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?

dthfytr was being a bit tongue in cheek. Truth veiled with heavy sarcasm.

I am well aware of that. However, being sarcastic and glib doesn't change the (legal) reality of the situation. I have seen many nurses get into trouble over the years because they didn't take scope of practice seriously, or believed that the "rules" weren't to be taken seriously or didn't apply to them.

when I was a new grad a resident gave me a verbal order for pain meds for a patient. He had the chart so I assumed he would write it. Well he didnt and I took the med out on override so it looked like I took out a narc with no orders to back it. I didnt see him after that morning to get the order and he wasnt a regular. I didnt even know his name. That was scary. On my most recent unit it was common practice to get stat cxr and abgs for pts in distress....ekgs for CP. And every time the docs would ask if I had done those things when I finally got around to calling them. They almost expected it and got kinda ***** if you called them with nothing to report to them, maybe because it was the middle of the night...IDK. I will admit that I am not perfect and I have done these things but some of you are not being honest. What about when a doc orders 25mg of phenergan but you thought the old lady only needed 12.5mg and thats what you gave. Or what about not giving certain meds at all and just not saying anything or calling the doc. I have seen IVFs that were turned off without a docs order and then just tell the doc on rounds why you cut it off. I think there are a lot of things we do without orders but you just dont think about it.

Not only do I think it depends on where you work facility wise, but I also think you will, in general, get different opinions from those who work in the ED vs. those on the floor.

That's all I'm gonna say... ;)

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.

Takeaway point here: Be VERY VERY careful what you say online, in a public internet forum. Nobody is truly anonymous

On that note, here I am with my aide Igor practicing medicine without a license.

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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.

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.

Wow.

On admission, we check off orders for tylenol for pain or temp, our bowel protocol that includs MOM, ducolox supps and enemas and a skin tear dressing order (its not always appropriate) These are checked off so essentially they are orders that each resident has written already. Other than that...nada. All of our diabetics get an order for low blood sugars too.

I do nothing that wouldn't hold up in court.

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!!!

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