Will you give out a medication without the order yet?

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Just wanted to vent.....yesterday was a very busy day. The charge RN did an admission and apparently forgot to ask the dr. for a nicotine patch for a patient who was a heavy smoker when she asked for the admission orders of the patient. I gave out all the STAT orders and then the patient asked for the nicotine patch. I said, as soon as I get the order, I'll give it. Apparently, patient told charge nurse about it. Charge nurse barges in the medication room upset asking why I was making a big deal out of "just a nicotine patch" and also said that as an experienced nurse, she knows that it was not something to make a big deal of. I replied that I was uncomfortable giving something that was not ordered for legality's sake and it wasn't even an emergency! I don't care even if they say it's "just" Tylenol, Motrin, or a Nicotine patch-----if a patient gets a reaction and there's no doctor's order, I don't want to be in trouble. Because before, one patient told me that one of her allergies was a nicotine patch-----so it's possible to have an allergy from that. To the highly experienced nurses out there, was I out of line? What are your thoughts on this? How would you have reacted?

Specializes in OB.

You absolutely did the right thing.

I can give you a concrete example. A nurse on a unit I was working on was unable to reach the doctor shortly after he left the hospital (spotty cell phone reception in the area) so gave a med that is very commonly used in our specialty. Unfortunately because of the patients condition it was absolutely the wrong med to give - it sent her BP through the roof. It took me about 6 hours and multiple doses of other meds and constant monitoring to get her BP back to normal.

Would you really want to be explaining that to doctor, patient, etc.?

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I have seen nurses give out tylenol, nicotine patches, and more but I refuse to do it. One day there is going to be a problem and I definitely do not want to be on the witness stand saying I was practicig medicine.

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Specializes in Critical Care.
You would give a controlled substance without an order? Please tell me you know that is wrong. It's practicing medicine without a license, prescribing, diagnosing. Please don't ever do that.

Okay, then. I'll wait for my patient to go into status or respiratory failure/aspiration on me as the attending is taking 20+ minutes to call back at 2:30 AM. That's some splendid advice.

Common sense overrides textbook nursing. At least in the ICU. Thankfully it's rare occurrence as if the patient has any pathology that is prone to possible seizures, our standing orders on admit tend to cover most contingencies well.

Please tell me you don't wait for an order for narcan or romazicon if you feel a patient needs it, too.

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You did the right thing. If the CN thinks it's no big deal let her do it and put her license on the line. I bet if you told her if she was comfortable to do it she would have backed right down. She knows it's wrong.

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Specializes in Family Nurse Practitioner.

You did do the right thing but as charge I probably would have just rolled my eyes and applied the thing myself if the admitting nurse wouldn't. I'm not saying this is the correct way to do it but on a psych floor things like nicotine patches can be the straw that breaks the camel's back so in all honesty I often have to weigh the risks and benefits.

Edited to add: OMG I admitted to being prone to an eye roll...thats lateral violence for sure. :D

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Specializes in LTC Rehab Med/Surg.

I will not lose my job or my license if I stick to the rules. No meds given without an order. Period. Doctors prescribe, nurses administer. I don't trust a single doctor I work with to back me up if I decide to give a med they didn't order. I once gave D50 IVP for a blood sugar in the 40s. Pt could not eat. I could not reach the MD. It was policy to give the D50. The next day the MD wrote in his progress notes that I had given a med without an order. IN HIS PROGRESS NOTES. A LEGAL DOCUMENT. The doc was a butt, and he didn't like me. Nothing happened because it was policy, but let me tell you, reading that line in a pt's chart was chilling

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Specializes in Critical Care.
I will not lose my job or my license if I stick to the rules. No meds given without an order. Period. Doctors prescribe, nurses administer. I don't trust a single doctor I work with to back me up if I decide to give a med they didn't order. I once gave D50 IVP for a blood sugar in the 40s. Pt could not eat. I could not reach the MD. It was policy to give the D50. The next day the MD wrote in his progress notes that I had given a med without an order. IN HIS PROGRESS NOTES. A LEGAL DOCUMENT. The doc was a butt, and he didn't like me. Nothing happened because it was policy, but let me tell you, reading that line in a pt's chart was chilling

This is absurd.

You'd rather not treat a hypoglycemic patient when you can't reach the MD rather that take the correct and possibly life-saving measure?

You'd (plural-- people of allnurses) rather sit on a crumping patient until they coded so that then any actions you'd take would then be procedurally correct?

Does the R in "RN" stand for "robot"?

Next time that happens you give the D50 and chart to cover your butt: "unable to reach MD at this time. Nursing administration notified. 1 amp D50 administered per standard of care. Will continue to try to reach MD and will monitor patient and serum glucose levels". No court would hold that against you and if they did, at least you can take comfort knowing you made the correct ethical choice if not the correct procedural one.

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Specializes in LTC Rehab Med/Surg.

I did give the D50. I chose not to watch the pt die. I charted, charted charted. That did not stop the MD from accusing me of giving a med without an order. If you had read my post you would have seen I did the correct, unabsurd thing. I'm simply saying when you give a med without an order you are vulnerable. I can assure you I am no robot. I sweat blood that night knowing I could be putting my job on the line. And STILL I did the right thing. In this situation I had no option. Whenever I have an option, which is most of the time, I'll wait for the order.

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Specializes in Oncology.

I've given meds without an order twice. Once was a run of potassium on a patient with a critical level when we couldn't get a hold of the MD. The other was some IV benadryl on someone having a severe allergic rxn. Again, could not get a hold of the MD. Both drugs I had orders for within 5 minutes of getting in touch with the MD. Both times the MD thanked me.

A nicotine patch, however, is not an emergency. And you didn't even try getting in touch with the MD.

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Specializes in ER/Geriatrics.
Okay, then. I'll wait for my patient to go into status or respiratory failure/aspiration on me as the attending is taking 20+ minutes to call back at 2:30 AM. That's some splendid advice.

Common sense overrides textbook nursing. At least in the ICU. Thankfully it's rare occurrence as if the patient has any pathology that is prone to possible seizures, our standing orders on admit tend to cover most contingencies well.

Please tell me you don't wait for an order for narcan or romazicon if you feel a patient needs it, too.

If you don't have standing orders to give those medications you are wrong wrong wrong to do so!

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A nicotine patch, however, is not an emergency. And you didn't even try getting in touch with the MD.

Huh? Please reread my post-----my reply to the patient was: "As soon as I get the order, I'll give you the patch". So obviously I had every intention of talking to the physician. Note that the patient just came in and the orders for this patient was very new and I just gave out the STAT orders when the patient started asking for the patch. It was the patient's first time to ask me for that patch. But that's beside the point because the main issue was the CN wanted me to give something without an order yet and it was not even an emergency!

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Specializes in Critical Care.
If you don't have standing orders to give those medications you are wrong wrong wrong to do so!

Wrong wrong wrong?

How so?

Procedurally? Probably.

Legally? Maybe, but I could have been just as liable had I not acted at all. That's the catch-22 of nursing, after all.

Ethically? Most definitely not.

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