Prescribing out of Speciality?

Specialties NP

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Just wondering - are there rules for NP prescribing by specialty? Example: if a PMHNP wrote an antibiotic prescription for a family member with an ear infection?

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Specializes in Psychiatric Nursing.

Yes there are rules. In the states I have worked you cannot prescribe for yourself or family members.

I think there are also rules about prescribing out of specialty. Check your state BON. I wouldn't since I don't have training out of my specialty.

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Specializes in Neurosurgery, critical care.

I know it is "looked down" to prescribe for friends or family. If you MUST, I would write up a HPI, PE, ect and have the patient sign it as well with included therapy options. This would somewhat legally protect you. Although the best scenario would be to not prescribe anything.

As far as out of speciality, depends on your BON, to my knowledge as long as you have EBP rational behind your clinical decision you should be good. However do not turn your patients into lab rats. Remember... Do no harm.

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Specializes in Nephrology, Cardiology, ER, ICU.

Writing scripts for family will get you reprimanded by the BON. At least in IL....

Look it up...State of Illinois Division of Professional Regulation

Prescribing outside your specialty can get you into trouble too.

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Specializes in OR, Nursing Professional Development.

Working in the OR, I have seen coworkers ask PAs, NPs, and surgeons for prescriptions. I am unaware of any board actions; however, several were contacted by HR. The reason? There is no professional relationship (provider-patient) between the person writing the prescription and the person requesting it. I would stay away from any situation that involves writing prescriptions for someone with whom you have a personal relationship or no provider-patient relationship.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Providers who prescribe for themselves, family members, and friends are more common than you think in the absence of specific regulations banning this where they practice. Even if it's allowed in your state, there are ethical considerations to ponder.

The AMA has this to say about the topic: Opinion 8.19 - Self-Treatment or Treatment of Immediate Family Members

A good read on the topic covering the gray areas involved can be found here: Should You Treat Yourself, Family or Friends? - Mar 2005 - Family Practice Management

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Also, prescribing medications relies on the provider's training or knowledge base and practice environment. A Psychiatrist is not prohibited from writing an antibiotic in fact some probably do. Some who work in institutional settings where patients can present with infections and have no available Internists who round on the patients will have to treat the infection as the primary provider in charge of the patient.

A lot of this is common sense and knowing your boundaries. I work as a nurse practitioner in an adult ICU where we admit critically ill oncology patients who present with acute hematologic malignancies requiring initiation of chemotherapy. I don't know anything about chemotherapy, hence, our Hematology-Oncology consultants and write those medications. However, I'm very comfortable writing antipsychotics for delirium in an ICU patient or treating DKA without an Endocrinology consult.

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Specializes in Anesthesia, Pain, Emergency Medicine.

Personally, I'd tell HR to take a hike and mind their own business.

If I write a script for a co-worker in the OR, which I've done. I DO have a provider-pt relationship. I also document a PE, assessment and plan in my trusty IPAD (Drchrono).

Working in the OR, I have seen coworkers ask PAs, NPs, and surgeons for prescriptions. I am unaware of any board actions; however, several were contacted by HR. The reason? There is no professional relationship (provider-patient) between the person writing the prescription and the person requesting it. I would stay away from any situation that involves writing prescriptions for someone with whom you have a personal relationship or no provider-patient relationship.
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So there are no specific laws banning this? I'm not talking about restricted drugs, scheduled 2s, etc - I just mean very simple things. For example, I have a brother who gets ear infections 5-6x per year because of the strange shape of his ear canal. When it happens, he is in so much pain he typically wants to start antibiotics immediately, so he goes to an urgent care. 3-4 hours and $100 later, he has his antibiotic prescription. I plan to be an NP, I'm not sure what type, but I just wanted to know if it would be okay to help him out with this once I graduate. Instead of being such a huge burden each time he gets an infection, I could call in his typical antibiotic and he could be on his way.

Obviously I would never feel comfortable writing a new prescription for someone without a relationship, but we're talking a family member with a well known history who uses the same medication each time it happens. Would it really be frowned upon/ lead to disciplinary action to do this for him once I'm an NP? And if I do become a PMHNP, would I be unable to do it because I'm in the psych field?

I'm really curious about this..

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Specializes in Anesthesia, Pain, Emergency Medicine.

It depends on your state. In my state:

I would write a prescription for him after the normal PE etc.

You should probably document the exam and treatment to make the board happy.

If you are in the psych field, I think you would take a hit if you treated a patient with this complaint.

If you were an FNP, Adult or acute care NP, it would be fine.

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Ok thanks - I will just not do it. Better safe than sorry.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

The question is not whether you can or can not because if your state does not have specific rules prohibiting the practice, nothing is stopping you from doing it. The bigger questions is, do you really want to take on this responsibility knowing that the provider-patient relationship in this case is influenced by emotional attachment because the patient is your brother. It's not like he doesn't have any other options but to go to urgent care. If he has this medical condition, he needs to have a primary care provider that manages this and can easily call or email a prescription to a pharmacy based on his reported symptoms (granted this is really something ongoing). Urgent care just fragments his care and you taking on this one aspect of his care makes it look like he's just getting a piece-meal approach to his overall healthcare management.

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