medicine without a license

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hello, I am new to this but there seem to be some intelligent people here. I have a question about LPN changing insulin dosing without a MD order? This is a nursing home, patient said he only wanted X amount of units, nurse granted request. I am looking for some verbage or legal document stating that this is practicing medicine without a license. We are in Georgia

HELP!:nono:

Specializes in Just about all of them.
hello, I am new to this but there seem to be some intelligent people here. I have a question about LPN changing insulin dosing without a MD order? This is a nursing home, patient said he only wanted X amount of units, nurse granted request. I am looking for some verbage or legal document stating that this is practicing medicine without a license. We are in Georgia

HELP!:nono:

This is not an issue of patient rights, any patient has a right to refuse meds, treatment etc, It is a matter of changing a dosage without an order to do so. To do so requires a license to practice medicine. Now of course most nurses would probably go ahead and do what the patient asks given thier cognitive status, but would follow up with a phone call to MD and an order to clarify the situation, what I am talking about has been going on for years with no order and no MD notification. Hence I am looking for some type of verbage that specifically spells out the scope and severity of changing med doses with no order. Nothing to do with taking anyones license, just a simple educational matter,

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Specializes in LTC.

If it's chronic thing a doc needs to be notified so they can adjust the residents sliding scale. If random residents and occassionally saying "I think 10units is too much tonight." They have the right to refuse part of their dose.

If I were in the hospital and the doctor orders two tyl PM to help me sleep at night, chances are I'd refuse one because I know my body and I know two tyl pm are way to much for me. If my nurse stampped her foot down and told me I had to take two or none because it's what the doctor ordered, I would have the charge nurse in my room right away.

I'm sorry but who would be at fault for causing a residents blood sugar to drop from giving an insulin dose or having a blood glucose spike because a nurse had refused to give the med at all since the resident wouldn't take a full dose after the resident specifically said "I only want 5units instead of 10."

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Specializes in LTC,Hospice/palliative care,acute care.
This is not an issue of patient rights, any patient has a right to refuse meds, treatment etc, It is a matter of changing a dosage without an order to do so. To do so requires a license to practice medicine. Now of course most nurses would probably go ahead and do what the patient asks given thier cognitive status, but would follow up with a phone call to MD and an order to clarify the situation, what I am talking about has been going on for years with no order and no MD notification. Hence I am looking for some type of verbage that specifically spells out the scope and severity of changing med doses with no order. Nothing to do with taking anyones license, just a simple educational matter,

I wonder if you'll find anything specific for this situation-probably just generalities at your state BON's web site.Why don't you contact the DOH to clarify your concerns regarding resident's rights to refuse meds and treatments.I am betting they can help you-Whenever a resident refuses a med or accepts part of a dose we must document and notify the physican.If it is an on going issue the doc has to note it when he makes his monthly rounds and we careplan it.Keep us posted-I'm curious.

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Specializes in Oncology, Triage, Tele, Med-Surg.

Are we misunderstanding your question? Did she change the order for the dose - or just give half the dose based on pt. request? If she changed the actual order on the M.A.R. - that is wrong. If she gave half b/c pt. refused the full dose then she did nothing wrong. She operated within her scope / maintained patient's rights.

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Specializes in med-surg.

Pt has a right to refuse a med, but not a right to change a dose. In TX what she did was illegal because she changed a dr.'s order. But at my hospital insulin requires 2 licensed signatures. Look up your nursing practice rules and regulations for your state which you can probably access online.

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Specializes in A little of this & a little of that.
Not going after anyone's license, only trying to protect them as a good DON should do. It is alright for a patient to refuse any med or treatment for any reason, it is not alright to make a decision to dose based on a residents wishes without a doctor order. That would be like allowing a patient to take only 1/2 of their BP med because they feel so good today.

Actually, the patient can refuse all or part of their BP med if they wish. They often refuse Lasix if they're going out. The nurse just documents the refusal. The MD should be notified of refusals and orders obtained to hold the med or give different dose if resident requests.

If a nurse changes the order herself that would be illegal, If the physician is never notified and this is happening fairly regularly, that's bad nursing practice.

Practicing medicine without a license is for someone to allege that they are an MD when they are not, providing medical assessment and diagnosis or performing procedures that are only in an MD scope of practice. Giving meds that are not ordered or giving in some way not as ordered, is nursing misconduct.

I suggest that:

1. You contact the nursing board or haelthcare practitioner complaint dept whichever your state uses and make your complaint. The BON will then decide what, if any, rules/laws have been broken.

2. Since you are DON, make this practice against the rules and discipline as needed. As DON, the only rationale you need to change the way things are done is that you don't think it's good practice.

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Specializes in Geriatrics.
Not going after anyone's license, only trying to protect them as a good DON should do. It is alright for a patient to refuse any med or treatment for any reason, it is not alright to make a decision to dose based on a residents wishes without a doctor order. That would be like allowing a patient to take only 1/2 of their BP med because they feel so good today.

My question is this: Did you never run into an Alert/Oriented pt who questioned the strength of the med you are ordered to give? I have no problem with giving a pt a 1/2 dose if that's what they'll take, of course, I let them know that I will be contacting the Dr, and doing extra assessments to assure no neg. effects. I also chart the pts statement, my pt teaching, notification of the Dr., and any new orders or statements Dr. may have given. Still thinking your out to get the nurse, otherwise you would use that old fashion thing called Nurses judgement. Might be wrong, if so sorry.

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Not going after anyone's license, only trying to protect them as a good DON should do. It is alright for a patient to refuse any med or treatment for any reason, it is not alright to make a decision to dose based on a residents wishes without a doctor order. That would be like allowing a patient to take only 1/2 of their BP med because they feel so good today.

There's nothing wrong with that either. Again, we don't allow residents to make decisions regarding their own healthcare. They have that right, inherently.

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If it's chronic thing a doc needs to be notified so they can adjust the residents sliding scale. If random residents and occassionally saying "I think 10units is too much tonight." They have the right to refuse part of their dose.

If I were in the hospital and the doctor orders two tyl PM to help me sleep at night, chances are I'd refuse one because I know my body and I know two tyl pm are way to much for me. If my nurse stampped her foot down and told me I had to take two or none because it's what the doctor ordered, I would have the charge nurse in my room right away.

I'm sorry but who would be at fault for causing a residents blood sugar to drop from giving an insulin dose or having a blood glucose spike because a nurse had refused to give the med at all since the resident wouldn't take a full dose after the resident specifically said "I only want 5units instead of 10."

Spot on. I would also be throwing a righteous fit if a nurse told me I could not make my own decisions concerning treatment. Patients have autonomy, period. We do not, and should not, have the authority to refuse a medication simply because the patient wants a lesser dose. That is respecting the patients' autonomy and has nothing to do with practicing medicine.

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if the order is for 10, that is the order...in this incidence, if it is during the day, the doc gets an immediate call. if it is the pm (hs) dose i would give the 5 and call at the end of med rounds.....no, we do not have that right to change anything med or dose. it has been traditionally granted. but it isnt the law.....if this patient is alert and oriented and handled his diabetes well before admission, what you need is an order that the patient determines his dose....had a patient with this order and he did very well with it. and took the burden off of the nurses entirely....

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Specializes in Just about all of them.
Spot on. I would also be throwing a righteous fit if a nurse told me I could not make my own decisions concerning treatment. Patients have autonomy, period. We do not, and should not, have the authority to refuse a medication simply because the patient wants a lesser dose. That is respecting the patients' autonomy and has nothing to do with practicing medicine.

You are correct , patients do have autonomy and a right to participate in their care, care planning and right to refuse care/treatment. And the right to request a lower dose, or a higher dose. This is not about refusing to give a med, not unless you are on some super power trip. DUH

We have the responsibility to obtain an order to make sure that the patient gets what he /she wants legally, and safely To change a dose without an order is practicing medicine, something that I as a nurse do not have licensure to do. And yes, according to the SBON of nursing, it is illegal to do so.

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Specializes in Just about all of them.
hello, I am new to this but there seem to be some intelligent people here. I have a question about LPN changing insulin dosing without a MD order? This is a nursing home, patient said he only wanted X amount of units, nurse granted request. I am looking for some verbage or legal document stating that this is practicing medicine without a license. We are in Georgia

HELP!:nono:

After researching most of the day, I have found that it is absolutely illegal to change the dose of any medication without an order, that includes giving a lesser or higher dose upon request without notifing and receiving clarification. Of course the patient can refuse all or part of any med or treatment, and we as nurses can and do use our judgement to deal with this issue. However, what I think has been unclear about this is the fact that this has been going on for Years apparently with no notification to the MD, the nurses just give him what he wants with no thought to the long term consequences, especially if the MD isnt aware of what is going on.

Yeah I would throw a royal ***** fit if a Nurse refused to give me what I wanted, I would expect that nurse to be professional enough to get on the damn phone and do her job!

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