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?

[benegesserit]

The operative word in there AA, "[i']most[/i]." :)

Yep, gotta know your doctors! :)

[s0ad]

This def. depends on your organization and state, and even area. For instance in our ED nurses have basically standing orders, depending on a person's complaint (ie stomach pain) of things they can order. In our hospital there is a new policy that if there is no justification for a foley, we can remove the foley without an order (though I don't know of many nurses who wouldn't at least consult the doctor). We can't have a patient shower without an order. We can't access a port without an order. We can enter our own wound care or dietitian consults. We can put in orders about nursing care type things - like when wound care dressings need to be changed, etc.

And while this is not the correct practice, I'm sure, I have occasionally lowered IV fluids when the doctor would not page me back for hours and my one hundred pound eating and drinking patient could hardly breathe from the insane amount of IV fluids that were ordered. Or have increased oxygen/put on oxygen before getting an order. However, I always make sure to get the order ASAP, and haven't had a doctor who has had an issue. If doctors paged back within 30 minutes like that should... it really wouldn't even be an issue....

[Lala potential LPN]

Well if youcan't provide a list then don't anwser the question

[SoldierNurse22, BSN, RN]

Well if youcan't provide a list then don't anwser the question

There isn't a list. That IS the answer to the question.

[smartnurse1982]

Actually'you dont need a Dr. order for O2(up to 2 L).

[smartnurse1982]

oops,i see its been mentioned about the O2.

i know when i worked in the nursing home we needed an order to send patientts to the hospital ER.

[OCRN3]

They just instituted protocols for our hospital where a RN can give a flu or pneumonia vax if the pt qualifies under certain criteria with out an actual order from a doctor, we used to need an order.

Stuff I have done with an order:

Bedbath

Assessments

Vitals

Start an IV just heplock for being on the floor in case of emergency

CPR on full codes

Encourage turn cough and deep breathing

Reinforce dressings...

Sent from my iPhone using allnurses.com

[benegesserit]

Actually'you dont need a Dr. order for O2(up to 2 L).

Yes you do, but many places have this as a standing order.

They just instituted protocols for our hospital where a RN can give a flu or pneumonia vax if the pt qualifies under certain criteria with out an actual order from a doctor, we used to need an order.

Stuff I have done with an order:

Bedbath

Assessments

Vitals

Start an IV just heplock for being on the floor in case of emergency

CPR on full codes

Encourage turn cough and deep breathing

Reinforce dressings...

Sent from my iPhone using allnurses.com

Flu/PNA vax and heplock are probably standing orders.

At least where I work, Full Code and DNR are physician's orders (with FC a standing order until the patient and physician both sign the DNR). I can see this potentially being handled differently in an ER.

Bed bath, assessment, vitals, and encouraging coughing and deep breathing I believe are all valid things that a nurse can do without an order. Not sure about reinforcing dressings.

[NurseDirtyBird]

I find it interesting that some posters are saying they need an MD order to send a pt. to the ER from a nursing home. You do not have to have an order to call 911. If you have any reason to believe your pt.'s life is in danger and are unable to reach the doctor, you're mandated to call 911. At that point, the transfer to the ER is the decision of EMS.

What you can do without an order: Reposition a patient, perform a swallow screen, d/c a symptomatic IV, hold any medication which is clinically contraindicated, apply restraints in an emergency (though the order needs to follow).

As stated, anything invasive and anything pertaining to medications - and anything else which might be germane to the patient's condition (feeding vs NPO, ambulation vs bedrest, etc) - requires an MD order, either explicit, by protocol, or by tacit agreement.

[mcclot1993]

what is a swallow screen. Is a MD order the same as doctors order

[jadelpn, LPN, EMT-B]

Swallow screens need to happen in my facility with a speech/swallow therapist. So here's a rule of thumb--and yes, MD and doctor's order is the same thing--

There should be a complete set of doctor's orders. On it should have everything pertaining to the patient. Including showering, activity, etc. Your facility should have policies in place. Some have standing orders and protocols to follow. You should ALWAYS get an order if one is not provided for you, or is not covered by a policy, procedure, standing order.

If you feel as if you need something else (patient not swallowing well) ASK for an order to have it evaluated. Another reference is your charge nurse. Ask your charge to look at a "bad" IV, inform the doctor that the IV is infiltrated, or whatever the issue is. Get the doctor's ok to discontinue, and re-insert an IV, or to leave it out. Always follow your protocol, and always ask if you don't know.

Every facility is different. Cover yourself, and never hesitate to discuss concerns with your charge, the doctor, or both. As far as medications....if the patient's condition is a contraindication for a medicine--advise your charge, advise the doctor, and get an alternate order. If the patient is to be ambulated "x" amount of times a day, and declines, note it and advise charge and the doctor.

Don't ever assume that you can do something when you are not sure. Always be sure.