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?

[Tiaj72187RN]

Food for thought about Flo and the Crimean War. If we do not learn from our history, we are destined to repeat it. Florence was instrumental in facilitating change in the sanitation procedures, thereby significantly decreasing the rate of infection/mortality (inportant information for yesterday, today, and tomorrow, right?). She proved herslef not only as a warrior promoting respect for nursing, but established herself as a solid and innovative mathematician via her documentation demonstrating her new techniques of statistical analysis of the incidence of preventable deaths in the military during the Crimean War. She focused on the holistic needs of an individual and the importance of many components required to promote health. She experienced a hostile work environment, as the docs did not particularly care for her views on their military hospitals and identification of needed improvements (doesn't that still happen today). By embracing our gallant past, we can find to the stength to fight todays health care battles. Florence used her experiences to author books (Notes on Hospitals and Notes on Nursing) raising money to found the Nightengale School and Home for Nurse's at Saint Thomas Hospital, and she was a strong proponent on women's rights (is this not a current struggle as well?)

The history of the nursing profession is militaristic (remains so today). Consider the impact of the hospitalers (important history re: men in nursing). There are important lessons to be learned from our past.

I'm really glad you touched on this. Every nurse should be at least familiar with our roots. Florence Nightingale was instrumental in developing nursing practice as we see it today. :)

[Peetz, BSN]

Wow. I do apologize for my poorly written post that lead to such poor interpretation. It was a long 12 hour night shift, with a long drive home. I won't, however, excuse my behavior using extenuating circumstances to justify my illiteracy. I do appreciate you taking time to respond. Have a good day!

I understood your post by reading only ONE time. Seems some of us ( and you know who you are) can't admit when they are wrong.

No advice about giving a tylenol but your post was fine for being off a 12 hour shift and being 0200!! No need to apologize.

[wooh, BSN, RN]

If you had a child that complained of pain or was experiencing a temp, I would hope you would be calling their doctor to determine the cause and appropriate treatment.

Really? At the immediate start of a fever a mom should call the pediatrician? Do you immediately call a physician for every ache and pain and fever you have?

[mtdnk]

Really? At the immediate start of a fever a mom should call the pediatrician? Do you immediately call a physician for every ache and pain and fever you have?

The focus was a child. If it (pain or fever) had already been addressed and assessed by their LIP (meaning recurrent), no. If it were a first time pain serious enough to consider using medication (especially Tylenol- which has it's own issues in use with children), or a fever of unknown origin, you bet you boots I would take my child to the doctor.

[Esme12, ASN, BSN, RN]

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?

WHAT?? YOU really cannot see the difference? Giving a tylenol to a complete stranger while in uniform in the work setting has NO comparison to giving tylenol to a freind or child in your private life. If the child in a newborn you better call the MD before giving any meds as a fever in an infant can be an ominous sign of sepsis/mennigitis.:twocents:

[Esme12, ASN, BSN, RN]

"*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.

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.

I may check the blood sugar but I would call for the rapid response team or whatever code your hospital has for helping a visitor and the supervisor and fill out an incident report. Then I would transport them to the ED for further eval........

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.

It came from me.

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. Three days ago.........

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:

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".

You have every right to proceed until apprehended...............or at least until your liscense is taken or you are sued! I admit your intentions come from the heart and you mean well but those ambulance chaser lawyers are to be feared. I have found that those who should sue don't and the one's who do sue shouldn't but they sure do get rich quick.

The hospitals will "settle" an "undisclosed amount" just to keep it all hush hush..............but the corrective action taken will be you.

Listen to those who have been there done that. I have a sneaking usupicion that Flying ICU RN has been around the block a few as well as I have....I think emergency nursing makes you much more aware of the potential pitfalls that surround nurses and liability. Take Heed!

By the way "Good Ole Flo" although during the Crimean war had very little to do with the war itself but more that a young woman of means made a difference to human life and eased brave soldiers suffering while improving the conditions they lived and died in........to ease their suffering and pain and return their human dignity, is more than just admirable and taught that all you need to do is wash your hands..........please have some respect.:twocents:

[Esme12, ASN, BSN, RN]

:bdyhdclp:

Formulating a medical diagnosis is what was being discussed, I believe. That is not a privelege a RN has.

Food for thought about Flo and the Crimean War. If we do not learn from our history, we are destined to repeat it. Florence was instrumental in facilitating change in the sanitation procedures, thereby significantly decreasing the rate of infection/mortality (inportant information for yesterday, today, and tomorrow, right?). She proved herslef not only as a warrior promoting respect for nursing, but established herself as a solid and innovative mathematician via her documentation demonstrating her new techniques of statistical analysis of the incidence of preventable deaths in the military during the Crimean War. She focused on the holistic needs of an individual and the importance of many components required to promote health. She experienced a hostile work environment, as the docs did not particularly care for her views on their military hospitals and identification of needed improvements (doesn't that still happen today). By embracing our gallant past, we can find to the stength to fight todays health care battles. Florence used her experiences to author books (Notes on Hospitals and Notes on Nursing) raising money to found the Nightengale School and Home for Nurse's at Saint Thomas Hospital, and she was a strong proponent on women's rights (is this not a current struggle as well?)

The history of the nursing profession is militaristic (remains so today). Consider the impact of the hospitalers (important history re: men in nursing). There are important lessons to be learned from our past.

:bdyhdclp: WELL SAID!

[HamsterRN, ADN, RN]

A statement of fact as presented by you, now support it with a link to this supposed statute and or B.O.N. practice act.

My money is on you cant, which should put an end to the discussion.

As I pointed out earlier in this very thread, I have a feeling it is wise not to divulge identifying characteristics in this forum including your home state. I'm not usually that paranoid but the atmosphere here is contagious.

Maybe you'd be willing to provide your practice act or statute that supports the position that nurse practice acts apply to more than just professional nurse/patient relationships?

I've also pointed out that I can't determine what was technically right or wrong in the OP, what I'm curious about is the rationale used to justify some of the statements made. I certainly agree this is a dicey subject and the use of judgment is key, but I don't agree that what is legally safest and what is the best nursing judgement are always the same. There are very few cases of being sued for under-treating pain, yet lawsuits for complications of over-sedation are rampant. Legally the safest thing to do is treat pain using narcotics minimally if at all, although I don't think that is necessarily the best nursing judgement.

It seems we all agree that we do not have the same relationship with a visitor that we do with a patient; unlike a patient, we wouldn't feel obligated, or even able, to assess them and facilitate the treatment of their complaint. This is because the rules that apply in a nurse/patient relationship don't exist with someone who is not your patient and whom your are not being compensated to care for, so it seems odd to apply a standard of freedom from obligation and yet full obligation in the same instance.

If the rationale is that a nurse should never provide a visitor with something that normally requires a Physicians order particularly if it could cause harm to the visitor, would you refuse to give a visitor coffee without a full cardiac workup or at least checking their HR? Would you refuse to give a visitor a regular soda without checking their A1c or their current BG? What if their BG is 600 and you give them the sugar that puts them into a diabetic coma? What if you give a guest food tray to a visitor which turns out to have something on it they were allergic to?

[HamsterRN, ADN, RN]

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;)

Mainly just the hornet's nest part. I think we all benefit from thinking through the things we do, even to the point of monotony, rather than just blindly doing them, even if it makes no difference in what we end up doing.

[BluegrassRN]

Our hospital has a very clear policy: we are not provide any clinical services to anyone but the patient. If a visitor needs assistance (a CBG checked, a medication, etc) they are referred to the ED or their physician, or another family member is called to provide the necessary assistance. Basically, we are not to establish any sort of professional relationship with them, and checking a blood sugar or dispensing a medication does just that.

If someone is in serious distress, we'll call a rapid response or escort them down to the ED, whichever is appropriate. If they need their evening meds but they've decided to stay with their spouse overnight, they need to go get their own meds or have someone bring them up. If they need assistance toileting/eating/ambulating, then someone *else* needs to stay...we cannot and will not provide staff for this.

I feel our policy is entirely appropriate.

I do wish our hospital had a dispensing machine for personal items. Single dose tylenol/ibuprofen, toothbrushes, toothpaste and dental floss, hair clips, fingernail files, and contact lens containers and solution are somewhat frequently requested items that we are unable to provide for the family. If we had some sort of vending machine that provided these items, the visitor could access them independently, without having to leave the hospital or call to have someone bring them up.

[wooh, BSN, RN]

The focus was a child. If it (pain or fever) had already been addressed and assessed by their LIP (meaning recurrent), no. If it were a first time pain serious enough to consider using medication (especially Tylenol- which has it's own issues in use with children), or a fever of unknown origin, you bet you boots I would take my child to the doctor.

Teething pain, irritability, mild fever... No need for a mom to call the pediatrician.

[Ruby Vee, BSN]

if the rationale is that a nurse should never provide a visitor with something that normally requires a physicians order particularly if it could cause harm to the visitor, would you refuse to give a visitor coffee without a full cardiac workup or at least checking their hr? would you refuse to give a visitor a regular soda without checking their a1c or their current bg? what if their bg is 600 and you give them the sugar that puts them into a diabetic coma? what if you give a guest food tray to a visitor which turns out to have something on it they were allergic to?

i wouldn't give a visitor coffee -- we don't have any except what we buy for ourselves -- or soda. what we have is for patient use only. nor a guest food tray -- no eating or drinking in our patient rooms except by patients. and i certainly wouldn't give them tylenol. i've heard of too many bad outcomes from medicating visitors.