Can we recommend a medication to a doctor to prescribe?

Nurses Relations

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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?

No it was not out of your scope of practice. On my floor, at a teaching hospital, we deal with many doctors who are new and sometimes they need an idea of what your thinking. It is up to the doctor to order what they think they should.

Plus you have to remember while you have a handful of patients that doctor may have 100 or more and it never hurts to give advice to help with your patient. The worst that they can say is no.

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Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

I often make suggestions to docs, but phrased as, "I've given the patient XY and Z and they're still in quite a bit of pain. I was wondering if an order for something like W would be appropriate?" and they usually go yeah sure okay. I haven't ever had an issue that way. They might not always agree with you, but that'll happen.

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Specializes in Psych.

I work psych. I have never suggested a specific psych med, but rather class. Like "x is in the quiet room pounding on the walls and.combative with staff. We haven't been able to de escalate him. Could we get an order for something.to help him calm down?". Or if I know they will refuse a PO I'll ask what they would like me to do if pt refuses the PO. I only mention OTC stuff specifiy. "Hey x is complaining of constipation, can I give her Milk of Mag?".

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Specializes in Critical Care.

Despite all of our attempts to use SBAR where it doesn't belong, this is the one scenario for which it was intended, which includes the "R" which is now actually two R's, but anyway). And of all the aspects of SBAR, the one that Docs tend to most frequently say they appreciate is the "Recommendation" part, if there is something you have in mind, then don't beat around the bush, just come out and say it. If the Doc in this particular scenario didn't agree with that then that is their own problem, and they'll have to learn to deal with the idea that a Nurse can do their job better than they can, but most Doc's realize that Nurse's know what works and are often in the best position to suggest what will work.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Not only is it NOT out of your scope, but at our hospital, behaviors like what you demonstrated are actually sought out and praised as being indicative of more expert/senior nurses. Collaboration in patient care and making suggestions/recommendations to the physician based on your assessment and knowledge of the patient is a GOOD thing an encouraged at many places.

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Specializes in Med-Surg.

I hope your manager is reading this thread.

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Specializes in Pedi.

When I worked in the hospital (peds), we had adult residents who rotated through for 2, 3, 4 months and knew nothing about peds and the meds we use, etc. I used to text page residents and say "need order for xyz" or "please change morphine from q 4hr to q 2hr, dose is not holding patient." Once the residents knew us and how we worked, they didn't argue.

Actually, I once had 2 issues in the same day with a Resident who for some unknown reason refused to order a very appropriate medications for my patients... an adolescent who was s/p spinal surgery, > 24 hours post-op and would have greatly benefited from Toradol. He had no rationale for why he wouldn't order it, he just wouldn't and said "just keep giving her morphine and valium"... After arguing for several hours I finally went over his head and as soon as I spoke with the more senior resident, the order was written and, once the patient had had 2 doses she didn't ask for ANY more PRNs. Same resident, same day tried to tell me that my patient who was 24 hrs post-op from a full VPS replacement (old shunt tract was completely calcified and it was a complicated surgery) shouldn't need anything more than Tylenol. This patient had required morphine, dilaudid and valium on the night shift and he wanted to discharge her with nothing but OTC Tylenol and insisted to me that "we never sent shunt patients home with more than this." Right, because he'd been around for a few months at that point so he was surely an expert. I refused to discharge the patient without appropriate pain medication and when he finally gave the prescription, he threw it at me and stormed out of the room. After this, I contacted the Attending and told him he needed to address pain management with his Resident. Didn't have a problem with that Resident giving me orders from there on out.

As nurses, we are patient advocates and that includes advocating for the appropriate medication.

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Specializes in Oncology; medical specialty website.

I don't see what the problem is. When I was working I did it all the time.

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When I worked in the hospital (peds), we had adult residents who rotated through for 2, 3, 4 months and knew nothing about peds and the meds we use, etc. I used to text page residents and say "need order for xyz" or "please change morphine from q 4hr to q 2hr, dose is not holding patient." Once the residents knew us and how we worked, they didn't argue.

Actually, I once had 2 issues in the same day with a Resident who for some unknown reason refused to order a very appropriate medications for my patients... an adolescent who was s/p spinal surgery, > 24 hours post-op and would have greatly benefited from Toradol. He had no rationale for why he wouldn't order it, he just wouldn't and said "just keep giving her morphine and valium"... After arguing for several hours I finally went over his head and as soon as I spoke with the more senior resident, the order was written and, once the patient had had 2 doses she didn't ask for ANY more PRNs. Same resident, same day tried to tell me that my patient who was 24 hrs post-op from a full VPS replacement (old shunt tract was completely calcified and it was a complicated surgery) shouldn't need anything more than Tylenol. This patient had required morphine, dilaudid and valium on the night shift and he wanted to discharge her with nothing but OTC Tylenol and insisted to me that "we never sent shunt patients home with more than this." Right, because he'd been around for a few months at that point so he was surely an expert. I refused to discharge the patient without appropriate pain medication and when he finally gave the prescription, he threw it at me and stormed out of the room. After this, I contacted the Attending and told him he needed to address pain management with his Resident. Didn't have a problem with that Resident giving me orders from there on out.

As nurses, we are patient advocates and that includes advocating for the appropriate medication.

I've had residents try to send post-op patients home with only Tylenol. Some of them have not gotten DEA numbers and don't want to track down their upper-level to do the scripts for them. This is where the "patient advocate" part of nursing comes in. :)

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Specializes in PACU, pre/postoperative, ortho.

Yep, frequently. Sometimes have to suggest labs as well. A few months ago, notified a covering doc of a pt's 103 fever. She just says, "OK, I'll see him in the morning." Umm... would you like blood cultures? It wasn't too late, about 2200 or so, but I'm thinking she must have been sleepy.

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I'll take your situation one step further, OP: when I was night charge nurse on a surgical floor, if I called a doctor about a patient whose status needed to be addressed, it wasn't unusual for the first thing out of the doctor/PA/NP's mouth to be "what do you want to give him?"

The person I was waking up knew I already had an idea of what I was going to want, so why not just ask me up front? Saved us both time, and on occasion if he/she wanted to prescribe something else, so be it. Most of the time, though, I made the suggestion, and received the order. Not in my scope of practice? News to me!

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Specializes in Surgical/MedSurg/Oncology/Hospice.

Just remember that the 'R' in SBAR stands for 'Recommendation'...I frequently toss in suggestions for meds/labs when speaking with the physicians, ESPECIALLY this time of year (new resident season).

The most frustrating thing to hear when you call a new 1st year resident about an pt c/o chest pain with a heart rate sustaining in the 130's (who states they take Nitro when this happens at home), and ask for Nitro SL, stat EKG and troponin levels is: "I'll have to get back with you, I need to go over this with my senior":eek:

My firm, but polite, response to the resident was "I'm headed to the med room to grab the nitro, if I don't hear back from you in 20 seconds I'm calling a Rapid Response"...she called back before I even left the med room and gave me the orders.:sneaky: The fact that it was 0645 and no one, neither RN nor physician, likes a RR right at the end of the shift, may have helped expedite the process.

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