Do nurses choose meds?

  1. Hi All!

    I was wondering, do RN's choose the medication that they give patients? For instance for pain, would it be at an RN's descretion(sp?) to choose administer morphine or would you have to wait on a doctor's order. Also, can LVN's choose medication type for a patient as well? Here is another scenario... I know these arent the correct meds, but lets say a patient cannot sleep. would an RN or LVN choose to administer ambien or lunesta to help them sleep?
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  2. 11 Comments

  3. by   donsterRN
    prescribing medication is out of the realm of nursing practice.
  4. by   MIA-RN1
    All medications must be ordered by a doctor. The nurse may not give meds without a doctor's order.
    However, it is the nurse's duty to make sure that any meds given to the patient are safe and the dosage is correct and that the medication is given appropriately. Also that the medicine does not negatively interact with any other medications the pt takes.
  5. by   MarySunshine
    Also, the doctor may put in PRN ("as needed") orders for patient. So, from this list of PRN orders the nurse may chose what he/she thinks is appropriate within the order guidelines. So, for instance, the doctor may have IV morphine, PO percocets, and PO tylenol all ordered as PRNs and the nurse can use what is appropriate to the situation. But the nurse could never say "Well, heck, I think they need some Vicodin! I'll just give that!" That would be illegal.

    The same is true for sleep meds (or ANY med) -- the RN could give them at his/her discretion IF there was a PRN order in place. Otherwise, a call would need to be made to the doctor to get an order before the medication could be given.

    Of course, it is acceptable for an RN to suggest to the MD that a certain medication would be appropriate. But the MD doesn't have to listen! Just as the RN doesn't have to give a med that they do not feel is safe!
    Last edit by MarySunshine on Aug 22, '06
  6. by   Little Panda RN
    All meds have to be ordered by a physician. There are prn meds that are given to the patient as they request it, but no sooner than specified by the physicians order. I have never heard of an RN or LVN choosing what medication to give. Maybe I am wrong but I am sure others will have some input.
  7. by   madwife2002
    I would normally discuss with the pt what they need based on pain severity. A patient may be prescribed lots of pain meds but not all are suitable for the pain that the patient is experiencing at that time. For example a simple headache would not require IV morphine, yet post op pain may require more that po percocet. It would be a joint decision between nurse and pt, and what they were prescribed.
  8. by   TazziRN
    Doctors will often order, say, ibuprofen for mild pain, hydrocodone for mod-severe pain, and IV narcotics for severe pain not relieved by hydrocodone. In that case it can be the nurse's discretion based on her assessment, but she cannot go beyond those orders.
  9. by   bcskittlez
    Gotcha, thanks all. That would be basically prescribing if a nurse did that. I am aware that a PA or NP can do that though. It is interesting to find out that you do not have to give a med as a nurse if the doctors prescribe and you don't feel that it is safe. Does this cause conflict often?
  10. by   MIA-RN1
    Quote from Skittlez
    Gotcha, thanks all. That would be basically prescribing if a nurse did that. I am aware that a PA or NP can do that though. It is interesting to find out that you do not have to give a med as a nurse if the doctors prescribe and you don't feel that it is safe. Does this cause conflict often?
    I haven't come across conflict but I am new yet. I had a doctor mix up their colace (which should be twice a day) and simethicone (should be q6) I just called and asked them if they meant that dose to be like that and if not could I suggest colace bid and simethicone q6. Doc laughed and thanked me for catching it.
    The other night we'd admitted an insulin-dependent diabetic post partum patient. I paged the doc to come over and write me some orders and the two of us together talked about it. I was careful to state 'you are the doctor but this is what I remember learning about diabetes in school' and of course I didn't tell the doc what the patient should take. It was more her bouncing thoughts off of me, and then she went to another doctor for confirmation of what she was thinking of prescribing.
  11. by   purplemania
    It is great when everyone works like a team and respects the other party. That kind of trust takes time to build and is worth the effort. Nurses are patient advocates and since we are at bedside longer than the MD, most MD's honor our opinion. They don't always do what you recommend, but many times the docs I work with will at least listen and give a rationale for ordering otherwise. I learn that way too!
  12. by   SharonH, RN
    Nurses may not legally prescribe; however there is some autonomy involved in administering medication. You may need to assess a patient and decide if they need a certain type of medication based on the symptoms they describe within parameters prescribed by the physician. Also, the autonomy varies based on the work setting, away from the hospital setting nurses have a lot more latitude in choosing which medication to administer. Additionally, it is not unheard for nurses to call up a doctor and suggest a medication for a patient based on what you assess their needs to be and I have even had physicians ask me what meds I thought a patient needed.
  13. by   West_Coast_Ken
    Quote from Skittlez
    Hi All!
    I was wondering, do RN's choose the medication that they give patients?
    The short answer is NEVER, EVER.

    The longer answer is "it depends." For example there are "standing orders" a facility may have in place (derermined by doctors) such as in the ED where time is critical but these are limited and must fit certain criteria.

    There are also nursing specialty areas such as Nurse Practitioners, Nurse Midwives, and Nurse Anesthetist that certaintly do prescribe medication but the "typical" nurse who works in a hospital does not choose the medication a pt is given.

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