Wow. Just wow

jadelpn, LPN, EMT-B · Mar 4, 2015

Hi Brandon, no offense but I found your post a bit rude. I should have never posted this thread because I cannot give details. I'm also not over reacting , as this nurse was grossly practicing outside if her scope . Words from the nurse manager not me. Thank you everyone who did respond. I'm letting this go , it is now I n the hands of my employer .

And you may want to, going forward, just walk away. Unless you see everything a-z with your own eyes and it affects you or the patient which is under your care, I would just walk away. If a co-worker is getting an MD to write orders for narcs never given but put in a nurse's pocket, that you are asked to witness or waste a med that is not/was not given and is no where to be found....those are the things that I would get worked up about, as they would affect your practice, and your patient.

Otherwise, gossip and he said/she said/they did rarely turns out well. It can be career ruining.

VANurse2010 · Mar 4, 2015

That sounds very nice, but not always practical. At my previous job I received a pt from the PACU. After just a few minutes on the unit she was having severe vomiting. The resident was in the middle of a procedure and he said to me "give her 4 mg Zofran IV." I read it back to him, went to the Pyxis, got the Zofran, gave it to the pt., and the put the VO in. If I went 100% according to what you have above I would: 1. take the VO, 2. write the VO, 3. fax the VO to the pharmacy, 4. wait for pharmacy to "verify" the med and put it in the patient's eMAR. That could take a half hour or more. If I have a post op pt. vomiting (or in severe pain, or having a hypertensive crisis, etc.), I am not going to go through all those steps before administering the med.
I don't know what happened in the OP's scenario and I understand why she can't give all the details. However, I can understand how someone would not follow the protocol to the letter of the law.

I agree. I don't know what fantasy land she's living in, but this isn't about being "neat and tidy." My eyes rolled so hard at that one they practically popped out of my head.

OCNRN63, RN · Mar 5, 2015

Exactly. IMO, going into a patient's chart *THAT IS NOT IN YOUR CARE* to chart a med error that YOU THINK YOU SAW/KNOW, made by a nurse that IS NOT YOU - is grossly going outside your boundaries!!!! Wowsers.
I find that unethical and maybe even illegal.

It sounds like an example lateral violence, if you ask me. If you think a nurse has done something outside her scope of practice, you take it up first with the nurse, then the manager if necessary. You don't take your disagreements out in the patient record, for mercy's sake.

michlynn, BSN, RN · Mar 5, 2015

Technically, I see this all the time. For example, a patient becomes nauseated. The nurse retrieves ondansetron from the Pyxis and administers it IVP. The nurse enters the order into a computer under whichever doctor was covering the patient. The nurse informs the doc in passing (or not), and the doc signs off. Insert another med. I've even seen nurses be so brash as to do the same with scheduled meds.
And by scheduled, I mean controlled. i.e. schedules II-V.

That's pretty ballsy if I do say so myself. Giving tylenol for a back ache is one thing because you can go to the drug store and buy yourself some tylenol OTC but I would NEVER give a patient something that requires a prescription. You can't just assume that every time a patient gets nauseated that Zofran is going to be the first choice of treatment. What if there was something that contraindicated the choice of Zofran for that particular patient that you may not have caught because you just wanted to get them something for nausea right away? And this is just using Zofran as an example because that's the drug you chose to highlight in your post but no drug that requires a prescription should ever be given to a patient without an order. You could lose your license in a heartbeat if you put in an order like that for a doc who doesn't agree. You're practicing way outside of your scope of practice.

allnurses Guide · Mar 5, 2015

This is not an error this is deliberate malfeasance on both the nurse and intern's part - You have a responsibility to report this up the chain of command. I was almost stripped of my license several years ago for failing to report something very similar - lucky for me the accused admitted it and lost her license instead.

Libby1987 · Mar 5, 2015

This is not an error this is deliberate malfeasance on both the nurse and intern's part - You have a responsibility to report this up the chain of command. I was almost stripped of my license several years ago for failing to report something very similar - lucky for me the accused admitted it and lost her license instead.

OP's nurse manager knows about it.

VANurse2010 · Mar 5, 2015

That's pretty ballsy if I do say so myself. Giving tylenol for a back ache is one thing because you can go to the drug store and buy yourself some tylenol OTC but I would NEVER give a patient something that requires a prescription. You can't just assume that every time a patient gets nauseated that Zofran is going to be the first choice of treatment. What if there was something that contraindicated the choice of Zofran for that particular patient that you may not have caught because you just wanted to get them something for nausea right away? And this is just using Zofran as an example because that's the drug you chose to highlight in your post but no drug that requires a prescription should ever be given to a patient without an order. You could lose your license in a heartbeat if you put in an order like that for a doc who doesn't agree. You're practicing way outside of your scope of practice.

It really depends on the situation and the drug. I think your inexperience is showing here.

P.S. What you're saying about prescription vs. non-prescription is non-sensical when applied to the hospital, since everything requires an order in acute care. Tylenol isn't always innocuous, either.

cayenne06, MSN, CNM · Mar 5, 2015

It really depends on the situation and the drug. I think your inexperience is showing here.
P.S. What you're saying about prescription vs. non-prescription is non-sensical when applied to the hospital, since everything requires an order in acute care. Tylenol isn't always innocuous, either.

Quoted for truthiness. I'd probably give zofran without an order more readily than I would give tylenol!

I am a relatively new nurse (3 years and change), and when I started I wouldn't give so much as tums without an order. Now that I have built a relationship with our prescribers and have been exposed to the reality of bedside nursing, sometimes I do give meds before getting an order. And frequently, I will implement a verbal order before transcribing it, faxing it to pharmacy, getting it verified and entered in the eMAR. No WAY am I going to let my post op patient suffer while I wait for that verbal oxycodone order to go through the proper channels.

We have good standing orders on my unit though, so this rarely comes up. If I need a medication for a patient at 2 am and it is not on the standing orders, it usually means there's something going on that the provider needs to know about- and I do consider uncontrolled pain to be worthy of a call, even if I know it is within the range of normal for my post op c/s patient.

mhusen5 · Mar 5, 2015

Newsboy...

It is a BIG deal. Why don't nurses get it??

It's ALL criminal activity! It does not matter what the medication is!

If you HAVE a verbal order...you document it and give the medication.

If you have a written order..you give the medication.

Otherwise you have no order!!

Therefore you are practicing medicine outside the scope of YOUR license, period.

You are on a very slippery slope, legally, justifying the fact that you gave any

medication for which you did NOT have an order..regardless of how you want to rationalize that it was ONLY a motrin or an aspirin!!

The FACT is you gave a medication YOU ordered...not an MD!

The character of many of the doctors and nurses leave a lot to be desired..cover up, cover up, cover up! What happened to ethics??

Trust me, when you find yourself in court should the patient have an adverse reaction, and it does happen with OTC medications, you will be guilty of not only a medication error but also deception.

No patient, family, court or Nursing Board will ever tolerate/condone the deception.

Your license is toast!

Mistakes unfortunately happen. Deception is a deliberate act!

Those of you, who give any medication without an order will be thrown under the bus by the " buddy" MD, you didn't want to "bother"! He'll protect his license..not yours!

mhusen5 · Mar 5, 2015

If you know it and you don't report it......with at least a simple incident report,

you are complicit in the deception.

The incident report is your 'stay out of jail' card.

Nurses, stop being stupid!!

Stop covering for your 'friends' errors.

Your priority is the patient..that's why we have a medication protocol in place.

Stay out of trouble...follow it.

Your license depends on it!

allnurses Guide · Mar 5, 2015

Quoted for truthiness. I'd probably give zofran without an order more readily than I would give tylenol!
I am a relatively new nurse (3 years and change), and when I started I wouldn't give so much as tums without an order. Now that I have built a relationship with our prescribers and have been exposed to the reality of bedside nursing, sometimes I do give meds before getting an order. And frequently, I will implement a verbal order before transcribing it, faxing it to pharmacy, getting it verified and entered in the eMAR. No WAY am I going to let my post op patient suffer while I wait for that verbal oxycodone order to go through the proper channels.
We have good standing orders on my unit though, so this rarely comes up. If I need a medication for a patient at 2 am and it is not on the standing orders, it usually means there's something going on that the provider needs to know about- and I do consider uncontrolled pain to be worthy of a call, even if I know it is within the range of normal for my post op c/s patient.

Nice post. :up:

As hospice, I'm out in the boondocks far away from fax machines and my laptop doesn't have internet service so I'm not going to write the order, fax it to the doc, before I complete a verbal order.

Obviously hospice and home health has more challenges but I truly HATE the way technology has interfered with patient care.

When I was still working the floor, I could write an order quickly in the chart after talking to the doc on the phone and get it to the pharmacy just as quick. I'd get the med delivered quickly as well. Now, I have to log in to the computer and then log in twice to the electronic record system. Get to the "order" page, type the order, make a copy of the order for the doctor to sign when he/she comes once a week to our IDT meetings, etc. I call the order over to pharmacy and walk the paperwork over from my office to pick up the order. My focus in on the computer, not my patient.

I'm still not sure about what the complete story is with the OP but hope all will turn out ok.

mhusen5 · Mar 5, 2015

Cayenneo6

You are admitting to an illegal act on a public site!

You admit to deliberately and knowingly acting outside the scope of your license!

You are prescribing/giving medication without an order......that's a criminal/illegal offense.

What you think and 'feel' and your 'rationale' won't help you if

you find yourself in court, should your patient have an adverse reaction.

Sorry, that is not only stupid...it's arrogant....and shows your gross lack of experience!

I am trying to warn you to help you....your license is in dire jeopardy.

Go back to what you were taught.

The day someone, friend, foe, or stranger, reports your illegal activity, you'll wish you had!

You won't be the first or the last to wish they'd followed protocol,

when someone who does follow protocol, is appalled at your deception,

and reports your deliberately illegal activity.