Can we give advice?? Stepping over lines??

RN1982 · Jul 16, 2008

Personally, I wouldn't. I feel like I would be stepping on the toes of the doctor and I don't really think its within my scope of practice to be giving out medical advice. It just makes me nervous.

Penguin67 · Jul 16, 2008

One way you could do this is to speak directly with the doctor to ask if they wanted to order such and such. That way, you are not doing anything behind their back, and you have the opportunity to ask questions and learn from them.

I wouldn't suggest to a patient that they shoudl ask the MD about anything. That is my job! (Unless it was one of my family members, who I always prep for MD office visits by telling them what to ask for, but that's another issue!)

Dolce, RN · Jul 16, 2008

It really depends on the setting that you are practicing in. When we do screening colonoscopies on patients they sometimes come in with an elevated BP and are on no BP meds. Most of the time the endoscopy doctor is not their family physician and often the patients do not have a primary physician. In these cases I will tell the patient that they need to make an appointment with a physician. I am not giving out medical advice, I am just encouraging them to make an appointment where they can get further screening for HTN.

racing-mom4, BSN, RN · Jul 16, 2008

I agree question the Dr 1st, the ones I work with are generally very receptive to the nurses thoughts.

RN1989 · Jul 16, 2008

I think it depends on your comfort level. I have found that there were doctors that were not listening to the patient and were going in the wrong direction and the patient knew it too. There are ways to suggest to your patients to ask the doctor certain questions or to get another doctor without risking practicing medicine without a license and without making everyone angry. But it usually takes experience and practice to know how to do it.

As patient advocates, we cannot allow the doctors to do things that are inappropriate or not complete merely because we are afraid of stepping on their toes.

llg, PhD, RN · Jul 16, 2008

I seem to remember a case in which a nurse was either sued or accused of practicing medicine without a license when she recommended a course of action that was not consistent with what the physician was doing -- but I forget how it all came out.

Be very careful when giving "medical" advice. That's not within the scope of nursing practice. Make sure you are staying within the scope of nursing practice. It's one thing to say, "You might want to see a physician about that BP" and quite another to say, "I think you might want to explore this alternate form of therapy for your condition." Be very careful -- and be sure to discuss any questions you have about that aspect of practice with your supervisor or educator as you orient to a job. What's appropriate in one setting might not be appropriate in another.

Also, whenever in doubt ... it pays to err on the side of caution and get a second opinion from a supervisor, educator, or more experience nurse before talking with the patient. And as someone said, the best course of action may be to talk with the physician directly.

**SKM-NURSIEPOOH, BSN, RN** · Jul 16, 2008

i think it depends on your comfort level. i have found that there were doctors that were not listening to the patient and were going in the wrong direction and the patient knew it too. there are ways to suggest to your patients to ask the doctor certain questions or to get another doctor without risking practicing medicine without a license and without making everyone angry. but it usually takes experience and practice to know how to do it.

as patient advocates, we cannot allow the doctors to do things that are inappropriate or not complete merely because we are afraid of stepping on their toes.

i totally agree with rn1989 in that as patient advocates, there is no reason that we can't teach & inform patients how to ask or what to ask their healthcare provider(s)...md or apn...it matters not which.

how one could approach a subject or give advise is to first state as a disclaimer: i'm not an apn or md & am not legally able to give medical diagnosis. that being said...as a nurse, it *is* in our scope to teach patients how to follow medical treatment prescribed by their practitioners. if patients don't fully understand their instructions, we are suppose to further teach/elaborate on the instructions so that the patient will feel comfortable enough to comply. there isn't any reason we couldn't answer questions that will facilitate more communication between patients & their practitioners. so suggesting that a patient ask their practitioners for certain tests that might uncover an illness or rule it out is not practicing medicine. it's simply keeping the patient informed as well as giving them more control over their care. i'm definitely not advocating diagnosing & treating patients without a medical or advance practice degree/license...i'm just saying that it is within our scope to educate & refer patients to the proper medical discipline.

personally, i feel that we as nurses have more right to educate & refer our patients to their practitioners with more defining questions/guidance than those annoying pharmacuetical commercials that tell patients to "ask your doctor is ****** is right for you." i find those commercials and ads to be more invasive to the mds/apns than us nurses looking out & educating patients.

again, rn1989 is also right in that how you go about teaching patients is just as important. you don't wanna come off as giving medical advise; but simply educate them so that they understand their course of therapy as prescribed by their practitioners.

cheers,

moe

Epona · Jul 16, 2008

THANKS for the responses! So I guess (to be safe) the only ones who can make a suggestion about uncovering an illness or to take a test to better diagnose a problem would be an NP. Otherwise, I guess you are technically practicing medicine.

Wow. Ok. That I think is gonna be kinda hard for me as a regular nurse. One of my clinical instructors who is a PhD told me that I would be a great NP. I really like the detailed medical info. (the chemistries and labs) and the communication and explaining to patients. In my first degree I was Pre Med. So I guess that has something to do with it as well.

Thanks all! :nurse:

Tash4nvyblues, RN · Jul 17, 2008

I agree question the Dr 1st, the ones I work with are generally very receptive to the nurses thoughts.

I agree also, and the patient is also entitled to a second opinion if you are really concerned that problems are not being followed up properly. Be very careful about what advice you give. It could damage your career.