I'm an RN. It sounds like you're already winning over the nursing staff by just being professional. Continuing to provide snippets of education as you discuss the patient and give orders will help the nurses feel empowered and invested, too- it makes us feel acknowledged for our contributions, like actual members of the team. Plus, we're learning. From the other side of things, I can tell you that they know what this nursing director is like, and her behavior will only make you look better.

From personal experience- after working with a particular type of provider for years, nurses become accustomed to how things used to go. A lot of times, there's a one-time discussion of what a provider "wants" and nursing is expected to know, and follow this, indefinitely, forever. Though it's never actually documented in a standing order, of course. Generally, this comes from a person who will fly off the handle at you if you call to clarify. So, in terms of nurses titrating (etc) when you haven't ordered that- my guess is that another provider expects it, and they don't want to rock the boat or feel stupid for asking you. The solution there is simple- tell them you don't want them to do that, explain your rationale, and have the charge nurse spread the word. Then, be respectful when they call you in the middle of the night to ask.

It sounds like the protocols do need to be updated, though...That's a lawsuit waiting to happen. Isn't there a medical director? Ultimately, I think in a PR battle, you'll come out smelling like a rose, and everyone will get better care. Not everyone's up for the job, though, and I don't think anyone would fault you if you didn't want to take this on.