[missouriman]

I have as an RN, worked ICU mostly. I went to dialysis for the day job.
I am going to try to post up the best that I can my situation and the problem.

I work for a hospital. not a doctor.....
now I under stand that a nurse, working for a doctor can be an agent of the doctor and may renew, write scrips for the doctor.

I have always worked for hospitals, not a doctor, I have never written or renewed a script.
according to the south Dakota state board of nursing.. several phone calls and many emails a RN is not allowed to write or renew a prescription.

so at my work place they have been doing this for years. I came on 5 years ago, questioned this, never have written a prescription. but it is now coming to a head. they the managers are trying to make it part of my job. I thought that I had this taken care of 2 years ago. then a year ago they tried forcing me to do it again. at that time the manager said if I had a problem with it t o bring it to her and she would take care of it.

good, I guess that I had not had a prescription asked of me for all that time. then about 6 months ago, another nurse at my unit came along.. and we don't get along she is the access person, and barked,, out all these scripts that the patient needed or wanted. this is after I thought that it had been taken care of.. that we could not write or renew..
well she went to the supervisor, and he called me in, threatened me and my job. the manager called me into the office for a 2 hour ass chewing.. and this 2 hours was (breaking it way down here), that IF the board of nursing wrote back to the hospital that we could write scrips that it would be my job to write the scrips. my job has been questioned many times during this... I said yes, if the board says it is ok I will write them but right now they say no, I can't.) she went on and on. about how it would be my job to do this.. I kept saying lets see what they say and take it from there.

I am feeling so harassed that, I can't even start to share. the board of nursing has told me no..
the management has told me that I have to or it is my job.. then when I got pushed and ****** I went up. now the hospital is fighting with the board of nursing over this. I have gotten NO support from any of my co- workers on this.

Now I didn't think about it, but this affects all of the hospital, and out laying area's.

do you,,, working for a hospital, not a doctor,,,,, have to write or renew scripts?

[traumaRUs]

If it is against your state's practice act, you can't do it. Plain and simple. Do you have APNs that make rounding visits? Or...is this an acute unit? How often do the MDs visit. You would need to get their okay to call in refills anyway, right? I'm an APN in several chronic units, some physically located in hospitals, others free-standing. I practice in IL and in IL an RN can not call in refills on her own. That is considered practicing medicine without a license. I wouldn't think the MDs would even slighthly approve this practice.

[missouriman]

OK,,
do you write or re-new prescriptions and what state are you in?
I am still getting heck over this and I will soon be leaving my job.

[traumaRUs]

I live in IL but I'm an advanced practice nurse and have prescriptive authority as well as a DEA number and controlled substance license. As an RN in IL, I would not be authorized to renew or write scripts. Good luck.

[lillady1225]

This is very interesting to my. I've been an RN only about 1 1/2 years. I work in a chronic unit and we as nurses obtain refills on perscriptions constantly without calling the MD. I wouldn't do it on pain meds but on BP meds, renal meds (binders, sensipar, vitamins), and others we call in all the time. I was told as long as we have a record that the med was being taken by the pt in our system we could call in the refill. I did queston this at first but my manager told me it was routine practice and that it was ok. However reading this post makes me question what should I do?

[traumaRUs]

You are eseentially prescribing when you authorize refills. I would sincerely doubt this is allowed in your state. When I refill meds, I always look to see the effects the med has had on the pt and reassess the need for the med as well as the doseage.

My guess is that your supervisor says that its okay because they don't want you taking the time to call the MD. Not a good practice IMHO. It YOUR license.

[missouriman]

well the management had first told me that the opinion section of the state board of nursing didn't matter when I showed them where it said we could not write prescriptions.
the harassment continued.
now they have gotten an opinion from the state board of nursing that writing (prescriptive protocols is ok).
well we all ready do that with the hepatitis series and some others.
the management is trying to stretch this (now ok) opinion to include all drugs the patient lists.
BUT the patient medication list doesn't say what doctor wrote the script.

I pointed out the conflicting opinion's to my manager and was told that the latest opinion over rides the previous one.
But I can't find this new opinion any where on the site.

here is what I gave them. I am not an advanced practice nurse so I am sure that I don't have prescriptive rights.

((Prescriptive Authority for Clinical Nurse Specialist — Advisory Opinion

A Clinical Nurse Specialist in South Dakota does not have prescriptive authority for medications.
The Board of Nursing rendered this opinion upon submission of a written request. Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as guidelines for nurses who wish to engage n safe nursing practices. South Dakota Board of Nursing, November 13-14, 1996 meeting, adopted this advisory opinion.))

and I showed management this flow sheet. all of which points to not with in scope of practice.

http://doh.sd.gov/boards/nursing/Doc...fPractice3.pdf


board

http://doh.sd.gov/Boards/Nursing/

To me it sounds like there would have to be a standard protocol written for each drug.
this would have to be signed by the doctors.
but you would still have to look up and see if it was one of the approved doctors!!!!!!
then explain all this to the patient if their doctor was not on the list.


Do to the harassment of this prescription thing and some other factors I have resigned my position with the dialysis unit.
that and 18 patients a day is to much for 1 RN.

I guess the opinion statements of the nursing board are only to be followed if that is what you want.

I will be working in ICU now.

I am up set and frustrated that I didn't get any support from my co workers or management once I pointed out that the state board of nursing had said no. I thought that would be the end of it two years ago. but the manager seemed to make it her goal to have me writing prescriptions against my judgment and the state board.

so I gave up and quit.

[missouriman]

Originally Posted by lillady1225

This is very interesting to my. I've been an RN only about 1 1/2 years. I work in a chronic unit and we as nurses obtain refills on perscriptions constantly without calling the MD. I wouldn't do it on pain meds but on BP meds, renal meds (binders, sensipar, vitamins), and others we call in all the time. I was told as long as we have a record that the med was being taken by the pt in our system we could call in the refill. I did queston this at first but my manager told me it was routine practice and that it was ok. However reading this post makes me question what should I do?

You didn't say what state that you are from.
I was told the same thing, but having never written a script I asked to see the protocol. there wasn't one.
so I called the state board of nursing 5 years ago and this all started.

we also have nurses that will hook up a patient from anouther unit with out a signed consent, or orders.
I was called in for that also. after 30 minutes of getting chewed out I said lets call the legal office and see what they have to say. pointed out that no consent is a law suit and that no orders is practicing medicine.

[traumaRUs]

I guess I am pretty fortunate. In IL where I practice, a CNS is able to prescribe and is considered an advanced practice nurse. In fact, CNS, NP, CNM and CRNA have the same exact nurse practice act.

[missouriman]

WOW, all heck has broken loose.
I have to give a 30 day or month notice. did that. now they are blocking my transfer in the same hospital. I am going to let the managers fight it out. I knew the dialysis manager was going to do something anything to make this transition less then pleasant.
so now I have gone from one of the strongest nurses in the unit to the worst example of a nurse in the unit.

would you want to keep working for a manager like that???
the whole hospital just went through this studer ship mandatory.
cliff notes
you should be encouraged to be your best.
you should get the support to be your best.
you should try to help every one to be their best.
you should support your fellow nurses to be their best.
you should be happy in your job or look for something that will make you happy.
you should be supported in any change that will help you be happy or be your best.
the customer is first and any thing else is secondary. ( customer,, not patient).. family also...

this would just be AWSOME if everyone would get on board. but it is just not working this way.

I am shocked that this is not a way hot topic. It is not only about the prescription writing but about legal issues and support of your team members.

more cliff notes.
our work load has increased over 30 percent patient wise. 30 percent paper work wise. and now prescription writing 15 percent or so..
no change in staff, I have talked with the manager about all this. and it is do it or be done.......

I am a very good nurse, I am done. they are still playing the team work side.
Oh crap it go's on and on.........
I had a pt the other day, last 10 min of treatment say that he wanted to see the doctor right now... yeh right!!!!!!! then said ( you are just doing this because I am an Indian and you hate Indians)...

what the heck... I have taken care of this guy for 6 years. I have never said, done, acted, any different to him then any of my other patients. really hurt my feelings.
and this Indian thing is a BIG DEAL in my unit. they then look away and won't respond to anything.
I told him that it offended me, took me off guard, and that I had treated him with all the respect the he had ERNED from me.

aww crap.. I am done, quit,, I just give up. going on. last part of that story is he said he was sorry.. a big thing for an Indian.
I am just done with the chronic patient. I get to know them, get the like them, then they die. No not all of them, just the few, the rest, I hate to say, but I just don't care. The ones that demand, don't show up, pull the race thing.

I was just going to hit refresh and delete all of this but I am going to hit post instead.

this is honest and I would like your opinion.