Please help!!! New NP Dilemma :(

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Hi All,

I am a new Nurse Practitioner working in an outpatient surgical department. This department has 3 well experienced surgeons, 1 chief PA and 2 Nurse Practitioners. This practice, the surgeons are old timers and having major challenges with online prescription as their Electronic Medical Record is a nightmare to navigate. All 3 surgeons still writing prescriptions routinely. On a daily basis, they will write controlled drug prescriptions to give to the patient and many times the patients request to send their medicine order to their pharmacy online so that that they can pick up the medicine on the way home. This falls on me. Other times patients will call the practice to request controlled drugs for pain management. At this time, the surgeons will write prescription and fax to the pharmacy which thy will reject the order.

This is a real dilemma for me as a new NP working in this practice, as I am forced to prescribe controlled drugs for the entire practice because no one else can order this online. I have never seen the patient and no where in the chart what pain medication the surgeon previously ordered. The surgeons will not write why the patient needed the controlled drug, what other options they have tried, how long are they planning to give etc. I am not talking about few weeks post operative pain control. Patients are taking it for years.

What should I do in this situation? Any suggestion??

Thank you All

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Hi All,

I am a new Nurse Practitioner working in an outpatient surgical department. This department has 3 well experienced surgeons, 1 chief PA and 2 Nurse Practitioners. This practice, the surgeons are old timers and having major challenges with online prescription as their Electronic Medical Record is a nightmare to navigate. All 3 surgeons still writing prescriptions routinely. On a daily basis, they will write controlled drug prescriptions to give to the patient and many times the patients request to send their medicine order to their pharmacy online so that that they can pick up the medicine on the way home. This falls on me. Other times patients will call the practice to request controlled drugs for pain management. At this time, the surgeons will write prescription and fax to the pharmacy which thy will reject the order.

This is a real dilemma for me as a new NP working in this practice, as I am forced to prescribe controlled drugs for the entire practice because no one else can order this online. I have never seen the patient and no where in the chart what pain medication the surgeon previously ordered. The surgeons will not write why the patient needed the controlled drug, what other options they have tried, how long are they planning to give etc. I am not talking about few weeks post operative pain control. Patients are taking it for years.

What should I do in this situation? Any suggestion??

Thank you All

I agree that it's crazy to expect you to write all of the controlled substance prescriptions for your practice.

Just say no. Yes, it would be nice if the patients could pick up their prescriptions on the way home, but if the surgeon cannot be bothered to learn how to input it online, they can just say no. In the three states I've lived in in the past couple of years, it's illegal to put in prescriptions for controlled substances online. They have to be handwritten or printed out and signed, handed to the patient or her representative directly (cannot be mailed) and given to the pharmacy by the patient or representative along with a driver's license or other proof of identity.

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Protect your license and only write prescriptions for patients you personally see and have a relationship with. Next, only write scripts you can professionally justify in a note with a clear assessment and plan.

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Yes. Will try. Thank you

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Specializes in Reproductive & Public Health.

JUST SAY NO. Say it nicely but firmly. No no no no. Management should give them a mandatory half day of EHR training, if this minor task is really such a hurdle for them. Or you could offer to walk them through it the next handful of times they do it, and make a cheat sheet for their reference (but that really shouldn't be your job!).

Anyway at least in CT, you cannot handwrite controlled meds anymore, thank goodness. We do online only with 2 step authentication on our phone.

Paper scripts are the least secure, BY FAR. Not to mention the risks of leaving your blank pad out by accident (or even just unlocked, with staff access), which inevitably happens alllllll the time.

n a pinch, you can call over and I think manually fax the script, but the process has to bypass the patient completely.

And OMG e-prescribing is sooo much quicker and less error-prone. Takes forever to write out a formal script.

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Yes. thank you

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