RN Functions

Specialties Emergency

Published

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)

Specializes in Nephrology, Cardiology, ER, ICU.

Hmm - we just had JCAHO in our facility and they said absolutely nothing about our ER standing protocols. They are hospital policy and we have had little to no problems with them. I'm gonna go to the JCAHO website too.

Up Vote Up Vote ×
Specializes in ER, PACU, OR.

This is a touchy subject and you never know who will read this stuff. I will just say no doubt yes, no doubt at all.

Up Vote Up Vote ×
Specializes in ER, PACU, OR.

Unfortunately the nursing law is gray in color. we are not allowed to initiate medical orders, among other things. However, if you as the nurse knows a patient is in jeopardy, and you do not initiate the action that will prevent harm/injury/or death to that patient you are liable.

Interpretation on my part. Anything is acceptable if the conditions are right, but make sure it's absolutely a must do situation.

:-)

Up Vote Up Vote ×
unfortunately the nursing law is gray in color. we are not allowed to initiate medical orders, among other things. however, if you as the nurse knows a patient is in jeopardy, and you do not initiate the action that will prevent harm/injury/or death to that patient you are liable.

interpretation on my part. anything is acceptable if the conditions are right, but make sure it's absolutely a must do situation.

:-)

in short all we have reported in the forum these functions:

:rolleyes: patient assesment:

controls: blood preasure, temperatures, ekg, catheter...

doc. prescription controls: blood analysis, med administration, x. rays...

others.

:rolleyes: patient treatment:

no emergencies: to follow hospital protocols (med administration and others).

emergencies: to start full cares till the arrived of the docs; after that following their orders; so emergencies imply to take speed decisions about starting some crisis actions and two responsabilities to prevent harm:

1. no action can supose responsability (you do not initiate the action that will prevent harm/injury/or death to that patient you are liable).

2. the action must be stablished as good practice too.

:rolleyes: health education.

:rolleyes: research:

to do research into what are the best protocols by r.n., as long as we are working with some techniques the protocols can be changed to give a best service to patients.

:) i would like to ask more time and resorts to enjoy of good research and authonomy, though it does not depend of us, does n´t it?

regards.

Up Vote Up Vote ×

a 2 year old arrived in resp distress, i took the liberty of ordering a respiratory

treatment and am now being told that i am practicing outside my practice guideline's......the e r doc's were very busy and i was tranfusing a pt with a hg of 3...the asthmatic was placed in a hall bed outside the room i was assigned, 2 hours had passed and the doctor had still not seen the child so to keep the family happy i also ordered a cxr and disscussed my treatment and the cxr order with a doctor......the hosp where i work has suspended me and is in the process of terminating me for "practicing outside of the scope of practice" is there a time line established for what is considered reasonable amount of time for a doctor to cover what any nurse would do in a situation where a patient is in resp distress, and is there any guidelines as far as how long i'm suppose to run around looking for a doctor to cover me........any help at this point would be appreciated.............the child did well and was able to be discharged....i on the other hand have not?????????? :rotfl:

Up Vote Up Vote ×
a 2 year old arrived in resp distress, i took the liberty of ordering a respiratory

treatment and am now being told that i am practicing outside my practice guideline's......the e r doc's were very busy and i was tranfusing a pt with a hg of 3...the asthmatic was placed in a hall bed outside the room i was assigned, 2 hours had passed and the doctor had still not seen the child so to keep the family happy i also ordered a cxr and disscussed my treatment and the cxr order with a doctor......the hosp where i work has suspended me and is in the process of terminating me for "practicing outside of the scope of practice" is there a time line established for what is considered reasonable amount of time for a doctor to cover what any nurse would do in a situation where a patient is in resp distress, and is there any guidelines as far as how long i'm suppose to run around looking for a doctor to cover me........any help at this point would be appreciated.............the child did well and was able to be discharged....i on the other hand have not?????????? :rotfl:

WoW!

I don't know about a "time line". Based on my experience, I would not administer a neb treatment without a doctor assessing the patient first and giving me an order. What would a nurse do in this situation that is within the scope of practice? I would anticipate the order and have it ready to go, but I would wait for, at least a verbal order. I might even initiate filling in the cxr form, but I would not send it or the patient until the doctor or NP signed it. I would set up O2 and get the doctor but if the child was in severe respiratory distress, and I couldn't get someone, I would call a code. IMHO, unless you have exact, detailed protocols (to cover the range of patient ages and symptoms), you are not, as a RN, covered to order treatments and tests.

Fortunately, for me, I work in a small clinic and I know the doctors well, and they know my skills well. If they are with a patient and I interrupt them to tell them a patient is in distress, they stop what they are doing and come. That, in part, is because they know I would not interrupt them unless it was critical. If they are in another emergent situation, they will at least give me an order for what they want done. I think it would be difficult to work in a situation where the doctor did not "trust" or believe that my assessment of "respiratory distress" is really resp distress!

I know how frustrating it is to deal with families who are impatient with waiting. We have some families who get impatient with waiting 15 minutes! But, we still can't let that feeling lead us to cross the line of our scope of practice. Also, even though we are great at anticipating what the doctor will order, we should not carry them out unless the MD/NP gives the order.

I hope there can be a positive outcome to your situation.

Up Vote Up Vote ×
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 nurses in general (ICUs, ED, floor, outpatient) have much more autonomy than some of us utilize. There are tons of nurse/physician driven protocols.

I personally have never worked in the ED but I know that even on the surgery floor I work on if someone c/o chest pain you're going to get an EKG, slap some O2 on, asa if indicated, trop draw etc. You're not very likely to wait for the doc to show up before doing those things. Same with pts that are tachy, low bp, low uop etc.....get a second line and start bolusing fluid, make sure they have recent cross match etc. I believe nurses should utilize their critical thinking skills!!! You don't want to sit around and wait for a fresh intern to scroll though his PDA while the pt is hemodynamically unstable. I'm not suggesting start them on a dopamine gtt, transfuse them etc. Do things that a PRUDENT nurse would do in a given situation.

Don't tell the docs what to do. Make gentle suggestions and then move on but cover your butt. After the episode always make sure the doc signs an order for your interventions. Remember no matter what department you work in, unless there is an approved protocol in place, you need a physicians order for your actions.

Up Vote Up Vote ×

dear bio2: you are a hero; the bibligraphy is reporting about these and other roles of health profesionals and of course of penalties too.

i think that firing a nurse from a hospital is not fair, specially a good nurse like you, this penalty must not for you.

though i work as lalorap and brigite said and we i am not a heroe (heroes die in the battle and free people and countries), i must recognize that you have done the best for this boy, that is, exactly what i have never done.

i hope you will not need to change your hospital, it is not fair for you, it is unjustice.

i would rather appreciate bio2, moreover, i want to add an important function or task for all, we must help bio2. we need be joined together, one day we will have the same or similar problem.

what can we do by bio2?, how can we help him?, it is my question for bio2 and all of you.

other important function i want to add is teaching to people and governors to change the laws to be more tolerants . patients and we need this change:

tolerance.

regards

Up Vote Up Vote ×
dear bio2: you are a hero; the bibligraphy is reporting about these and other roles of health profesionals and of course of penalties too.

i think that firing a nurse from a hospital is not fair, specially a good nurse like you, this penalty must not for you.

though i work as lalorap and brigite said and we i am not a heroe (heroes die in the battle and free people and countries), i must recognize that you have done the best for this boy, that is, exactly what i have never done.

i hope you will not need to change your hospital, it is not fair for you, it is unjustice.

i would rather appreciate bio2, moreover, i want to add an important function or task for all, we must help bio2. we need be joined together, one day we will have the same or similar problem.

what can we do by bio2?, how can we help him?, it is my question for bio2 and all of you.

other important function i want to add is teaching to people and governors to change the laws to be more tolerants . patients and we need this change:

tolerance.

regards

thanks for your support

Up Vote Up Vote ×

Well Big02 ...There are a ton of ED jobs just waiting for you in cali..come on over...

I believe that we make these decisions in the best interest for the patient..Yesterday I had a Amb. pt..waiting for a room he had one neb tx. still stridor and wheez..i gave the EMT 2 orders for another tx.(Im a MICN and there are no Medics yet). If the docs are busy and i have wheezing kid, do the same as big02, I run it by the Doc and tell him my findings get a CXR and Neb tx. These are the basics. The Doc sticks his head in the room takes a look at CXR if done..orders some IV meds if needed. We have other protocols for other things which make it nice!

Up Vote Up Vote ×

With increased autonomy comes increased responsibility. Protocols are inherently inflexible, and require someone on the other end to make judgments about when to apply them. Those who undertake that responsibility need to be prepared for when someone comes to them and says "justify yourself".

As for giving a nebulizer without an order, I have questions about your situation. If the child had been there for two hours, was the situation really that urgent? In the end it doesn't matter. Your duty ended when you performed your assessment and consulted the physician about the urgent need to see this patient. If a nebulizer treatment was not included in your standing orders, you absolutely deserve to lose your job and your license. If you don't have the credentials, you are just freelancing. It is illegal, no matter how dire you think the situation is.

Up Vote Up Vote ×
With increased autonomy comes increased responsibility. Protocols are inherently inflexible, and require someone on the other end to make judgments about when to apply them. Those who undertake that responsibility need to be prepared for when someone comes to them and says "justify yourself".

As for giving a nebulizer without an order, I have questions about your situation. If the child had been there for two hours, was the situation really that urgent? In the end it doesn't matter. Your duty ended when you performed your assessment and consulted the physician about the urgent need to see this patient. If a nebulizer treatment was not included in your standing orders, you absolutely deserve to lose your job and your license. If you don't have the credentials, you are just freelancing. It is illegal, no matter how dire you think the situation is.

Sometimes ethic can result illegal, remenber the rising of Hitler; the question is that laws can be changed, moreover must be changed in the healt scope.

The only problem is how we can develop constitutions and laws, the action of Bio was looking for the patient, in this case a two year old; these changes need the union of nurses as Jews joined together fighting against nazis.

I do not believe you are a Nazi, but I think your point is mistaken.

Yours truly;

alanpe.

Up Vote Up Vote ×
+ Add a Comment