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.
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.
Nope, no prescribing---I added another very important part below. But to call a surgeon at 0100 to clarify whether the order that says "Accuchecks 4x/day" is really q 6 hrs or AC/HS? Or to call and ask at 0430 for an order for a med that we don't stock in med system, don't carry in pharmacy, the patient doesn't have, and isn't due til the next afternoon? Those things are what ****** doctors off. Don't cry or be offended if s/he is short or grumpy with you if you didn't use your brain to begin with!
BTW, I was informed in a staff meeting a little earlier---"no such thing as nursing judgment anymore" and that is part of the reason we don't have standing orders anymore.
You do not write orders for meds -- even just change in the route of a med. You're risking your license. You needed to call the doctor and get one of her doctor to do a phone order for this.
Shame on the doc who said "thanks for not calling me for this". He's encouraging you to order & give meds before checking with him.
Specializes in Emergency, Case Management, Informatics.
Same here. You got a verbal order earlier in the day, but wrote it as a telephone order at 2am? Something doesn't seem quite right there. Are you sure you aren't backpedaling because you didn't get the response you expected?
You cannot write med orders based on "nursing judgment". Show me anywhere in your nurse practice act that says you are allowed to prescribe meds as a non-APRN. The MD doesn't want to get a phone call at 2am for an order? Too bad. He signed up for the job. If he doesn't want to take call, he can open a private practice somewhere and see how that goes.
When it all comes down to it, are you annoyed by this "by-the-book" nurse because you cut so many corners yourself?
A v.o. is different, but had the situation been as originally presented, what if by some crazy chance the patient had choked on that Tylenol. Can never be too careful.
I would have written a verbal order and back-timed it. I never change orders or write new orders on my own, though ...even in painfully obvious situations.
That is false documentation if nothing else. Perhaps if the MD gets enough midnight calls then standing PRN orders will be available. I would never write "telephone order" for an order I did not call on, I value my license too much. We should all practice by the book.
I would not have done something like that and practiced out of my scope. I will not disagree that it is common sense, but I have seen great nurses lose their licensure for A LOT less! There is also a code of moral conduct to follow, and unfortunately there is no other way around it: You lied, legally saying you spoke with the MD and took an order when no such conversation occurred. If you were untruthful there, what else? If I were that patient and found out, I would be angry. I'm not saying you are a bad nurse or person, but please! Be more conscious of your actions! You worked too hard for your license to lose it over something that could have been so easily avoided. I always call the doc and almost always know what their answer will be before they tell me. Sometimes they do yell at me. But I would rather be overly cautious and hear them yell at me for being "bothersome" than to hear a patient's family cry to me that I killed their loved one because I was "not careful enough."
Specializes in OB, Telephone Triage, Chart Review/Code.
Sorry, I'm "by the book" also. Its too bad the doctor doesn't want to be called for things like this. It is their responsibility to write the orders and I think too many MD's do not "pay attention to detail".
I am a student nurse, there are other nursing actions that I can think of that could have been taken without giving the Tylenol. Perhaps a cool compress, accupressure, temple message or even hydrating the patient.
For the 0100 and 0200 calls to the MD we're being taught in school to have a second nurse on the line to co-sign the telephone order when we get our license and can take orders. Who knows if the MD is fully awake and aware of what he is authorizing at that hour. What if he went to a dinner party earlier and had a few drinks, or took an Ambien? You CYA when you have a second nurse on the line when you take a telephone order in the middle of the night and the MD and facility can't throw you under the proverbial bus if something goes wrong.
TX.RN.Shannon
103 Posts
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.
Nope, no prescribing---I added another very important part below. But to call a surgeon at 0100 to clarify whether the order that says "Accuchecks 4x/day" is really q 6 hrs or AC/HS? Or to call and ask at 0430 for an order for a med that we don't stock in med system, don't carry in pharmacy, the patient doesn't have, and isn't due til the next afternoon? Those things are what ****** doctors off. Don't cry or be offended if s/he is short or grumpy with you if you didn't use your brain to begin with!
BTW, I was informed in a staff meeting a little earlier---"no such thing as nursing judgment anymore" and that is part of the reason we don't have standing orders anymore.