NP refusing to write meds?

[nishali78]

Hi , I work at the hospital in Houston and I'm an RN but I work with an NP in a transplant center. The NP refuses to write meds for patients who need them and her excuse is that she doesn't feel comfortable writing medications for patients that she hasn't seen.....but she also refuses to see any post transplant patients. When she refuses to refill their medications the doctor always asks me to put the medication order in and he will sign off.

The medications the patient needs are usually just refills on transplant meds. She gets paid to be an NP but refuses to write med refills or any meds at all.

This is the first time I've encountered an NP who refuses to write meds at all for a patient. Is this common?

[twinmommy+2, ADN, BSN, MSN]

It would be common for any provider to not write prescriptions for someone they haven't seen before. It wouldn't be safe for her to do so. Her not seeing transplant patients doesn't change the question at hand.

[nishali78]

Right but she refuses to see patients who are post transplant. A few of HER patients have needed medications. One patient flew here from out of town and forgot his insulin. She would not write orders for one day's worth of insulin so I had to enter and have the doctor sign off.

[nishali78]

She does not want to write medications for her patients because they will call her for refills and she does not want that. She mentioned this in the beginning when I first started working here.

[Lev, MSN, RN, NP]

Right but she refuses to see patients who are post transplant. A few of HER patients have needed medications. One patient flew here from out of town and forgot his insulin. She would not write orders for one day's worth of insulin so I had to enter and have the doctor sign off.

That patient should have called his PCP.

[Lev, MSN, RN, NP]

She does not want to write medications for her patients because they will call her for refills and she does not want that. She mentioned this in the beginning when I first started working here.

That is understandable. People need to follow up with their PCP.

[Lev, MSN, RN, NP]

Prescriptions for meds that are taken at home (unless it is a completely new med) should be written by the PCP. It is so important for patients to follow up with their PCP and get scripts from them. The dependence on the acute care hospital is what drives up healthcare costs.

[KatieMI, BSN, MSN, RN]

Prescriptions for meds that are taken at home (unless it is a completely new med) should be written by the PCP. It is so important for patients to follow up with their PCP and get scripts from them. The dependence on the acute care hospital is what drives up healthcare costs.

Prescriptions for meds, to be taken home or not, should be written by a provider who knows what he or she is doing, first and foremost. The nowadays universal reality of PCPs and FNPs writting scripts neuroleptics, benzos, Norco by tankloads, high-dose steroids, fertility stimulators and everything else just because they can do it saves some money on the very short-term basis. On long-term basis, the current opioid abuse epidemics was quite in part caused by providing PCP providers an option to prescribe controlled substances with little reasoning and even less of control.

If the NP in question doesn't physically see and examine these patients, chronic post-transplant or not, he/she shouldn't write scripts for them. Whether the NP or provider under whose license the NP works share the job in some particular way, we do not know. Transplants are VERY special patients and many providers are extra cautious to touch them - and for a good reason. But it is definitely much easier to meet this NP once and ask her "hi, can you tell me, if I care for patients of Dr. X, in which cases I should call you, and in which cases him, so I wouldn't have to sit on your neck?" Then ask the Dr. X the same question, and I am sure that puzzle will come together :)

[LovingLife123]

What is the role of the NP on the unit then if she doesn't see the patients? I'm confused as to why she is being paged for meds then.

On my unit, the NPs round with the physicians on patients and we page them for any of our needs. But the NP has always seen the patient.

[cleback]

I feel like there's more to this story.

If she's in a transplant service, she should only be prescribing transplant-related meds. My guess is insulin was not directly related to his transplant plan of care. He might even see an endocrinologist for his diabetes, in which case prescribing insulin may be "stepping on their toes".

All specialty services I've worked for operate this way. The only exception is if the service is admitting, then they'll continue home meds for the duration of the admission and maybe at discharge to hold them over until their follow up appointment with their pcp.

My advice to you would to see who originally prescribed the med and forward them the refill request first.

[nishali78]

So she refuses to write any meds , transplant or non transplant related. At one time she was also refusing to do H & P on our transplant patients and she got away with it for a few months until they realized we were doing exactly the same job role except she was not having anything to do with any NP functions but was getting paid an NP salary. Then our boss had to say well you have to see patients for H & P for their initial visit. This same NP also doesn't like her patients to have her extension as she doesn't like too many unnecessary phone calls. She prefers them to have the main ext. and have our program support assistant take the calls for us.

The other NP who is our post transplant NP will refill meds on patients that run out of their immunosuppresants by looking at our doctors last note and verifying with them the correct dosage and name of the drug that they need. If they are not sure and she has not seen the patient then of course she wont write it but at least she will refill Tacrolimus medications if our doctor is not there for the day. The other NP refuses to write ANY medications even on patients that she has seen. You can't get rid of her because we do not work for the private side and she's about to retire.

[BostonFNP, APRN]

Like it or not, she has the right to refuse to write a script for any reason.