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

Nurses   (21,211 Views 69 Comments)
by PureLifeRN PureLifeRN (Member)

PureLifeRN has 4 years experience and specializes in OR.

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics.

28,756 Visitors; 2,855 Posts

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.

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klone has 13 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

3 Followers; 113,879 Visitors; 13,161 Posts

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!!!!

You'd be surprised. I've been on the internet and message boards for well over a decade, and I've seen lots of crazy stuff happen. People develop dislikes for other people, and not everyone is stable and rational. The lines between online and real life get blurred, and I've seen people stalked in real life, as well as employers called and people "reported". Not a chance I'm willing to take, and not one I'd recommend anyone else take, either.

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

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rn undisclosed name has 4 years experience and specializes in Telemetry, Oncology, Progressive Care.

5,463 Visitors; 351 Posts

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.

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7,154 Visitors; 460 Posts

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.

fstshot.jpg

Edited by Flying ICU RN

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5,523 Visitors; 302 Posts

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.

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CoffeeRTC has 25 years experience.

21,410 Visitors; 3,725 Posts

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.

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968 Visitors; 14 Posts

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

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655 Visitors; 5 Posts

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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blondy2061h has 15 years experience as a MSN, RN and specializes in Oncology.

1 Article; 37,233 Visitors; 4,094 Posts

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.

When I worked as a camp nurse we had standing orders for tons of PRN OTC meds as long as the parent gave permission. It was fabulous.

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3,820 Visitors; 149 Posts

Wasn't there some hospital in FL where a lot of old time nurses got in trouble for doing stuff without orders even though it is how the docs wanted it?

I often wish there was a way to get the orders needed to care for the patient when docs don't call back.

What do you do when a doc leaves a pt NPO (was for a test to be done Friday, it didn't happen, pt is in over the weekend) and goes off for the weekend and no other doc wants to call back to give you a diet order? Do you leave the patient NPO for the weekend or change the diet and go back to NPO Sunday night for the test Monday?

It's a rock and hard place issue I hate!

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9,440 Visitors; 659 Posts

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.

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NeoPediRN has 6 years experience and specializes in Pediatrics, ER.

17,173 Visitors; 945 Posts

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.

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