If you’re a new nurse, you’re likely going to hear the term “nurse dose,” or “Christian dose.”
So in this article, I’m going to talk about “what is a nurse dose? and should you do it?”
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What is a Nurse Dose?
A “nursing dose” is when a nurse gives an extra dose of medication (typically a narcotic) if they determine the amount the physician ordered is not adequate. A nurse doing this is practicing outside their scope of licensure and therefore putting their license at risk.
Furthermore, it’s also a patient safety issue, as you’ll see in the example below.
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Why Do Nurses Give Nursing Doses?
Nurses give “nurse doses” when they feel like the ordered medication is not enough for the desired outcome. I’ve primarily heard of this done in two main scenarios.
- The first is when giving pain medications to a patient who’s been complaining of severe pain.
- The second is for a patient that’s needing to get psychiatric medications (i.e. Ativan, Haldol, etc.) and the nursing staff have had to initiate therapeutic holds on them.
I’ve heard of nurses also doing this at night when they’re trying to avoid calling and waking up a physician and risk getting yelled at or “cussed out” by a physician for waking them up.
Some nurses may also do this because they anticipate what the physician’s orders may be.
Overworked nurses who don’t want to come back so soon to deal with a patient’s continuing condition may also be at an increased risk of considering this practice.
Side Note:
Some nurses may have different names for it. I have heard some nurses call it a “Christian dose.” Just note that “nurse dose,” “nursing dose,” “Chrisitan dose” are all referring to the same thing.
What is An Example of a Nursing Dose?
Here’s an example. Let’s say the physician ordered Morphine 1mg IV.
The vial your facility orders comes in a 2mg/mL concentration. Using dosage calculations, you know you should give 0.5mL (1 mg).
A nurse giving a “nursing dose” may decide to give 1.5mg of the Morphine but then still chart they gave 1mg while wasting the other 1mg of the Morphine in the Omnicell.
Why is Giving a “Nursing Dose” Bad Practice?
Giving nursing doses is a bad practice for many reasons.
1. You’re Practicing Medicine Without a License
The first and probably most obvious issue with “nursing doses” is that you’re practicing medicine without a license. You’re neither a physician nor an advanced practice nurse, so you cant arbitrarily make your own orders.
2. You’re Not Documenting What You’re Giving
The second issue with this practice which I hope you were able to catch from my example above, is that nursing doses by nature are deceitful.
For you to not get in trouble, you have to document that you gave the ordered dose while also documenting you wasted the other medications.
The end result is that you’re not accurately charting what you’re doing for the patient.
Something to Think About:
You have to document it like that. Otherwise, it becomes obvious you’re giving a higher those than you should have, or it looks like you’re diverting medication.
3. Potential Bad Patient Outcome
I don’t know the likelihood of anything bad happening to the patient, but I think it puts the patient at greater risk for it.
Can you imagine a situation where the nurse that came before you gave nursing doses? You did the same thing during your shift, and then after your shift, the other nurse also gave nurse doses.
What’s the likelihood of all that happening? I don’t know. But I have to imagine there’s a risk for it.
Something Else to Think About:
The other thing to keep in mind is that once you start giving extra doses of narcotics to control pain, you start setting up the nurses following you up for failure who aren’t giving extra doses.
What You Should Do Instead of a Giving a Nursing Dose
Instead of going outside your scope of license, do these things instead.
1. Call the Physician
You need to call the physician for new orders. It doesn’t matter if it’s the middle of the night. You need to call the physician and stay within your scope of practice.
I understand some physicians are jerks about it. I get it. Ultimately you have a job to do, and so do they. Besides, if you don’t call them and something bad happens, you as the nurse will be thrown under the bus.
Related: Why is Night Shift Hard?
2. Talk to Your Manger or Treatment Team
If it becomes an ongoing issue where the patient’s problem (pain, psych, etc.) is not being managed, follow up your chain of command to see what else can be done.
If nothing else, the patient’s needs are clearly not being met, and one of your roles as a nurse is to be a patient advocate.
Protect Your License
You worked too long and too hard to get your license to let something like this make you lose it.
Make sure you’re doing the right thing so you can continue working as a nurse and taking care of the people in your life.
New Nurse Academy
Graduating from nursing school is a joyful time, but it quickly leads to a lot of stress once you start working as a new nurse. Check out the course that helps new nurses bridge the gap and transition smoothly to becoming nurses.
