ethics question

[amyphee]

This is also posted in the correctional nursing thread. The position I am questioning is a psych nurse position at a jail.

I need some advice from some experienced jail nurses. I interviewed for a position at a jail recently, and it is likely that I will be offered the job. It is for a part time psych nurse. During the interview, I was told some things about the position that bothered me. I didn't ask for clarification at the time, but I want to know if this is standard practice. This job is with a regional company that contracts with that particular jail. The administrator of the medical program told me that I will be seeing patients and determining if they need medication. She mentioned various protocols and drug formularies, but stated that I can pretty much order whatever I wanted and start administering it. I wouldn't have to wait for the MD to sign off on it, but that he would sign off on anything I ordered as long as it wasn't anything "crazy". Isn't this practicing medicine without a license? I only have a BSN and RN license. Is this standard practice at a jail? The nurse decides what the inmates need and then just gets the MD to sign off on it. Please, I am very interested in this position, but this is worrying me.

Thanks!

[vpierre]

I am not a jail nurse, but maybe I can shed some light on the matter. I work in ICU, and sometimes we can order certain things without an MD order. Example: I can write for some zofran, morphine, a cepacol tab, ect.. and for non-pharmaceuticals items such as a foley catheter or an NG tube although I should have an MD order. Just like she said "as long as it wasn't anything "crazy"" I can write the order and the MD can sign it off in the am. Although there are many things you should take into account: 1.Which MD will be signing off on it. you have to have a relationship with that MD assuming that they trust your judgement and they are ok with you doing that sort of thing. 2. Use great nursing judgement. You don't want to gice the patient morphine to a patient who have never have it before, then you'll be the first one to find out that they have an allergic reaction to it. (so it will be great if the order was just D/C).

I would say, if you're not confortable with it, then don't do it. you cannt get an trouble for calling an MD for an order, but you can get in big trouble for administering med without an order.

[Whispera, MSN, RN]

The words "as long as it's not something crazy" leave a huge door open for interpretation. What one person might think is a crazy med choice another might think is perfectly AOK. I think as you go along you'll come to your own conclusions about what is crazy and what's not, but that doesn't help now, nor if the doctor doesn't agree with your thinking. Most places have lists of drugs that doctors are ok with a nurse writing a "standing order" for. These would include dosages and timing. I wouldn't be comfortable just coming up with a drug, dose, and timing on my own, without knowing the doctor pretty well and knowing the patient too. I think you could get into all sorts of trouble, legal, and medical (if the patient has a bad reaction) if you do this on your own.

Beware!

[elkpark]

I have no idea whether this is "standard practice" in correctional settings, but what you are describing is, indeed, practicing medicine without a license and outside the scope of your practice, unless you have formal standing orders or protocols under which you're operating.

That is not a position I would ever consider taking -- too much risk (for the clients/inmates as well as for you!)