Without Orders

[Apollo8933]

Hey all! Have been reviewing multiple websites, state government and blogs and found that laws are very vague. I know this is to allow grey areas to occur to allow patient safety as well as protect nurses and other health professionals in emergencies but I was wondering...what are some of the things that you all can do without doctors orders? Obviously comfort is a consideration here but name some examples all responses welcome :)

[Born_2BRN]

On my floor, we don't need order to start IV but do need if the access is other than IV.

[MN-Nurse, ASN, RN]

what are some of the things that you all can do without doctors orders?

I can't do anything outside my scope of practice without an order, and I am getting very good at getting those orders (or entering them myself) before doing any of them.

This is one of of the things you learn as you go along with help from your coworkers, and it varies greatly by facility and field. I recently had a urologist tell me, "Take out that foley and put in a 24 Fr. irrigation catheter and make sure he has something for pain."

That sentence gave me free reign to enter a crap ton of orders.

Hospitalists and residents, bless their hearts, are much easier - they enter all the order sets themselves and if you need to add or change something they are just a page away.

It's scary at first, but you get pretty good at knowing what to do when and with whom - and which coworkers are helpful to you in this process.

No easy answers for this one.

[Apollo8933]

Really? That's pretty incredible and surprising actually! So you don't need an order for just NS? For hydration?

[VANurse2010]

I think she means just placing a peripheral IV - not running fluids

[emtb2rn, BSN, RN, EMT-B]

On my floor, we don't need order to start IV but do need if the access is other than IV.

You may want to doublecheck your facility's policy. I'm pretty sure a iic/heplock requires a physician order. It's invasive. Could be wrong, wouldn't be the 1st time.

[DedHedRN]

I have what we call progressive orders. Otherwise, its business as usual.

[Morainey, BSN, RN]

We have some older nurses who are comfortable with our docs, so if the patient's BP tanks out they will start a fluid bolus immediately and then call the MD to tell him later once the patient is ok. The MD is always like, "yeah, yeah, that's fine". I guess technically the order is covered then but I'm not brave enough to do that

[puroticorico, MSN, CNA, RN]

Each hospital varies due to their policies and procedures. Since I'm in the ICU, we often are required to take action without a doctor being there right away. We receive all the necessary orders after the fact, and then some. The nice thing is your can receive the orders in person or over the phone, and enter them yourself .

[VANurse2010]

You may want to doublecheck your facility's policy. I'm pretty sure a iic/heplock requires a physician order. It's invasive. Could be wrong, wouldn't be the 1st time.

Technically it does at my facility also, but it's part of a standard order set that *every* patient in the hospital is on.

[Born_2BRN]

I need to clarify what I wrote. I meant if their old IV (not fluid, we talk PIV insertion) had gone bad or they come up for blood transfusion not through ER. Yes, I know you suppose to get order everything. I remember I got ding for given patient a bandaid after he bumped himself. He asked for it and as a new nurse I didn't know better. Can you imagine being punished for given patient a bandaid?

[BrandonLPN, LPN]

If a facility has standing orders for giving Tylenol or starting an IV in certain situations, you're still technically following doctor's orders. Such policies were still written bu medical staff, and I'm betting there's some sort of document somewhere detailing these orders that bears a physician's signature.

I'm pretty sure there's just about nothing in the way of medication administration that nurses initiate completely independently of some sort of physician's order. At least not in a hospital or LTC facility.