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

BrandonLPN, LPN · Jun 30, 2013

Standing orders are still physicians orders. If you apply O2 per facility protocol you're not really acting independent of a physician order.

NurseOnAMotorcycle, ASN, RN · Jun 30, 2013

I know that all of these answers are really confusing and not very definitive right now. Really the best way to learn the answer will be when you get into nursing school and they can take you through it.

For now, just know that nurses are the eyes and ears for the doctors. That will be the biggest part of anything you do, so study hard so that you will be able to tell when you need to get more help for a patient.

joanna73, BSN, RN · Jun 30, 2013

Depends where you work, the standing orders involved AND the physicians you work with....in addition to your nursing practise act.

I work in a very small rural facility. We often do things without a Doctor's order and inform them after the fact. Technically, this isn't allowed, but my residents would be in jeopardy if we waited for the Doctor.

For example, depending on the situation, we will start O2, discontinue IVs and insert or remove catheters on certain residents who have foleys.

Esme12, ASN, BSN, RN · Jun 30, 2013

technically the answer is nothing more that what you do a CNA......There are standing orders, standards of care, policies that make one thing right and wrong......all written under the medical directors direction and approval once again making it under a MD(medical doctor/physician/doctor) name/license based on each states Nurse Practice Act which varies state to state.

nurseprnRN, BSN, RN · Jun 30, 2013

Everything you listed needs a physician or NP prescription after a medical assessment.

We try so hard to stop people thinking about ORDERS. This is not the Army and the physician/NP is not your boss. Yes, nursing is obligated by law (the Nurse Practice Act) to implement parts of the medical plan of care (other places, like lab, PT, dietary, radiology, and others implement other parts of the medical plan of care); we also implement parts of the nursing plan of care that are not prescribed by the physician/NP but by the registered nurse upon nursing assessment. Importantly, though, we are obligated NOT to implement care prescriptions that we have good reason to think will harm the patient; it behooves us to check that out and not blindly "follow orders."

However, most places have protocols or prescribed interventions for RNs to implement upon appropriate nursing assessment. For example, someone admitted to the ER with chest pain will certainly get an EKG, lab draws, and an IV start per protocol; a major trauma case will get a Foley catheter (among other things). ICU nurses will draw ABGs when indicated by change in condition (among other things). This is because nursing is a collaborative and autonomous position and not merely an extension of the physician/NP reach.

Does that help?

BrandonLPN, LPN · Jun 30, 2013

And, of course, all this talk about making lists of "things" (ie tasks) we can do with or without a doctor's order downplays the most important nursing functions: observation and clinical judgement.

Yes, it's the doctor who orders the lasix for the nursing home resident with CHF exacerbation. But who was the one who noticed the edema, the SOB, the crackles? Who called the doctor? The nurse. Our most important role in that scenario wasn't administering that dose of lasix, anyone can do that. It was being observant and prudent and knowing when intervention was necessary. If our most important function is giving meds or doing treatments, they might as well replace us with CNAs.

Really, our assessment abilities are more important than all the doctor ordered "stuff" on that list put together.

SoldierNurse22, BSN, RN · Jun 30, 2013

We try so hard to stop people thinking about ORDERS. This is not the Army and the physician/NP is not your boss.

Even in the Army, the physician/NP isn't your boss! That is one of the things I enjoy about the service. My nurse managers always outranked the interns and residents on the floor. If we had issues, we could go to them and the doc would have a nurse who outranked them on his/her tail. Often times, the NMs were Majors and Lieutenant Colonels (Lieutenant Commanders/Commanders for the Navy folks out there). If some intern (1LT/CPT for Army; LTJG/LT for Navy) or resident (CPT/MAJ) got cocky, we'd send our NMs after them and they'd give the doc a verbal smackdown unlike anything I've ever seen in a civilian hospital.

Also of note, our NMs were often of comparable or higher rank than the attending physicians. That was the level upon which their experience was valued. If that didn't do it, the DCN (deputy commander of nursing) was always at least a LTC or Colonel who could easily handle a physician gone wild.

And while physician's orders are still referred to as orders, they're less orders and more "suggestions for nursing's review" in my book, especially when entered by interns.

mcclot1993 · Aug 23, 2013

I know a few such as administering medication, giving intramuscular and subcutaneous injections, head to toe assessments, auscultating lungs, heart, and bowel sounds. Giving IV"s inserting urinary catheters, taking vital signs, changing dressing wounds, making care plans. Is there anything else that I have missed please let me know. by the way what is everything a nurse has to chart on during the shift. You know like paper work.

RNsRWe, ASN, RN · Aug 23, 2013

I'm taking it you're a pre-nursing student, looking to find out what an RN does on the floor?

Depends on the floor, of course, but here's off the top of my head:

PICC dressings, blood draws. IV infusions. NG tube insertion and monitoring; surgical floors have a variety of drains from a variety of body parts to choose from. JPs, chest tubes. Wound Vac machines. Telemetry monitoring. Ambulating patients. Dealing with restraints (if applicable/allowed). Psych patient protocols. Suicide-watch patient protocols. Correctional facility patients and their issues. Turning and positioning, pain management, PCA pumps. End of life care. Family care for aforementioned EOL patients. Ortho patients on CPM machines. Urology patients with CBIs.

Paperwork? Timesheets signed that show when you did T&P, the "watched" (suicide, psych, patients with sitters) patients have additional paperwork. Patients on heparin drips have specific paperwork showing times increased or decreased, when labs are due or were done. PCA pump medication charting.

Charting everything under the sun, actually.

nurseprnRN, BSN, RN · Aug 23, 2013

You sound like someone who might be looking to choose between career paths and think that what different roles are "allowed to do" would indicate how interesting or exciting they might be, perhaps choosing between medical assistants (MA), physician assistants (PA), EMS, and nursing.

One very important thing to learn about nursing is that it is not about what tasks nurses are "allowed" to do. The things you ask about are not skills but tasks. The nurse practice acts in the various states, under which nurses are licensed, mandates that we implement certain parts of a medical plan of care (though not many others, such as lab, diagnostic radiology, physical therapy, dietary...) and that certain tasks related to doing so must be performed by a registered nurse, and some can be delegated by the registered nurse to a licensed vocational/practical nurse (LVN/LPN) or certified nursing aide (CNA).

However, and this is where public understanding of our work is limited, registered nurses also have great statutory and moral responsibilities for independent and autonomous practice even within employment in hospital, facility, or other settings. I don't mean being a nurse practitioner, which is an advanced role. I mean that the registered nurse at the bedside or in other patient care contacts is held to a high standard for being able to assess patient/family condition, use nursing skills to diagnose response to injury or illness, and prescribe nursing interventions to address them. While we practice in concert with physicians, and are expected to use many of the same data and techniques for assessment that physicians do, there is a whole separate, parallel, independent aspect to nursing practice that often goes unnoticed or unacknowledged by lay people. None of the other things I mention have that statutory responsibility-- PAs and MAs practice consists entirely of actions that must be approved/covered by physicians or nurse practitioners, for example.

Registered nurses take extensive college-level education in hard science, psychology, and other basic educational preparation before they can begin studying nursing, because nursing uses hard science and associated critical thinking skills to be able to fulfill those responsibilities. They need writing skills to be able to document and communicate their findings, plans, and results. They need leadership skills to delegate and evaluate team members with lesser education and legal responsibility.

I hope this has been helpful in answering your question.

mcclot1993 · Aug 23, 2013

Supposedly I wanted to work in the ER, ICU, the OR, Labor a delivery. Do I have to specialize to work on those units. Do I need a BSN to work on those units and additional training. I seen youtube videos what the ICU is like. It looks like everyone is hooked up to an IV and ventilators. What are good units in the hospital to start working at if you were a new grad nurse.

mshessle · Aug 23, 2013

I'm sorry, but the fact that you can't even write a complete and correct sentence makes it hard to take you seriously. If I was asking educated people in my chosen profession for advice I would at least make sure I spell checked my writing. Why is nursing the one profession everyone thinks they can do? Augh. I wish you the best in your career, but realize professionalism is essential in nursing.