Will never write order again w/o permission from doc

[*Posh*]

This RN is one of those people that you look forward to your shift when you know she is working. Great nurse, friendly and doesn't mind helping out if you need it.

A supervisor let it slip this nurse couldn't be the only RN on the floor. Of course, rumors started about narc diversion and the like. I reasoned that she wouldn't even be on the floor if this was the case, but people like to believe the worst.

I decided to look it up on my state's BON site. This nurse was working on the floor of a local hospital a year ago. One of her patients was on a vent and the family had decided to turn it off. The physician wrote an order that stated "remove life support after the patient's daughter arives at 1:00". The daughter arrived earlier than planned, said her goodbyes and after discussion with the rest of the family, told the nurse they were ready. The nurse found the RT and told her to go ahead and remove life support. The RT refused, stating that the order said 1:00 and she was waiting until then. The record didn't say how early it was, but I'm guessing it must have been a few hours since it did say the family did not want to wait until one. The nurse wrote an order that stated "ok to terminate life support now". When asked why she would write this, she said that this particular doc was one that she knew well, and every time she called to ask him for something he would say something along the lines of "whatever you want or whatever you want to do". So she felt comfortable writing the order. They went ahead and terminated life support and the patient died a few minutes later.

The record did not say who reported her to the board. It stated that initially, the BON wanted to suspend her license for two years, but settled on probation for two years. The stipulations include a minimum amount of hours to work every month, her employer has to send a letter to the BON every three months stating how she is performing, she can have only one job at a time and cannot work home health, clinic etc - has to be hospital. Another RN has to be her direct supervisor, but doesn't have to be on the same floor as she as long as the RN is in the building (which isn't what my supervisor said). The remedial education is significant and she has to pay for all of it. She went to the hearing without an attorney. Maybe the reprimand wouldn't be this harsh if she would have had one?

After finding out about this, I will never do this again and I will discourage my fellow nurses from it. The only times I've ever written orders like this are for things like air mattresses, and recently, for tele when my patient was on a drip and no monitor for three days (yeah, another story all together:madface:). I can confidently say I will never do this again. It scares the you-know-what out of me to even think about it.

Just wanted to share....

[DroogieRN]

Wow... a few of my colleagues will do this if they know the doc well and it is for something seemingly insignificant, like Calmoseptine, but even I won't do that. As for terminating life support? That's heavy/scary and I know I wouldn't go there on a bet. I think that nurse is really fortunate to still have a license.

Just my

[OhioCCRN, MSN, NP]

Scary!!!!

[netglow, ASN, RN]

OP, I am almost positive I have read here on Allnurses, either a first person account or a second telling by someone who knew what was going on (anon coworker), of this very incident. It is here somewhere and I think something happened similar to another family member was also to arrive at a later time, unbenounced to local family or something like that as the reason why the actual timing of the withdraw order.

Simply that RN no matter how nice and helpful, was getting very used to practicing medicine and it truly bit her in the butt.

[angeliclpn]

OMG!! I'm so sorry to hear this!! I work in a skilled nursing facility where I have seen other nurses write a simple Dr's order for a chair alarm or other things like that without asking the Dr. That scares me to pieces thanks for your story. It just goes to show that its safer to follow the rules no matter how little or simple it may seem.

[StrwbryblndRN]

Wow. So not worth the risk. I know she meant well. But such a huge order to write. I do not think I could have put it on paper without having the md state it twice to me. I am not afraid of the pt passing I just do not want to slip with something so important.

Lucky for us we have hospital protocol for mundane things like, air matresses etc. (not for any meds though)

[netglow, ASN, RN]

Can you imagine a scenario: Say a daughter is flying in and has talked to the MD about the timing to make sure she can say her goodbyes. Dr. writes order. Other family is disraught and really maybe isn't really close to this daughter but the daughter is the one who has dealt with the MD for years re "Mom". The family who is able to arrive is unnerved at the vent, and is OK with everything to d/c and discusses with the nurse. The nurse for some reason decides she can just facilitate family wishes and thinks she is pals with the MD and without calling the MD writes her own d/c order. Daughter arrives and finds out that "Mom" is dead, is very disraught and says to nurse what happened? Daughter says, that can't be, I talked to the MD this morning... out comes the cell phone and she calls the MD who states, "I wrote no such order!" Guess who did write the order, all Hell ensues.

That ain't never gonna be me. Withdrawing life support is a huge legal well documented thing, always. You are allowing someone to die, when you had the ability to keep them alive...

[Esme12, ASN, BSN, RN]

WOW.......all I can say is....... WOW........

I feel like Dr. Phil......WHAT WERE YOU THINKING??????? Why would you ever pull a stunt like that........I don't care how minor.....you can't write an order without talking to the MD......and before anybody asks......No....NEVER. I have never in 32 years ever written an order that I didn't ask the MD myself about.......not ever.

Wow.....

[SCnurse2010]

I'm a newbie but I refuse to write even something simple like adding tele or a chair alarm without calling the doc. No way no how. Sometimes my charge will say it's fine based on which doc it is but I won't do it. If she chooses to, that's her license. I won't cosign it either. If it's not super important I'll wait til someone else pages and talk to them then rather than waking them for something minor. I worked too dang hard for my license. I'd like to keep it for a while!

[glutton4punishment]

CYA, CYA, CYA.....always, CYA.

My glasses are no longer rose colored after a short year working as a nurse. Thank you for reminding me that ppl can be real a holes.

[Biggirl71]

I am so sorry this nurse is learning the hard way that the rules are in place for a reason. The truth is, anyone can report us to the board. It could have been one of her co-workers, her manager, the family, and even the physician. I have been a nurse for 12 years and I have NEVER written an order that was not given to me directly. There are even physicians that I will put on speaker phone so I have another nurse witness because they have histories of claiming they didn't give the order. With something like end-of-life, you can't play around. A quick call to the physician to say, "look, the family arrived early and they have decided that they are ready, can I change the time on the order?" By doing that, you cover yourself and you do the physician a courtesy by letting him/her know what's happening. I hope it works out for your friend. Those remediation classes and answering to the board are expensive and arduous but if it saves her livelihood, then so be it. After all of this, I guarantee, this nurse will ALWAYS call the physician for her orders.

[adnrnstudent, ASN, RN]

Well my interpretation based on how the original poster described it is that daughter was arriving at 1 and it was okay to terminate after that.

What if the daughter had showed up late, would anyone interpret it was okay to terminate at 1 still? I doubt anyone would.

I'm not saying I disagree with anyone about calling the doc to do it early but playing devil's advocate if the daughter showed up early and came out and said okay, then the whole time thing is just semantics.

The focus of the order was daughter was arriving at 1 so not before daughter arrived.