Can we recommend a medication to a doctor to prescribe?

[stallion8797]

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?

[Pepper The Cat, BSN, RN]

I recommend meds all the time.

One weekend recently, the MD on call was a new MD. I needed orders for a constipated pt. she was going to order glycerin supp PRN. I said to her " glycerin supp is crap. I need a order for dulcolax." She said " I learn so much from you experienced RNs"

I've also called docs and said " I need an order for this, this and this. " they trust me well enough to give me what I want. Of course, it did take a little while to reach this level of trust.

[mmc51264, BSN, MSN, RN]

We have a lot of interns on call and we ask/make recommendations. They learn pretty quickly to (for the most part) trust the nurses.

[wannabecnl]

In PACU we have a pretty standard set of PRNs ordered by the anesthesiologists, but I often call and ask for something else, such as oral pain meds the surgeon has written a scrip for but hasn't ordered in the computer, or a Duo-Neb when their lungs sound awful. Usually the docs will let me enter those orders without further ado, but some of them like to come check the patient themselves and then have a sidebar with me in person. Ativan is another common one; some docs seem to order it for everyone (PRN), while others prefer to be called, but I can't think of a single time when a doc wouldn't order it when I asked. Our anesthesiologists take our input seriously, which, as a relatively new nurse, I find humbling and empowering at the same time. I don't see how this kind of thing could be out of the nurse's scope of practice; unless docs are going to start spending all their time hanging out at the bedside, they pretty much have to be willing to discuss options with the folks who do!

[NurseDirtyBird]

OP: it rolled downhill and landed on you. MD mad at on call doc, on call doc blames it on nursing, nurse manager gets butt reamed by the doc, and in turn reams yours. It had to go somewhere, you were just at the bottom of the hill.

[Mandychelle79, ASN, RN]

I will never forget the time I called the on call doctor and said So and so is throwing furniture I am going to give 2 of ativan and 5 of haldol IM now, is that ok? He laughed and said sure. The reason he laughed 2 months before that, the first time I called him, he asked what I thought the patient should have, to which I replied, Im a new nurse, I dont think yet.

For our unit, the doctors take our recommendations seriously.

[wooh, BSN, RN]

OP's manager is an idiot.

[BD-RN, BSN, RN]

One academic facility I worked at, if I wasn't specific with what I wanted, THAT was when I'd get a snippy response. Especially if I had to call the pain team, which at night rolled over to anesthesia. Basically, they wanted to put an order in and go back to sleep. I'm surprised you got that response from your manager. Like other have said, does he/she not know what SBAR stands for?

That being said, another facility I worked at I worked with staff who didn't seem to always take to kindly to my specific suggestions. I guess to each his own? Whatever, you did the right thing. Keep doing what you're doing, that's good nursing right there.

[VivaLasViejas, ASN, RN]

I have one nurse-manager who absolutely hates it when I recommend something to the doctors---she thinks it's a scope-of-practice issue---but I do it anyway, because my experience has been that MOST of them like to have some potential solutions when I bring them a problem. That shows I've thought it through and done my legwork, and I'd have to say that 8 or 9 times out of 10 they'll give me what I ask for, or if not, the rationale for NOT doing so. That's collaboration, and when it works well, we nurses earn their admiration and respect. A win-win situation all around, because the patient benefits as well!

[PMFB-RN, RN]

Uh, your nurse manager has no idea what a nurses job is.

[SE_BSN_RN, BSN]

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?

Absolutely, you can! I have, and I have also been asked by the doc "What do you think?" If you can give rationale behind your reasoning, yes. I have also questioned orders, and have asked for a specific reasoning as to why the doc picked that med....for my own knowledge and education. Many of them have no problem explaining their rationale, also.

[Caffeine_IV]

Not out of your scope. Doctors I've worked with appreciate the recommendations as long as you have valid reasoning behind it. As stated, they have the final say in whether they wish to order it or not. Even better I like a doctor that will explain why they say no to the order.

[dishes, BSN, RN]

Was there a reason the primary psychiatrist did not want the patient's medication changed? Sometimes patients with chronic medical conditions, do not have adequate insurance to cover the cost of different medications. If an inpatient's medication is switched to one that is not covered by their insurance, it makes it difficult for them to afford to purchase it, once they are discharged into the community.