Giving tylenol to a family member.

[Tiaj72187RN]

So I just got home from work and I had a frustrating incident. A family member asked if I had some tylenol for her. She had a headache and her husband was very sick and it was 2am. I told her I probably had some in my purse. When I mentioned it to one of the older RNs she said it was outside of my scope of practice because I was then "prescribing"??? It was my own personal supply of tylenol, its an over the counter medication, it was an adult who had a headache, I had already clocked out and was getting ready to leave. I gave it to her despite this other RN telling me I could lose my license. Was I wrong? I live in the state of Texas, I've read my NPA and I intepret it much differently than she did. Thoughts? Advice?

[Reno1978, BSN, RN]

Additionally, what I am trying to relate to the membership in posts 18 and 30, is that opposing council in such a scenario would place doubt on precisely "what" medication was administered, eluding to the possibility of further unnecessary harm. The primary focus however, would have been an unqualified provider and a missed opportunity for proper standard of care.

Folks, let me tell you that I understand and admire the mindset of the ambulance chasers, my mind is likewise wired so I use that to my advantage in practice. It is only by happenstance that I became a nurse.

Judge for yourselves, heres my graduation picture from nursing school.

I don't have anything to add, other than to say that this is the best post of September, so far.

[delilas]

No way is that out of scope.

People do that without a thought to nursing. My roommate and I gave each other tylenol and ibuprofen throughout college years before I became a nurse.

Does this also mean mothers who give their children tylenol without a doctor's approval are practicing without a license?

[Flying ICU RN]

No way is that out of scope.

Prove it.

Link us to a statute that supports your statement.

Otherwise, this is unsubstantiated opinionated rabble, and a potential danger to the uninitiated and or gullible membership.

[delilas]

It's common damn sense. She didn't administer the medication. She related where it was, and an adult took it from there. I don't see a precedent anywhere against this case. She didn't force it; the person was a completely willing and able adult. She didn't administer it, or give medical advise. It's no different than pointing out where the medicine cabinet is.

So, just for my sake. If my mother is experiencing a migraine as she waits on my dad in the hospital, and can't get up, and asks me to give her tylenol, I am to state I cannot, because that is outside my scope of practice as a nurse? I am to leave someone in pain because retrieving or pointing out the location of an OTC med that is available in vendors along the hallway is now outside my scope.

It's OTC. You didn't tell her what to take, how much to take, how to take it, why to take it. No advice was dispensed. I wouldn't get by a day in my workplace if I didn't tell people where to get tylenol. I'd love to see the write-up I'd get as well for refusing to tell someone where it is when they ask.

[HamsterRN, ADN, RN]

Our very limited scope of practice makes it very easy for us to keep from being liable. (I've been an ICU nurse for 17 consecutive years, and it ain't Rocket Science). It's when you cross that line, (regardless of how innocuous that line may appear), that you place yourself at significant risk for a fall.

I won't argue that without taking into account specific state laws and facility policies we're unlikely to come to a firm conclusion and I certainly don't think I know the textbook answer, but there are some apparent misconceptions being thrown about that probably are sending this discussion in wierd directions.

I would never describe an RN's scope of practice as "very limited" since our potential scope is actually extremely broad. Each state's Nurse Practice Act basically defines our scope of practice with a short list of things we can't do and a short list of things we have to do, everything in between is essentially up for grabs based on what we choose, or are required, to add to our scope. Because in the end, each nurse can limit their own scope to their own preference and comfort level, it is possible to maintain a "very limited" scope which is by far the safest way to go, but sort of pointless in my view.

This is a little nit-picky, since it really doesn't apply here, but it's been bugging me: dispensing a medication is not "giving" a medication, giving a medication is "administering", and dispensing is not out of the scope of practice of a nurse as a general rule. I prefer to keep my home state anonymous, but this is from the state of Missouri, which is one of the most clearly written examples I found:

Dispense

The act of dispensing includes the selection and labeling of prepackaged medications ordered by the physician or advanced practice nurse to be self-administered by the client. Medications may only be dispensed by a physician, pharmacist, or registered nurse.

Again, this doesn't apply because they weren't ordered, but we should at least all be on the same page.

I can see the argument for not giving someone a tylenol if your main priority is to protect your license and your paycheck, but I'm curious where we draw the line using that rationale. Would you give a personal tylenol to a co-worker? To a family member? To someone at church? I'm also a little confused about the rationale that giving a family member a personal tylenol while off the clock would be wrong since they wouldn't be going through the same evaluation process as a patient who had a headache; is it common practice to do head CT's on every patient who has a headache and is asking for a tylenol?

[Flying ICU RN]

It's common damn sense.

You still did not offer proof that your opinion is correct,

The four points of fact in post #30, stand solidly on their own merit.

I challenge you to disprove those points each in turn.

[Esme12, ASN, BSN, RN]

That sounds ridiculous, I don't even know where to begin on this one, even ignoring the supposed tylenol/hemorrhagic stroke connection.

I can't imagine coming to work everyday just hoping to not get sued.

Then you need to be sure that you carry malpractice insurance.

When you are a nurse and in uniform there is an implied consent that you know what you are doing. The public perception is if it comes from a nurse it must be true or medical advice. When dealing with the general public you need to be very careful of what you do and say especially when "on duty" or "on premise" whether "clocked in" or not..............

Let's say you gave the tylenol to the exhausted family member and they lie down to help the pain go away. A few hours go by and now it is daylight and another family member comes running into the ICU saying there is someone on the couch in the waiting romm and they won't wake up. That innocent tylenol you gave for a headache stoppped that family from seeking and being seen by "qualified" personel that could have prevented this person form being in a come due to a subdual hematoma when they hit their head on the car when they slipped in the parking lot because they were in a hurry to get inside.

Think it is ridiculous as much as you wish........but this happends to be a real story. The patient remained in a persistant vegitative state......the nurse.....lost everything......she never worked again and had her liscense revoked from the board.

She lost her home and everything she'd ever worked for (she didn't carry malpractice) after civil wrongful death suit found her guilty. She later committed suicide. She was a good hearted person. She meant no harm. She was a good friend.

Please listen to other nurses who have been at this longer and may know a few things. It may sound ridiculous and we may sound paranoid but after so many years of dealing with the genral public we may have picked up a few things along the way.:twocents:

[Flying ICU RN]

I would never describe an RN's scope of practice as "very limited"

An oversimplification perhaps to drive home a point, my apologies for the tone.

I can see the argument for not giving someone a tylenol if your main priority is to protect your license and your paycheck, but I'm curious where we draw the line using that rationale. Would you give a personal tylenol to a co-worker? To a family member? To someone at church? I'm also a little confused about the rationale that giving a family member a personal tylenol while off the clock would be wrong since they wouldn't be going through the same evaluation process as a patient who had a headache; is it common practice to do head CT's on every patient who has a headache and is asking for a tylenol?

The problem here was location and the players involved. The argument to be made in the scenario would be that the plaintiff was lured into a false sense of security by a medical professional in a health care environment, and suffered damages as a result.

Your family member, and the church lady would not be the same circumstance, and would be perfectly appropriate by all measures of law and reason.

Remember, that we live in a litigious society, particularly when it's a fight for survival (economic) and blame is being assigned.

[Caffeine_IV]

I don't feel it is outside of our scope but I wouldn't have done it because it could be a risk. As Ruby stated, I don't check family or visitors blood pressures, o2 sats etc and I have been asked. If someone feels symptomatic, I suggest they go to the ER. I have a question kinda related to this topic so maybe I will create a spin off.

[HamsterRN, ADN, RN]

The four points of fact in post #30, stand solidly on their own merit.

I challenge you to disprove those points each in turn.

The scenario I referred to as ridiculous did not include any medication, but was the one you posed about refusing to check the blood sugar of a visitor who said they were diabetic and felt dizzy. Where I work our glucometers require scanning the patient's band, which is why every glucometer case has a "dummy" sticker which is labelled as "visitors". I can't imagine as a nurse refusing to check someone's blood sugar who stated they were concerned they were hypoglycemic, particularly if I had a glucometer less than 50 feet away at all times. If that's not what a nurse does then I have no idea why even exist.

"*This was done under someone else's roof, (a health-care institution), correct?":

Again, the scenario in question in the post you are referring to did not involve a medication, but even if it did, I'm curious how geography comes into play. Would it be OK in the parking lot? On the sidewalk?

"A pharmacological agent was dispensed (given) not freely chosen off of a retail shelf, correct?":

No, a pharmacological agent was not given (administered) it was provided to the patient to take of their own free will, it was not provided to a patient by a designated caregiver which is what it means to give ("administer") a medication.

"*The visitor had a headache, ostensibly of unknown etiology, correct?"

Again, the scenario I questioned did not involve a headache, although even if it was, tylenol is often given even in a true patient/nurse relationship without a definitive and exhaustive rule out of potential causes.

"*RN's do not have legislatively granted prescriptive or diagnostic privileges in any State, correct"

Actually not totally correct, in my state RN's can initiate diagnostic procedures in which they have "proven and maintained competency", but still irrelevant to the scenario at hand or the original scenario since the nurse was not prescribing or diagnosing.

"*Ridiculous, I suspect for reasons that have no bases in law or fact as in the above 4 points, correct?"

Yes, telling a visitor who tells you they are diabetic and DIZZY to walk to the ED without even checking their BG is ridiculous and hardly safe in terms of liability.

U]*There is no connection whatsoever between the Tylenol and the Hemorrhagic stroke scenario[/u]. What was required, was the ability to interpret meaning via extrapolation. In the scenario, the lady has a stroke that was developing anyway. She was then "treated" by a licensed professional within the walls of a professional health care environment, and went home without a proper diagnostic standard of care having been provided, by an unqualified provider.

I have no idea where the "lady with a developing stroke" came from, as I can't find it mentioned anywhere prior to this. Tylenol is not an NSAID and does not have the anti-platelet effects of other similar medications such as aspirin. If being a source of tylenol is "treating" someone then the cashier at the local supermarket is my Primary Care Provider.

I absolutely agree that there are many forces that work against and even prohibit our attempts to fulfill the basic tenants of nursing, including defensive medicine, greedy administrators, egotistical doctors, etc, which is why I can't understand why nurses would so willingly side with any of these forces. I absolutely agree with the arguments that seek to ensure the safety of the visitor, just not premise we should so easily allow our priorities and values to be defined by "ambulance chasers".

There is a new book out called "The Florence Prescription". I'm not a huge Florence Nightengale fan since I have a hard time seeing how the Crimean War relates to the modern healthcare setting, but there is one quote I enjoyed that seems relevant:

"Proceed until apprehended".

[Esme12, ASN, BSN, RN]

I won't argue that without taking into account specific state laws and facility policies we're unlikely to come to a firm conclusion and I certainly don't think I know the textbook answer, but there are some apparent misconceptions being thrown about that probably are sending this discussion in wierd directions.

I would never describe an RN's scope of practice as "very limited" since our potential scope is actually extremely broad. Each state's Nurse Practice Act basically defines our scope of practice with a short list of things we can't do and a short list of things we have to do, everything in between is essentially up for grabs based on what we choose, or are required, to add to our scope. Because in the end, each nurse can limit their own scope to their own preference and comfort level, it is possible to maintain a "very limited" scope which is by far the safest way to go, but sort of pointless in my view.

This is a little nit-picky, since it really doesn't apply here, but it's been bugging me: dispensing a medication is not "giving" a medication, giving a medication is "administering", and dispensing is not out of the scope of practice of a nurse as a general rule. I prefer to keep my home state anonymous, but this is from the state of Missouri, which is one of the most clearly written examples I found:

Dispense

The act of dispensing includes the selection and labeling of prepackaged medications ordered by the physician or advanced practice nurse to be self-administered by the client. Medications may only be dispensed by a physician, pharmacist, or registered nurse.

Again, this doesn't apply because they weren't ordered, but we should at least all be on the same page.

I can see the argument for not giving someone a tylenol if your main priority is to protect your license and your paycheck, but I'm curious where we draw the line using that rationale. Would you give a personal tylenol to a co-worker? To a family member? To someone at church? I'm also a little confused about the rationale that giving a family member a personal tylenol while off the clock would be wrong since they wouldn't be going through the same evaluation process as a patient who had a headache; is it common practice to do head CT's on every patient who has a headache and is asking for a tylenol?

As a nursing supervisor...................as long as you are on hospital property you are representing the hospital as a professional,whether you are "clocked in" or not. In some cases if you are wearing your badge in public view,even at the grocery store, you are still considered "on duty" and a "representative" of the facility you work for because you are wearing the identification that identifies you with that facility,and can be held accountable.

You are right,excluding APN's, RN's have a liscense to administer meds not dispense them and you need an order. Your scope as a nurse is very limited in the bigger picture of things. You may think you wield power but you are restricted into a very narrow scope of practice. Giving tylenol to a family member at home is different and you know it. It is the assumption that a nurse patient relationship was developed and how you represent yourself. When you come upon an accident scene and state I"m a nurse.......you have established a relationship. While doing a CT on every patient before giving tylenol is unrealistic. Sending the patient to the ED will have her evaluated by qualified personel,obtain a history and physical, and have an evaluation that may reveal clues to a potential problem. Overkill? probably.......Necessity? absolutely.

Do I give Tylenol to strangers in the shopping center? The answer is no! I give family members Tylenol in my home? yes. At church? hum...probably not. Paranoid? YES! As I previously stated in a previous post about an innocent act gone horribly wrong. I'd rather be safe than sorry. It seems I have said this kind of thing to you before. You like to stir up controversy...............my question is.............do you actually believe and practice some of the things you say or do you just like to stir up a hornets nest.....Just curious;)

[Esme12, ASN, BSN, RN]

That sounds ridiculous, I don't even know where to begin on this one, even ignoring the supposed tylenol/hemorrhagic stroke connection.

I can't imagine coming to work everyday just hoping to not get sued.

HINT: She was having the stroke and that is why she had the headache!