Can we recommend a medication to a doctor to prescribe?

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I recently ran into a situation where I called a doctor and recommended to them a medication for an agitated patient. The patient had not had this medication in the past but had no allergies to it or its contents and no medical condition that would have made the recommendation inappropriate. The doctor wrote the order, patient received med, and no ill effects came from it. My manager is telling me it is out of the nurses scope of practice to recommend a medication to a doctor. Is this true?

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Specializes in Oncology.

No. The doctor ultimately made the choice to order it.

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It would only be out of your scope if you gave the med without an order. I phone doctors all the time with suggestions or requests.

Your "recommendation" is no different from me saying, "My patient is sounding very wet. I would like to give him some lasix." and the doc subsequently ordering the patient to have lasix. Or, for that matter, me saying, "The last time she had a UTI, she responded better to septra than to cipro."

As long as ultimately the doctor put in the order, I don't see how what you did is out of your scope.

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Specializes in Emergency, Telemetry, Transplant.

It is totally within your scope to recommend a med. A nurse with good critical thinking skills would be able to looks at a situation, weight the different medication options, anticipate what will be ordered, and question (in a professional manner) any medicine that he/she thinks is not appropriate.

On a side note, if the patient has never had the med, how did you know they were not allergic to it or its content? (sorry, just curious)

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Specializes in Emergency & Trauma/Adult ICU.

What you did was totally in your scope, and your manager is a little nuts. BTW -- if this was a conversation between you & the patient's physician, how does your manager even know about this?

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Have to do this all the time in ltc.

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Let me clarify the allergy comment in saying there was no documented history of an allergy. The doctor was an on call psychiatrist and the primary psychiatrist was upset and went to my manager about it. I consider myself to be a good nurse with good clinical judgement and I advocate for my patients all the time. This pt stated "im hearing a lot of voices. Everything they give me doesnt work. Give me something to help."Im glad you all agree with me. I was starting to doubt myself for a moment.

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Specializes in Emergency & Trauma/Adult ICU.

You've learned a lesson about that oncall psychiatrist then -- when someone disagrees with his/her judgement his/her automatic response is to look for someone else around to take the heat, rather than say, "yes, I ordered that -- do you want to discuss why you disagree?"

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Specializes in Critical Care.

I hope your manager is not not a Nurse, if so they missed the basic premise of Nursing (pt advocacy) while in school. If the primary psychiatrist was upset with a decision made by the on-call (regardless if it was at your suggestion), then they shouldn't leave on-call duties to someone else.

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Specializes in Neuro ICU and Med Surg.

As rapid response I have to recommend meds all the time. The other night we had a pt we had to narcan due to medications and she went crazy after we gave it. We had to call to get an order for something to calm her so she wouldn't hurt herself. We suggested haldol. We got the order and gave it.

To me no different from calling for an order for TPA to declot a picc line. You ask if you can give cathflo 2mg per picc port and you give with order.

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Specializes in NICU.

Depends on the ego of the doctor and how much he/she respects your knowledge and judgement. You are the most knowledgeable about the patient at that particular moment. You are suggesting based on your experience of what has worked the best in the past with this situation. If the doc respects you, then they will probably go along with your suggestion. If they don't like your suggestion they don't have to pick that drug.

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I recommend medications all the time. The doctors don't know my patients as well as I do! As long as the doctor orders it you're fine. Sounds like your manager has no business being manager if she doesn't know we as nurses make recommendations to the doctors! Hold your head high and keep advocating for your patients!!

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