Am I risking my license?

SaoirseRN · Apr 15, 2013

Is there a pharmacist you can collaborate with on these medications?

anangelsmommy, ADN, BSN, RN · Apr 15, 2013

Is there a pharmacist you can collaborate with on these medications?

No not an option. And I thought my health officer would be looking them over but she handed them back without a glance. She also doesn't have a license to prescribe.

nurseprnRN, BSN, RN · Apr 15, 2013

If they are to be signed by a physician, and they must be, that physician is responsible for knowing what s/he is signing. You can prepare a sheet with any standing medical plan of care and associated prescriptions, but you don't implement them on any patient without a valid physician signature. It has nothing to do with anything like a telephonic order-equivalent.

Your license is not at risk unless you act on those protocols without physician signature, or if you implement any that you know to be inappropriate or dangerous, the same as you are obligated for any physician plan of care in any setting.

BrnEyedGirl, BSN, MSN, RN, APRN · Apr 21, 2013

I don't see a problem with this either. I work in a level I ED, the nurses have a huge part in creating the protocols we use everyday! As GrnTea mentioned, they aren't orders until the docs sign them off!! This is a great opportunity to get the protocols you need! Take advantage of a change to make your day to day work easier!

Jory, MSN, APRN, CNM · Apr 29, 2013

I have been asked by my health officer to write up a series of standing orders to be signed by our medical director....There are a few that I am not familiar with the drug so the only way I can garner the information is to well....go to the internet. I raised the issue that I was not comfortable with doing this and that I was not sure but this might put me at risk since I was basically determining a prescription for someone that I was not licensed to be doing. I was told that it was not an order until it was reviewed and signed by the physician and this was the same as taking a verbal order as I had done many times. I believe it is different because when I do this, I actually take an order from a physician who has a licensed to do this. Can anyone give me any feedback on this?
angels mommy

You cannot ADMINISTER medications without the following:

1. Verbal order

2. Written order

2. Administered under protocol (which are approved by physicians)

You know what these three have in common? The dosage, route, frequency is given to you by a physician and THEN you administer, not the other way around.

Now, that is not what they asked you to do...they basically want you to come up with standing orders and they should NOT BE ADMINISTERED without a physician's signature, stating that he reviewed and agreed with them.

Let's say that your calculated dosages was wrong...do you know who will be to blame?

1. If the physician signed off on it...the physician and the nurse.

2. If the physician didn't sign off on it, only the nurse, because she administered meds without them being signed or verified by a physician.

I don't see where your license is at risk...at all. This doesn't even closely resemble a verbal order.

psu_213, BSN, RN · Apr 29, 2013

So would you be writing the protocol orders that would then be used on all patients after a doctor had signed off on them? If that is the case, I would think a doctor should be involved in writing the orders (not just signing off on them), making sure the dose is correct, etc. When I have worked with protocol (or standing) orders, a doc needed to sign off on the orders each and every time they were to be applied to a patient. For example, our unit had standing orders for potassium replacement (if K 3.0-3.4 give 20 meq PO KCl, if K 2.7-3.0 give 40 meq PO KCl, etc....I forget the exact parameters/replacements, but you get the idea). Well, a doctor still had to sign off each time he/she wanted the protocol used for a pt and they still could choose to treat each individually rather than go with the protocol.

If your health officer does not have authority to prescribe, then whether or not she reviewed the orders is totally immaterial.

anangelsmommy, ADN, BSN, RN · Apr 30, 2013

Thanks for the feedback. The one I am not comfortable with is because every patient will need a different dosage and possibly a different type of medication. I dont see how we can do a standing order on this. I did go back and tell my HO this and she agreed after I presented the exact scenarios. I will present it to the medical director signing off and see what he believes we should do in this situation, if he thinks we should have something for emergency, he can tell me what to print up for him to sign off on. thank you so much for all your information, I did discuss with some other departments in other states what they are doing and I feel better also. I just dont want to write up a complicated order I know nothing about for nurses in my department that may not understand the order and end up doing something wrong based on an order I wrote. I got all my orders back from my HO without a single note and realized she never looked at them. so I triple looked them over until I was absolutely sure they were right before I take them to be signed.

angels mommy

Jory, MSN, APRN, CNM · Apr 30, 2013

Thanks for the feedback. The one I am not comfortable with is because every patient will need a different dosage and possibly a different type of medication. I dont see how we can do a standing order on this. I did go back and tell my HO this and she agreed after I presented the exact scenarios. I will present it to the medical director signing off and see what he believes we should do in this situation, if he thinks we should have something for emergency, he can tell me what to print up for him to sign off on. thank you so much for all your information, I did discuss with some other departments in other states what they are doing and I feel better also. I just dont want to write up a complicated order I know nothing about for nurses in my department that may not understand the order and end up doing something wrong based on an order I wrote. I got all my orders back from my HO without a single note and realized she never looked at them. so I triple looked them over until I was absolutely sure they were right before I take them to be signed.
angels mommy

I'll be honest..if they never looked at them with no notes, I would drop it and make them do it.

Seriously...I thought that in your OP, you were referring to a protocol for the facility, not individual patients.

Sounds like you have doctors at your facility that don't want to do their job. They need to write their own medication orders for each one...they don't have to change them, but they need to write them, not you.

No way would I touch that with a 10-foot pole..you are not at risk, but what I worry about, is the nurse that DOES THE ACTUAL administration, thinking a doctor wrote the orders, and the orders end up being wrong? That isn't right.

anangelsmommy, ADN, BSN, RN · Apr 30, 2013

Well in general most of the orders are just that, general orders. But there are a few that are very complicated that i went back and refused to write for that reason. They can't be done for that exact reason, you write individual orders for individual meds because they are for individual patients. And that is why we need to have a medical director around that can sign for these orders when we need them and that DOCTOR needs to give the order.