Nurses To Prescribe Medicine - page 3

My Mom lives in New Zealand and she sent this article to me. She thinks NZ nurses are starting a trend that will eventually end up here. What do you all think? Today In New Zealand News ... Read More

  1. by   flowerchild
    Originally posted by LilgirlRN
    I work in the ED too, the nurses often give meds and then tell the doc what was given and the doc orders it. We spend much more time with the patients than the docs do, we know what they need and the docs that I work with respect our judgement in most cases and will 85% of the time do as we suggest. We see so many people in the ED it would be quite helpful if we could prescribe just normal everyday stuff. How many times has a friend or relative called you up and asked what medicine they should buy for their cold, or their diarrhea? Same thing in my mind. Wendy
    What happens the other 15% of the time? How many nurses end up in this position? Giving meds, doing procedures, etc. that are not Dr. ordered. Leaves the nurse hung out to dry. Wouldn't it be better if we had legal prescribing ability, parameters, protocols, and procedures in place to cover our butts?
  2. by   Peeps Mcarthur
    What about getting trained?

    Is my program(which I'm transferring out of to a 4 year college) just unique in its lack of pharmacology substance, or do nurses think that it's ok to skim this material and still obtain prescribing authority?

    The students in my soon to be former program could not be relied upon to prescribe water. Even the reaction of hydrolysis is beyond them I'm sure.

    I think the liability issue is huge.
  3. by   SKM-NURSIEPOOH
    originally posted by peeps mcarthur
    what about getting trained?

    is my program(which i'm transferring out of to a 4 year college) just unique in its lack of pharmacology substance, or do nurses think that it's ok to skim this material and still obtain prescribing authority?

    the students in my soon to be former program could not be relied upon to prescribe water. even the reaction of hydrolysis is beyond them i'm sure.

    i think the liability issue is huge.
  4. by   panda_181
    That's a nurse practicioner's job...that means they have extra schooling...so all the power to them! Nurses are the ones who see the patients most of the time anyway...the day-to-day care within the hospital. And even out of the hospital in a medicare setting...

    Amanda
  5. by   JillyT
    Thank you for all of your input on this topic.
    I have a question for all of you though....
    Since we have a background in Pharmacology and study the drug interactions of those meds we administer to the patient, why then could we not prescribe on a LIMITED (ie general pain meds, ducolax) basis? Are we not liable for the meds we administer anyway?
  6. by   nurseleigh


    My thinking was on the same line as Canoehead. Isn't that why most physicians have standing orders for all of the "average" meds that they prescribe? Like Tylenol, Dulcolax, MOM, etc.

    I graduate in a week and have not worked as a nurse yet, but the way I see it, they are basically handing us a list of meds that we can decide to use if they are needed.

    I don't know that I would be comfortable just prescribing away without that doctor order. As has been mentioned numerous times, the liability just isn't worth it and the pay isn't high enough for the risk.

    Leigh
  7. by   Peeps Mcarthur
    By Jillyt
    Since we have a background in Pharmacology and study the drug interactions of those meds we administer to the patient, why then could we not prescribe on a LIMITED (ie general pain meds, ducolax) basis? Are we not liable for the meds we administer anyway?
    IF the pharmacology included mechanisms of action, and pathophysiology in a purely medical model type curicculum, then perhapse we would have an outside shot at proper prescibing. Take into account the fact that a correct prescriptive form and dosage would only follow an acurate diagnosis. Look at the drug guide directly under the name of the drug and you'll see multiple scenarios and dosages. There isn't a constant. There is no replacement for medical training if you want a medical job description.

    Take an honest look at your pharmacology class (not classes) and realize it falls far short of even living up to those science prerequisites you had to take for it.
  8. by   RN2B2005
    I have to agree that it would be nice if floor nurses had the discretion to administer what are otherwise OTC medications, like Benadryl, without standing orders. That didn't occur to me when I first posted.

    I remember going to the Walgreen's at 3:00 in the morning for some Benadryl when my mother was hospitalised after her chemotherapy went sideways. She had a terrible runny nose and sneezles (from allergies, nothing special) and her nurse said it would be faster just to go out myself rather than wait for the doctor to call back and OK the nurse giving it.

    Otherwise, though, I agree with Peeps et al., that more pharmacology classes should be required before RN's prescribe on a routine basis.

    The legal liability is what makes me nervous--I can just hear some trial lawyer saying "--and Ms. Jackson, you had ONE pharmacology class in college, is that correct? --Yes. --And that ONE class made you feel that you were qualified to administer X medication to my client's now-deceased husband? --Uhhh..."
  9. by   Peeps Mcarthur
    Good example RN2B,

    Don't put yourself in a clinic a few years from now, but rather a witness chair!

    "I'd like to present to the jury your honor, the transcript of the accused"......................."let's see........psychosocial yada-yada..........psychological impact of yada-yada.........oh here's something, pharmacology........oh wait never mind it's psychosocial impact of pharmacology with some interactions thrown in to dress it up"

    :imbar

    "Do you know why you shouldn't give certain antibiotics perioperatively?"..................."well of course not" "You were trained in psychology, not pharmacology."

    "the witness may step down."

    "please leave your license with the baliff before you leave so it may be ripped to shreds, thank you."
  10. by   SKM-NURSIEPOOH
    originally posted by rn2b2005
    i have to agree that it would be nice if floor nurses had the discretion to administer what are otherwise otc medications, like benadryl, without standing orders. that didn't occur to me when i first posted.

    i remember going to the walgreen's at 3:00 in the morning for some benadryl when my mother was hospitalised after her chemotherapy went sideways. she had a terrible runny nose and sneezles (from allergies, nothing special) and her nurse said it would be faster just to go out myself rather than wait for the doctor to call back and ok the nurse giving it.

    otherwise, though, i agree with peeps et al., that more pharmacology classes should be required before rn's prescribe on a routine basis.

    the legal liability is what makes me nervous--i can just hear some trial lawyer saying "--and ms. jackson, you had one pharmacology class in college, is that correct? --yes. --and that one class made you feel that you were qualified to administer x medication to my client's now-deceased husband? --uhhh..."
    i understand where your mom's nurse is coming from but wasn't she taking a hell of a chance diagnosing her & making the suggesting for you to go out & buy the benadryl & give her the o.k. to give it??? i mean...i know your mom has probably taken it numerous times before...but what if this time she had had a reaction & her phyisican found-out about how she obtained it in the first place??? should something have of went wrong (perhaps lik a bad batch or somethng like that), would your mom's nurse be liable & would you also have been liable because you too hold a license...despite the fact that the patient in question is your mom??? isn't there laws against family members of the medical community treating their family??? it just seem like a sticky situation to me...i know i'm probably making a mountain our of a mole hill but if that have happen, what...if anything...could you've done to protect yourself??? never mind your mom's nurse...just a thought - moe.
    Last edit by SKM-NURSIEPOOH on Dec 2, '02
  11. by   psychonurse
    I work in a correctional facility and we have some protocols that we use when we see inmates in sick call and in an emergency basis. They are like standing orders for ICU or ER. We see someone with an ear infection or bronchitis we can order them some antibiotic or if they have constipation we can order them MOM for that. There are very few of the medications that need a prescription before ordering them. The orders for the medication that need a prescription have to be signed by the doctor within 48 hours of the order. The state board of nursing knows that we use protocols and I am very glad that we have them around cause we would be calling the doctor every 20 minutes about things that are going on. We also have emergency protocols for things like asthma and insulin reactions that we can follow to get the inmate through a rough spot, including starting an IV and giving D50. It really helps get through the emergencies without having to call the doc at the beginning.
  12. by   SKM-NURSIEPOOH
    ...nurses performing medical diagnosis & prescribing medication is something entirely different. i could see the necessity for nurses in extreme rual/hard to get to places getting additional certification/licensure in order to prescribe medication...but they would have to be on par with apns/pharmacist. peeps mcarthur is right...pharmiological make-up & chemical/biological breakdown of said pharmaceuticals are too complex & serious matter to get say...let the everyday nurses prescribe "otc or classes a, c, & d meds" with only one additional pharmacology course. i can see allowing pharmacist to prescribe medication...after all, they're drs of pharmacology & they understand the complexity of the chemical make-up & breakdown of drugs. i can almost go along with paramedics only because they're the first line of treatment for patients...i think that they could be given a lot more standing orders or emergency protocols...not so sure about them prescribing patient's medicaitons. i mean...what patients would they prescribe medication to??? the ones who call for a paramedic & then decline to go to the hospital??? yeah, i could just see that...there would be a field day with all sort of med seeking individuals just wanting some pain meds...calling for & holding up an ambulance...just to get a hit. what would be the parameters there??? lord...but i've digressed...sorry.

    again, i can go along with outpost or rual nurses that have no access to mds/apns on a daily basis & they really need to get treatment for their most sickest of patients or patients with chronic conditions such as asthma...then those nurses should go through a series of additional courses in order to be able to prescribe said medications...otherwise...standing orders or emergency protocols are just fine....everyday staff nurses already have too much responsibility/liability on their hands now...they don't need this extra one...jmho.

    cheers - moe.

    originally posted by nurseman
    outpost nurses can prescribe limited medication in canada without being a np.
    we got isolation pay but nothing extra.


    http://www.hc-sc.gc.ca/fnihb/ons/nur...m#introduction

    a class drugs are those that a nurse is authorized to prescribe independently.
    b class drugs are drugs that may be prescribed only by a physician.
    c class drugs are drugs that a nurse may prescribe for one course of treatment.
    d class drugs are drugs that a nurse may administer for one dose only, in an emergency situation; any subsequent doses must be authorized by a physician.
  13. by   TMPaul
    Advanced practice nurses with a Master's degree or better AND pharmacology education !!!

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