What have you done without a Dr. order?

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 that's 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?

Specializes in Professional Development Specialist.

I don't do much, but will gladly collect a stool sample prior to getting an order. :D I did give 02 without an order just this morning. It was purely therapeutic and taken off minutes later. But it got a lung CA pt through a few minutes of fear. If I had waited hours before the doc called back he may have been in actual distress. But a little O2 and a PRN pain med made it all better. We have no standing orders in our facility. If I want a colace or a Tylenol on a Saturday night I have to call unfortunately.

When it comes to meds, labs, tests - no order, no action. Commonsense tasks such as turning up 02 - sure, why not? The docs are not your buddies. All it takes is one MD to say "nope, I never ordered that" and you/your license are toast. Even an ABG. And I work in a critical care environment. I have no legal/ethical responsibility to perform any task outside my scope of practice. My license (i.e.: ability to earn a living) comes first...

Specializes in ER, Trauma.

Oops, I'm sorry, I've erred. No consent, no Dr's orders, and we can't bill for it. You see, the ultimate power in the universe is the almighty freaking dollar. But then I have a weird sense of priorities.

If I need an order to do it, I'm getting the order before I do it. I spent too much time studying & worrying about exams to lose it. If I ever work somewhere where docs are slow or don't respond in a timely manner, I'd get my behind out of there ASAP. New grad speaking

In LTC (at least my state) there are no standing orders. None. If someone is in rep distress you need an order for O2. Sooooo this is a holiday or late shift and you are trying to get ahold of a doc. You've called the service and left a message requesting a call back stat, you've tried his cell phone. Now what? You call the medical director...quess what...same problem.

What do you do? 2L of O2 might help.

What about that stool specimin or obvious UTI? Get the sample and then get the order? Or wait for ever and get the order in the am when the office is open?

We all know what the right answer is to the OPs question and yes.

CYA and know your docs.

Specializes in Geriatrics, Dialysis.

I work in LTC and our facility has an excellent set of house orders to cover most situations. Ok to give tylenol, bowel meds, maalox etc unless contraindicated and follow up with MD if used more than 3 times. Initiate dressing orders for skin tears, Stage 1 or 2 ulcers. O2 at 2-3 LPM prn, C-Diff or UA if suspected infection. Change med from tablet to liquid or suppository at RN discretion. 3 day trial diet change to mechanical soft or puree, change from thin to thickened liquid if choking or aspiration risk at RN discretion [this one requires follow up with speech therapy]. These are just a few I remember off the top of my head. The only requirement is documentation that the standing order was initiated and follow up with the MD if the order requires.

Specializes in Telemetry, Oncology, Progressive Care.

I know a fair amount of seasoned nurses who have done things without a md order. Apparently many of you have never heard the term "nurses" order or "nurses" dose. I agree if the wrong person finds out about it there is risk of losing your job or getting a reprimand/suspension/loss of nursing license.

As far as doing things without an order. It definitely depends on the facility you work at. Community hospital nurses have more autonomy than at a teaching facility.

Someday, doing all those things wlithout an order will catch up to you. A not very nice MD or someone you work for/with with with cure you of doing that.

Does your hospital/floor have Protocols? These are pre-written orders which specify what steps a nurse can take based on clinical outcomes. If not, suggest them; I did. The doctors like it because it reduces the number of calls they receive and it promots prompt action for situations. In the case of labs, once the results are available, decisions on treatments can be made by the doctor right away. Less delay of treatment. In the ICU/IMC/telemetry units that I work it is standard procedure.

What I have also learned: do not excede your scope of practice. You can will be fired for it!!!

Well, I DID helicopter a guy out once. worked at a prison. I was there by myself. They brought me an inmate that had been beat to a pulp by another inmate plus had majic shave sprayed on his face then set on fire.

The guy was literally at deaths door and it takes prison Drs forever to respond. I felt it was my only option or he was going to die.

Of course, I got chewed out pretty good for that one.

Specializes in Pediatrics, ER.

I'm spoiled. Where I work, there's a moonlighter making $120/hr to sit 24/7 and answer nursing calls. For the most part they're up within 5 minutes to write an order, and if it's an emergency I swear they have wings because they fly from the on call room and up three flights of stairs to be in the pt's room in under 10 seconds. They listen to our suggestions and I almost always get the orders I want/need for my patients.

Specializes in Nurse Leader specializing in Labor & Delivery.

That's one thing I LOVE about working at a teaching hospital. There are ALWAYS doctors around. Often too many, and they're tripping over each other.

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