What are tasks that nurses can do with or with out a doctors order

[mcclot1993]

What I Mean is out of all the tasks that nurses do inserting catheters, giving enemas, inserting iv, drawing blood, intramuscular injections, passing medication, and so on and many more. What are nurses allowed to do with a doctors order and what are nurses allowed to do without a doctors order? Can someone give me a list?

[classicdame, MSN, EdD]

no we cannot provide a list. Too much is involved, starting with the Nurse Practice Act in your state. Basically no meds or invasive procedures without an order, and that includes oxygen. Hospitals have medical executive committees to approve policies allowing certain tasks without an order, but they should be clearly outlined. Sometimes there are pre-approved orders, like what Dr. A wants done for every patient of hers that is having a baby with a lady partsl delivery.

[SoldierNurse22, BSN, RN]

Generally speaking, orders are required for all the things listed above.

The exception is if your facility has standing orders or a protocol that is followed for every patient, but again, those are still orders.

Things I have done without orders: a physical assessment, a health history assessment, vital signs, patient education, I&O tracking, calorie count.

Invasive procedures (such as catheters, enemas, IVs, blood draws etc) and administration of medication in any form require orders. Nursing interventions, such as the items described above, can be instituted by nurses without a doctor's orders. You'll notice that most of them focus around information gathering versus treatment.

[roser13, ASN, RN]

From your other posts, I gather that you are in nursing school or pre-nursing school. A good place to discuss your homework questions is the Student Forum. At the top of this page is a horizontal yellow strike - one of the categories is "Student."

[mcclot1993]

I am acutally a nurses aide right now trying to better grasp the concept or a nurses job.

[Havin' A Party!, ASN, RN]

Depends on the facility involved and your license, certifications and training.

[mcclot1993]

well I have been working in a nursing home. I do not know much a nursing home differentiate from a hospital.

[NurseOnAMotorcycle, ASN, RN]

Also, every hospital has its own protocols as to what nurses can/can't do. I agree with classicdame. This is too broad of a question. The best way to get a better idea is to go to the practice lab with a teacher and have them run you through some scenarios on a training mannikin. You'll feel a lot better for it.

Also, go through your nursing interventions in your Nursing Diagnosis book. That's a great resource to get answers for your question.

[benegesserit]

well I have been working in a nursing home. I do not know much a nursing home differentiate from a hospital.

It doesn't really. No matter what the setting, a nurse (disregarding advanced practice nurses) needs an order to do anything beyond assessment and basic things like repositioning. Everything you listed needs an order.

However, knowing this doesn't really give you any idea of a nurse's job, because a huge part of the job is carrying out the doctor's orders. And, with the existence of standing orders and PRN orders, it may look like a nurse is deciding to do something independently, when the order is actually preexisting. I can slap a dressing on Mr. Johnson when he gets a skin tear at midnight instead of calling the doctor first because we have a standing order for that. I can give tylenol to someone running a fever or complaining of a headache because everyone who enters the facility and doesn't have a contraindication for it gets a PRN order for tylenol for fever or minor pain. We used to have a standing order to straight cath someone if we felt it was needed. We don't anymore, so now we have to call the doctor first, but another facility might still have that as a standing order.

There's also practicality. A nurse might, for example, stick oxygen on a patient with a low oxygen saturation or send a crashing patient to the emergency room before calling the doctor, even though this is technically outside a nurse's scope of practice. However, most doctors are on board with keeping their patients alive and won't throw a fit about it.

[Havin' A Party!, ASN, RN]

... Everything you listed needs an order...

This is correct... from experience in several jurisdictions.

[aachavez]

However, most doctors are on board with keeping their patients alive and won't throw a fit about it.

this cracked me up! lol

[Havin' A Party!, ASN, RN]

The operative word in there, AA, "most." :)