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.

[R. Obias Jr., R.N.]

I agree, even if you are fully confident that your actions will resolve the issue,but you did get consent from an MD that will back up his orders , don't do it. Work within the confines of the duties of the nurse, if you still think that your suggestion will really help, suggest it to MD,even though some MDs don't accept suggestions, get their written consent before doing it on the patient.This applies to all nurses around the world , to avoid getting into trouble.

[mariebailey, MSN, RN]

Wait...I think I found a simple solution :):

[PMFB-RN, RN]

Do I like to get yelled at by doctors? Of course not.

*** Uh, doctors yell at you!?? Wow I wouldn't tolerate that for a second. I wouldn't choose to work in a hospital where administration was tolerant of physicians yelling at nurses.

If any physican trys yelling at me I put a stop to it immediatly. If they do it regularly I complain in writing the my chain of command and use words like "hostile work place".

Another effective method is to give the physician the strong impression, without actually saying so, that I would be VERY happy to catch him alone in the parking lot and teach him a lesson. Helps to be a large man when using this stratagy.

[JeffTheRN]

My mindset is chart and act as if a judge & jury were watching you.

[arallenrn11]

I'd probably have said "pr - only option at this time..."

This was my original thought after reading the OPs post. You had an order for Tylenol. The patient had a choice. Take the PR Tylenol or wait until morning and try alternative relief methods in the meantime.

[Caffeine_IV]

We nurses (some of us) may tread right on the line of what we can and cannot do but don't speak out about it. I'll leave it at that.

The nurse that goes by policy and procedure may get on the doctors nerves but you can't lose your license for that.

[TX.RN.Shannon]

Thanks to (most of) you who took the time to respond. There were some good points and information. I definitely learned a couple of important things.

Hope y'all have a nice day.

[veggie530]

*** Uh, doctors yell at you!?? Wow I wouldn't tolerate that for a second. I wouldn't choose to work in a hospital where administration was tolerant of physicians yelling at nurses.

If any physican trys yelling at me I put a stop to it immediatly. If they do it regularly I complain in writing the my chain of command and use words like "hostile work place".

Another effective method is to give the physician the strong impression, without actually saying so, that I would be VERY happy to catch him alone in the parking lot and teach him a lesson. Helps to be a large man when using this stratagy.

quoted for truth. i'm not a doctor, but that doesn't make me a servant.

[iluvivt, BSN, RN]

I would advice any RN currently practicing to read their Nurse Practice Act for any state you are practicing in the US . I am amazed just how many nurses have NOT done that. I would also read any position statements they have and check back frequently as these are changed and updated as nursing practice evolves. For example, in many states nurses can ASSESS a CXR and determine where the tip of a CVC is and release it for clinical use prior to a radiologist looking at the film. I am in a state that allows me to do this and this is an example of how nursing practice changes and evolves. Also find out how your state handles the "GREY" areas of practice when there is an overlap between nursing and medicine. There are two main ways these are handled..find out what yours is.

I can tell you equivocally by changing the route from per rectum to po you are practicing medicine and that is against the law. I say too bad if the MD gets upset..he should have changed the order and if he did not then he can except the nurse to call if needed. He should treat you with respect when you call and it's not acceptable if he does not behave professionally.

You should practice with the scope of your license and when you delegate a task make certain that the health care worker can do the task you delegate within in their scope of practice. You would never allow a NA to administer an IV medication and probably would be quite upset and concerned if they gave the IV medication on your patient. MDs can also be bent out of shape if you step over your bounds and write an order.You never want to lose your ability to earn a living in your chosen profession.

[PennyWise]

I agree with the posts I read so far: Wouldn't have done it.

I use my nursing judgement on things, but medications isn't one of them. I know what you mean by "by the book" and calling the doctor for every little thing. I knew a nurse who called the doctor in the middle of the night to get a fan in the room OK'd. Not appropriate.

On the other hand, I also knew a nurse who got fired for writing a verbal that was not given. No harm came to the patient, no contraindications, doctor didn't even really have a problem with the order (as evidenced by the fact that he signed it the next day and stayed active for the rest of the patient's admission). In fact, if I remember correctly, it was for Tylenol. Well..........guess what. The doctor who the order was written under came in and was in a bad mood. He complained that people were getting too comfortable writing their own verbals and one thing led to another and..............yeah, that nurse was gone.

What really makes this story interesting is that this doctor had always been the one who flipped out about phone calls during the night. He was usually the one telling people to write things and he'd sign or fix it in the morning during his rounds. Despite this, when he all of a sudden decided he didn't like it and complained.............well, that guy got a very up close look of the tire treads of the bus.

[PMFB-RN, RN]

On the other hand, I also knew a nurse who got fired for writing a verbal that was not given.

The doctor who the order was written under came in and was in a bad mood. He complained that people were getting too comfortable writing their own verbals and one thing led to another and..............yeah, that nurse was gone.

*** More than once I have taken a telephone order and in the morning had the physician deny giving it. Usually happens when an attending comes in and has a fit at the resident who gave the order. Several times I have experienced when the resident, in the middle of getting their butt chewed out, try to get out of trouble by claiming they didn't give that order at all. My word has alwasy been taken over theirs.

[PennyWise]

*** More than once I have taken a telephone order and in the morning had the physician deny giving it. Usually happens when an attending comes in and has a fit at the resident who gave the order. Several times I have experienced when the resident, in the middle of getting their butt chewed out, try to get out of trouble by claiming they didn't give that order at all. My word has alwasy been taken over theirs.

Wow. Thats all I can say.........Wow.

I'm lucky, never been involved in that.