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What have you done without a Dr. order???

PureLifeRN specializes in OR.

So what things have you done withOUT a doctor's order, for a patient?? I don't think I'm too bad, I'll send off a stool for c-diff if a patient has diarrhea, order a stat ABG for a pt in resp distress before calling the doc as well as an x-ray and will order a blood test or something if I think its necessary. I don't think I have ever given a med though, without an order (well, I have been known to give out a cepacol lozenge, but thats about it.) But I do know nurses that give out a maalox or robitussin without calling the doc. So I just wanna know, what kind of things do you feel comfortable doing without an order?

:redpinkhe PureLifeRN

klone specializes in Women's Health/OB Leadership.

Yes, let's all announce things that could have us fired and get our licenses taken away. On the internet!

Sorry, I think participating in this thread is not the wisest of choices.

I don't feel comfortable doing anything that requires a physician's order without that order, and the facilities in which I've worked don't permit that, anyway. It's been a long time since I've worked anywhere that one could get away with doing stuff like that -- i.e., computerized systems for entering orders that would require you to lie about having a physician's order in order to enter the order into the system, pharmacy systems that require you to scan the actual written physician's med order to the pharmacy, etc.

"I don't think I'm too bad" is a justification/rationale that makes me v. uncomfortable. I'm not saying this as a personal criticism of you, or anything, but I'm shooting for a higher professional standard than "not too bad." :) IMO, if people want to be able to order meds, procedures, etc. (outside of established, legitimate facility protocols, standing orders, etc.), there are educational/professional pathways to legitimately accomplish that -- pursue an advanced practice role that suits you. Otherwise, you are ultimately taking chances with your license. If a situation goes bad and comes back to bite you (even if it's just a matter of a physician taking offense and complaining), you won't have a leg to stand on -- is that a risk you want to take?

However, I'm v. "old school" when it comes to scope of practice, and I'm sure I'll turn out to be in the minority on this question (as I so often do on this site). :)

Edited by elkpark

I agree--I don't think that this is very smart--I will just say that I think that some of the things that the OP mentioned, you may actually have orders for and not even realize it. In the hospital that I came from, we had standing orders for a patient experiencing respiratory distress to get an ABG or for O2, etc...while we were notifying the MD. Because, a prudent nurse wouldn't watch a patient turn blue while they waited an hour for an MD to call them back to okay the ABG and resulting cascade of orders...

As I said on another thread, I am the "Oxpecker" on the Rhinoceros's back sounding the alarm. It just doesn't get any easier than that.

noahsmama specializes in pediatrics, public health.

I guess I'm wondering why you find it necessary to do these things without a doctor's order? Are the doctors that slow in responding that you can't get the order you need in a timely fashion? When I worked in a hospital (I'm in public health now), doctors were generally very good about responding to pages, especially since we had the option of sending a text page, in which I could explain exactly what I needed and why. If I had a pt in respiratory distress, I could get an order for a stat X-Ray and ABG within minutes. And nurses weren't allowed to enter an order for X-rays or labs -- there was no way I could enter it into the computer even if I wanted to, and the lab would not do any tests unless a doctor had ordered it.

I could see saving a stool sample without an MD's order, but I would ask for the order before submitting the sample to the lab. What if the doctors want to test for other things besides C-diff?

Since we weren't allowed to take verbal orders except in emergencies, I wouldn't even give a med, even if I had spoken to the doctor and they had assured me they would enter the written order, until the order actually came up -- if I had to call the doctor again to remind them to enter the order, so be it.

I only worked in a hospital for a short period (1.5 years), but I don't think I ever once during that time did anything that required a doctor's order without actually having the order. To do otherwise is to risk losing your license, and why in heavens name would you want to do that?

PsychNurseWannaBe specializes in Psych, LTC, Nursing Management, WCC.

I only order things that I have standing orders for; which include things like get xray if fracture is suspected, obtain UA with C&S if S/S of UTI, etc.

We've all done things, such as giving o2 to a patient that has desatted without a doctors order. However, that's written in most standing orders anyway.

If anyone here admits to doing so, there'll be the holier-than-thou replies.

MassED specializes in ER.

like you wrote, xrays (for a resp distress, febrile, productive cough) obvious fractures, etc. EKG's for cp, order labs, u/a's. I know some nurses give Zofran for nausea/vomiting without an order and go back for an order, but I never give meds without an order. I might pull it up and ask the doc "I have 4 of Zofran pulled up for the pt in such and such room for n/v - can I give it IV" ? I insert Foley's for hip fractures and ask after for an order, if the MD forgot.

I now work at a teaching hospital, so my autonomy has been stolen on what I might have done at "other" places.

PureLifeRN specializes in OR.

Sorry I didnt know I was committing such a big crime with this post! Sheesh! I would do the blood/stool/urine samples if I knew the doctor and they hadn't made their rounds yet. Never had a complaint so far!

MassED specializes in ER.

Yes, let's all announce things that could have us fired and get our licenses taken away. On the internet!

Sorry, I think participating in this thread is not the wisest of choices.

well first of all, we should be anonymous on here, and any other internet site, if you're concerned about privacy.

MassED specializes in ER.

Sorry I didnt know I was committing such a big crime with this post! Sheesh! I would do the blood/stool/urine samples if I knew the doctor and they hadn't made their rounds yet. Never had a complaint so far!

you are not. Depends on where you work as to how you answer this question too. Don't let people jump all over you. It's a great post, I think.

blondy2061h specializes in Oncology.

I gave meds twice without an order in situations where the MD was just not calling me back and I was genuinely worried about what would happen with my pt if they didn't get the med. Both times I got the medication ordered shortly after. Once was IV benadryl to a patient who was having a bad platelet reaction and clearly beginning to lose their airway (hives coulda waited). I can't recall the other time.

Both times occurred before my hospital had a rapid response team.

We have standing orders for c-diffs.

nursel56 specializes in Peds/outpatient FP,derm,allergy/private duty.

Saving a specimen that might be harder to get later on for a test you know will be ordered based on taking care of hundreds of people and working with Doctor X and knowing his/her habits doesn't seem like it would be risking a license to me, but honestly I look forward to seeing the spectrum of opinions on this.

dthfytr specializes in ER, Trauma.

Oh no, I'm just a humble country nurse, not a starship captain. I couldn't even take a potty break without a Dr's order. If I accidentally saved patients lives, saved doctors asterisks, or saved patients from doctors, do you really think I'd enumerate it here? Just call me Mr Ed, because I'm a lot smarter than I look.

I'm probably too new of a nurse to answer this question because I've never been put in this type of situation, but I know I wouldn't hesitate when it comes to placing a patient in respiratory distress on oxygen. I also don't see the harm in collecting a urine or stool sample without an order, but I'd wait for the order before I send it to the lab.

I have given IV dextrose to a diabetic in an emergency. Immediately after, I called the doctor to get an order. The patient lived. I would have preferred to lose my job than allow someone to die unnecessarily.

PureLifeRN specializes in OR.

I had a patient once that had about 5-6 BM's during the shift. I decided to be prudent and call the GI doc and ask for a c-diff order, and his response was "hmmm, well what did the BM smell like?? If it smells bad, then order a c-diff." honestly, I never called him again for a c-diff order.

What kind of setting do you work in?

I could see this being an issue if you work somewhere where the doctors are slow to respond.

I work day shift in a teaching hospital, so getting at least a verbal or phone order is easy.

The fact that you are writing about this issue suggests you are not fully comfortable with this practice?


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