Would you do this?

[TX.RN.Shannon]

This situation came up at work a few shifts ago. Had 20ish year old admitted for acute appendicitis. All meds IV or PR since he was NPO for surgery. Next day--surgery went great, tolerating clear liquids, doing well. C/O headache that he wants Tylenol for at 0215. That is the one med the MD didn't switch the route on, so it's only ordered PR. The pt refuses of course, so I wrote a telephone order from the MD to change it to PO. He got the Tylenol, headache went away, yay. MD comes in, sees order, says thank you for not calling me for that. I think I did okay.

I'm not prescribing/writing orders liberally or often, but some things we know how to handle.

Another nurse is freaked out by this. Everything is straight by the book for her. There is no nursing judgment or using your brain. She calls the doctor for every, stinking little thing; but then cries when the doctor gripes at her.

[TX.RN.Shannon]

Another order might be for Chloraseptic spray for someone with a NG tube. Used to have standing orders, but now they're gone.

[uRNmyway, ASN, RN]

The facilities I have worked at had standing orders for things like Tylenol, Glycerine supp, and a few other things that I can't think of offhand right now. We would just write the standing order, leave it flagged in the notes, and the MD would sign it when he would come in.

But no, I wouldn't write an order without actually being told its ok by the doctor. My licence means a lot to me, by the book, nursing judgment, or not.

[brandinalove]

Definitely wouldn't have written that order, even though I would've been 99% sure that the route on the Tylenol only not being changed was an oversight, I wouldn't want to risk my license over the 1% chance that there was a reason for it. In the nursing home where I currently work I feel that nurses sometimes get a little too comfortable writing TOs without actually speaking to the MD. Say something adverse happened after the PO Tylenol, do you think the MD would've taken the fall? Nope, he would've denied giving the order (he really didn't) and you'd be in front of the BON attempting to explain why you acted beyond the scope of your license. Sorry if that came off as lecturing, just my humble

[netglow, ASN, RN]

I wouldn't do it unless 2 things:

1. It was an obvious situation, like yours seemed to be.

2. I REALLY knew the MD, and he/she REALLY knew me, meaning we had years of a great working relationship.

[xoemmylouox, ASN, RN]

I would NEVER do that. Are you kidding me? What if something had happened? It would be your *** on the line for it, not the doc that you never got the order from.. This is a def. do not for me..

[enchantmentdis, BSN, RN]

There is no nursing judgment or using your brain. She calls the doctor for every, stinking little thing; but then cries when the doctor gripes at her.

Based on your attitude it looks like this nurse who you say does not use her brain will keep her license and/or her job longer than you will. If there are no standing orders, always call the MD. That is the law and correct nursing practice. What you did was prescribe meds. You are not a doctor. Go back to school to become an MD, PA, or NP, and then you can prescribe.

[PMFB-RN, RN]

so I wrote a telephone order from the MD to change it to PO. He got the Tylenol, headache went away, yay. MD comes in, sees order, says thank you for not calling me for that. I think I did okay.

*** We all do what we do at work. What I would NOT do is come here and write about doing something like that on a public forum.

Personaly I would not choose to work at any hospital that didn't have standing orders / protocals that allowed RNs to do common sence things without risking their lisence.

[Whispera, MSN, RN]

Where I've worked nurses could give things like tylenol, chloraseptic spray, mylanta, as a nursing judgment thing. Doctors don't like to be called for some things and this was policy of the units. We wrote the order as a "nursing judgment" and the docs signed them when they came in.

[Not_A_Hat_Person, RN]

You wrote a telephone order without actually calling the MD?

No, I wouldn't do that. I'm very "by-the-book" because if something goes wrong, you're held to the book.

[TX.RN.Shannon]

I left a BIG part of the story out! Guess I shouldn't post until after sleep!! Lol

I had talked to the surgeon at the beginning of my shift abput another pt. He asked about the pt. above and said something like "I changed everything to PO, he's doing well, he'll go home tomorrow."

THAT is why I "wrote" the order. The nurse didn't want to give it because there wasn't the order. I tried to tell her about our conversation, but she still was gonna call. I didn't realize until later that the Tylenol was only PR; it hadn't been changed.

Thanks for the input. But just wanted to clear things up---I do NOT write orders. :-)

[brandinalove]

That definitely changes things...in this case I most likely would have done the same thing.