Ethical Decision Making

I think we often come into situations where we face with ethical dilemmas without really realizing that they are.  The most common practice of unethical behavior that I see on a regular basis is doing things without an actual order. Usually it is simple things, and things that the doctor would not care about, but you don't have an order for one so the nurse either just writes one, or just provides it to the patient. Have I done this? Of course, but mostly for very simple things like ordering a CPAP/patient uses one at home and RT won't allow it without an order. But where do you draw the line? I've had patients slipped a dose "contraband tylenol" after a fever of 38.8, in reality the doctor should have been called, but the night nurse did not want to disturb the doctor's sleep. Or another...the doctor admitted a Same Day surgery patient for observation for possible pain control problems and did not order their home meds, the night nurse told the patient just go ahead and take your normal medications. One of which was Kadian (basically oral morphine), so the patient did have good pain control. So what is the problem? Number One..no doctor order, and patients are not allowed to take their own meds without pharmacy reviewing them. The nurse is then practicing medicine by telling the patient its okay to take her medications. Number two: The medical record has no record of her taking her any medications. Number Three: The scheduled substances should be locked up down in pharmacy. Now have I ever looked the other way when a patient wanted to take a home med supplement that we don't carry and is not ordered, sure but this seems over the line. Ethical decisions often may have no right answer, and what is best varies from person to person. Why are we so scared to call the doctors? That is our job. We are the patients advocate, and should follow protocols or we cannot be protected in court. Ethical decision making happens everyday on the job...whether we choose to recognize it or not.