What have you done without a Dr. order?

Nurses General Nursing Nursing Q/A

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 ICU, ER, EP,.

Working in a non teaching hospital, where others know whom I am... I can simply say.. in the past, not so recent past that they will have ever seen or known..... There was at time, where we never called the attending doc unless a code was in progress... we wrote the orders, we did what we did and management turned a blind eye... we did everything.

That was over 10 years ago, and luckily we gained protocols to protect us. There are many small town facilities that are still working like this. You know who you are and I'd encourage you to have a liasion with the med ex. to establish those protocols you need to protect you.

years ago, it was a growth a learning exp. Now it would never happen. So those out there, take action and protect yourself. Been there, thought it was the norm and am older and wiser. There are administrative ways to protect you from the docs. Stand firm. All I have to say, because it's still out there.

I don't think its bad doing thing without Dr. order - I had number of cases in y department where nurses` awareness and actions saved peoples lives! we are not just doing things we are told to - we have to think and if doc is cannot solve the problem right away - we can help him. now, I am not talking about prescribing meds besides OTC, but taking blood samples, putting IV lines or giving fluids when necessary, its our duty I think. I am only doing this when I am 100% sure I am right and when I am not - I am calling a doc. but honestly - we are being near the patients more time - docs do. we can see and suggest things and eventually do things to prevent our patients condition worsening.

Specializes in Oncology.
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.

I'm spoiled like this, too, but there's only one of him. The two times I had to do something without an order he was tied up with a cardiac arrest on another floor. It is awesome to have someone on site all the time, though, and 99.9% of the time they're awesome about getting back to us very quickly.

Specializes in General Nursing.

Hi, great nurses! In the hospital where I work, Nurses always favour Doctors by doing their works even filling all sort of investigation forms, re-prescribing drugs that finished. With time I think we'll be given equal right with them.

Specializes in Management, Emergency, Psych, Med Surg.

In an emergency I have done everything except give medications unless I was functioning under a standing protocol. I have no hesitation at ordering certain blood work, EKG, CXR, applying oxygen, starting an IV if the patient needs it. I have never once in 32 years of nursing had a problem with any physician for doing this and taking the required action before speaking with them.

Specializes in Geriatrics.

I've sent patients to the ER w/o a Dr's order, calling the on-call number then waiting for a call back was time I felt my patient didn't have to waste. I called after they were gone, got yelled at for making what ended up being a good call, been told the patient was DNH/CMO, paperwork never completed & placed into the chart by said NP/PA/DR. Will I do it again??? You Bet!

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.

giving o2 to a patient who desatted ..is part of our job, isnt it?

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.

Specializes in ER.
PureLifeRN said:
Sorry I didn't 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.

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.

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