Newbie to Clinic Nursing - Questions on what is "normal"

[melissa_rn]

So...I've been working at my new clinic job for almost a month, and I have a few questions...

Most of the doctors have Medical Assistants working with them. I am the float nurse, so I will be helping everyone. I do a lot of calling Rx refills to the pharmacies. A few of the MA's don't even give the refill requests to the docs to approve. They say "he wants me to just go ahead and refill this stuff" when they are non-controlled meds. Is this legal? Ok?

The MA's in our clinic are not formally trained, but have been working as MAs for many years. They are very intelligent...but should they be giving medical advice to patients? They do everything nurses do (except give injections as my supervisor has denied this one to them). It just makes me wonder what the point of going to a 4 year nursing program is if someone with no formal training is able to do the same things I am (for the most part).

Also...I occasionally get the calls from the patients telling me about their symptoms and asking whether or not they should come in for an appointment. Am I able to suggest treatments? For example, if a woman is having trouble sleeping d/t pain, can I recommend her to try some Tylenol PM or Benadryl? Or is this considered prescribing/ordering?

Thanks for your help...

[LoriChr]

I am an LPN and have been working in a clinic for five years. Personally I would be extremely uncomfortable with anyone stating that the doc "just lets them refill a med" and calling it in. I don't care if it is just a stool softner, I talk to the surgeon before anything gets called to the pharmacy.

As far as medical advice, I am very careful about anything I tell a patient over the phone. If there is any, any doubt, they are adviced to come in and see the doctor. We always say we would rather have people come in and it be nothing then overlook something serious. We are especially cautious in post-op surgical patients, since so many things could be occuring and you don't want to depend on patient assessment over the phone. After surgery, there is no charge in the post-operative period, so this makes it easier to convince the patient to come and see the doctor.

I must admit I don't have a lot of experience with MA's and their level of education and what they are allowed to do. We have only a handful of MAs employed in our clinic and none in my particular dept.

["heynurse"]

I've been working in an outpt peds clinic for 5 years now and am amazed at the lack of consistency that exists in how MA's are utilized.

There are very clear definitions in our state's credentialing website of what an MA's (or Health Care Assistant's) scope of practice is, but depending on the clinic, it may or may not be followed.

This of course leads to alot of contention when you are in a situation where you know someone has exceeded their scope of practice, but they have never been aware of it.

But one thing is certain, refills that haven't been authorized by the prescriber (whether verbally, written, or by protocol) are not legal to give.

As far as telephone advice goes, find out if your clinic has any protocols that you can familiarize yourself with to help in understanding what (if there are any) expectations your clinic has in things like coming to clinic vs home care remedys, or coming in to clinic vs going to an ER etc.

But I'm with LoriChr, I always err on the side of having a pt seen if there is any question about the ever changing lists of problems a pt may call with.

Telephone advice is actually a huge liability, so be careful to follow the "nursing process" and cover your tush with good documentation.

hope this helps....

[SouthernLPN2RN, MSN, RN, APRN, NP]

I work with an LPN that does that, and it gripes me! "Her" doc gets mad if she's out and the nurse filling in won't go ahead and call rx's in or print them off. Anytime I get a med or refill request, it goes straight to the provider. IMHO, I think that in a legal case, it could be considered prescribing.