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?

it also depends on where you work. I work in a smaller ruraal ICU in a smaller hospital and know all of our docs one on one. That means I know when they do vs. Don't wanna be called. Certain docs don't even wanna be called about a resp distress unless I've already done portCXR, and drawn ABG's. Then we have other docs who wanna be called stat and then will direct care.

I will say that in this setting we are expected to have a certain degree of autonomy. With certain docs I'd think nothing of giving tylenol at two am for a headace IF THERE ARE NO CONTRAINDICATIONS. A lot of times it just means thinkin for oneself.

And as far as the oxygen thing...i believe in treatin the pt as needed. If a pt has a sat of 60% and I think a code is looming, I'll do whatever it takes while waiting on the doc to return page/arrive in unit.

just my opinion, nurse_mo1986

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.

Specializes in Trauma/Tele/Surgery/SICU.

I am suprised and frankly kind of jealous at some of the responses in this thread. At my facility we are responsible for inputting all orders, take multiple verbal orders per shift and are often waiting on doctors who are very slow to call back......we have had patients leave AMA after waiting upwards of 12 hours for orders for diets, pain meds, etc. It is ridiculous and an environment where "cowboy" RN's thrive. I WISH we were not allowed to take verbals except in emergencies and that the docs had to enter their own orders. I also wish we got quick call backs. Noahsmama I would love to work in facilities such as the ones you have described!!!!

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.

Ultimately, when you come right down to it, you can always defend doing what's best for the patient. Working in ER's, for example; I'd much rather face a jury for giving a minor good medical care without parental consent, than face a jury for letting a minor suffer or deteriorate for lack of parental consent. I might lose my job, my license, the $67 I have in the bank, but I wouldn't lose 1 minute of sleep. Somehow the human race survived a long time without doctors orders, so they just might not be the hallowed message from the Gods we're told.

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.

Somehow the human race survived a long time without doctors orders, so they just might not be the hallowed message from the Gods we're told.

I don't think anyone here has suggested that physician orders are "hallowed messages from the Gods," and I've never heard that suggested anywhere else, either. But they are legal requirements. Like driver's licenses -- I'm sure that you, and everyone else here, are just as competent as I am to drive a car safely -- but, if we do it without a valid driver's license, we're breaking the law and there will be legal consequences if we get caught. Not a chance I'm interested in taking.

Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.

What is it that we think is going to happen exactly by discussing this?

Specializes in ER, ICU.

I just stick to protocol. Need my license.

Specializes in ER.
You're naive if you don't think things like this can somehow be traced back. NOTHING is anonymous on the internet.

true, which is why one wouldn't want to post any incriminating information.

But really, I can't imagine there's any sleuth out there dead set on finding a nurse who posts that they put O2 on a respiratory distress patient without an order. Or similar lesser deeds that blur the line between physician order and nursing autonomy.

haaa!!!!

Specializes in ER.
Ultimately, when you come right down to it, you can always defend doing what's best for the patient. Working in ER's, for example; I'd much rather face a jury for giving a minor good medical care without parental consent, than face a jury for letting a minor suffer or deteriorate for lack of parental consent. I might lose my job, my license, the $67 I have in the bank, but I wouldn't lose 1 minute of sleep. Somehow the human race survived a long time without doctors orders, so they just might not be the hallowed message from the Gods we're told.

amen to that.

Specializes in ER.
I don't think anyone here has suggested that physician orders are "hallowed messages from the Gods," and I've never heard that suggested anywhere else, either. But they are legal requirements. Like driver's licenses -- I'm sure that you, and everyone else here, are just as competent as I am to drive a car safely -- but, if we do it without a valid driver's license, we're breaking the law and there will be legal consequences if we get caught. Not a chance I'm interested in taking.

dthfytr was being a bit tongue in cheek. Truth veiled with heavy sarcasm. I think how you respond to the OP depends on where you work also.

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