Would you do this?

If the doc told you that everything was changed to PO, I'd have written as a verbal order instead of a telephone order.

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.

It depends on the facility and the Dr. Every situation is different. It sounds like you have time put in with this Dr and know what needed to be done.

I would call the MD- That is why they get paid the big bucks... Also might help them to remember to check over their orders next time

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."

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.

Unless you have standing orders (which would cover you), I would have called the MD. I don't care if it was 0215 and I'm calling for Tylenol. My license is important and I worked VERY hard to get it. What if something happened with that PO Tylenol dose, for whatever reason? The MD wouldn't cover you because really, they didn't write or give you the verbal order.

Consider it a lesson learned.