ahead of the game with having some specific results to look at.

We also have them for potential fractures, GI bleed, abdominal pain, suspected CVA, pain, and others I forget at the moment.

Love the automomy - but you are right with it comes more responsibility - have to think on your feet - have great assessm't skills - communicate and evaluate with other team members. Wouldn't have it any other way though!

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Nurses in acute dialysis have plenty of autonomy. Lots of standing orders based on interpretation of labs and nursing assessment. There are many times when a treatment is initiated before the physician arrives or even without him arriving at all. There are many different electroyte bath preparations, sodium, bicarb, and Ultrafiltration profile setting depending on the acute needs of the patients

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alanpe

Chest Pain Protocol in our ER: verify: med history, aspirin today? copd? allergies? full complaint (time frame in case thrombolytics indicated)

if no contraindications it is automatic to: place on monitor, obtain EKG (compare with prior if available)- and show to any MD, give ASA (if none today), sl ntg x3 -1" ntg paste if effective, IV access (with labs of troponin, cbc, bmp, pt, ptt, dig if prescribed, bnp if hx chf & edema) start oxygen, portable chest xray (if painful - pa & lat if not), morphine (2-4), obviously ... if monitor or EKG look bad, lungs sound bad, patient looks bad ... be get a doc in ASAP - otherwise, when one is available we already are ahead of the game with having some specific results to look at.

We also have them for potential fractures, GI bleed, abdominal pain, suspected CVA, pain, and others I forget at the moment.

Love the automomy - but you are right with it comes more responsibility - have to think on your feet - have great assessm't skills - communicate and evaluate with other team members. Wouldn't have it any other way though!

It is a good protocol, I love autonomy too; before, I did not report very good what I would like to say; we work in a team, so we must work on this way.

:rolleyes:

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alanpe

Chest Pain Protocol in our ER: verify: med history, aspirin today? copd? allergies? full complaint (time frame in case thrombolytics indicated)

if no contraindications it is automatic to: place on monitor, obtain EKG (compare with prior if available)- and show to any MD, give ASA (if none today), sl ntg x3 -1" ntg paste if effective, IV access (with labs of troponin, cbc, bmp, pt, ptt, dig if prescribed, bnp if hx chf & edema) start oxygen, portable chest xray (if painful - pa & lat if not), morphine (2-4), obviously ... if monitor or EKG look bad, lungs sound bad, patient looks bad ... be get a doc in ASAP - otherwise, when one is available we already are ahead of the game with having some specific results to look at.

We also have them for potential fractures, GI bleed, abdominal pain, suspected CVA, pain, and others I forget at the moment.

Love the automomy - but you are right with it comes more responsibility - have to think on your feet - have great assessm't skills - communicate and evaluate with other team members. Wouldn't have it any other way though!

It is a good protocol, I love autonomy too; before, I did not report very good what I would like to say; we work in a team, so we must work on this way.

:rolleyes:

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We have done the same in our ED for 20+ years but we were told just recently that standard orders and protocols were beyond our scope of practice. Our supervisor stated that JCHACO forbid nurses from initiating medical orders (IVs, EKGs, any medications) without an order signed by a MD. Of course verbal orders were ok but as was posted above, We do not have time, many times to find the MD and get a verbal order. If this is true, then what about ACLS? Are we not expected to intervene to the best of our abilities and training? Are we lible? We have had very good relationships with our MDs but if my licience is in jeperdy with every IV start . . . how much can I trust the good feelings of our MD coworkers?

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We have done the same in our ED for 20+ years but we were told just recently that standard orders and protocols were beyond our scope of practice. Our supervisor stated that JCHACO forbid nurses from initiating medical orders (IVs, EKGs, any medications) without an order signed by a MD. Of course verbal orders were ok but as was posted above, We do not have time, many times to find the MD and get a verbal order. If this is true, then what about ACLS? Are we not expected to intervene to the best of our abilities and training? Are we lible? We have had very good relationships with our MDs but if my licience is in jeperdy with every IV start . . . how much can I trust the good feelings of our MD coworkers?

That is discouraging. Does anyone know if there is a web site for JCAHO? I'm thinking that it depends on how administration interprets its guidelines.

I was wondering about ACLS too. It seems to me that if we are trained then our scope of practice is extended, and we would be neglent if we fail to carry out those interventions because we were waiting for a doctor's order. (Our administration is telling us we cannot even take verbal orders because the MD's are right there. The exception is during a code, when there is a recorder writing down the verbal orders.)

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