Nurse prescribing. What do you think?

hoolahan, ASN, RN · Jun 9, 2001

I would say AMEN!! I wish this were so in the US! I mean come on, why should a nurse need an order for any reasonable OTC med? Tylenol, check LFT's first, MOM, Dulcolax, Maalox, bacitracin ointments and most wound care products and supplies, topicals, and emergency inhalers or nebs. We KNOW this stuff, why must we bother a doctor q time it is needed???!!! I would love that independence! I got caught by QA once in home health b/c I instructed a pt to take tylenol for pain instead of percocet which she felt made her too drowsy, and she was not in too much pain. I had to get an order to cover that!!! I mean, what is percocet anyway but over 50% tylenol?! Absurd! NOw I get around that by just charting the pt has decied to take their own OTC tylenol, which they have the right to do in their own home!

Bring it on! I'll write my own orders, YES!! Of course in HH this is much easier than in the hospital. Others may feel very differently.

Sue D · Jun 9, 2001

Thanks for that! As a ward nurse I oten feel frustrated that as a non nurse-pracitioner I can't prescribe meds that I know my patients need. I work on a surgical ward and very often need anti-emetics written up STAT.

As things stand I often wait hours for ondansetron or similar to be prescribed whilst my poor patient is miserably nauseated.

Why can't we prescribe these basic drugs?

JMP · Jun 9, 2001

In Canada ( I live in Ontario) nurse pracitioners can order meds from a limited list as well. They can also order certain diagnostic tests- xrays, ultrasounds, etc.

I considered becoming a NP, however then I found out that the only way to practice is to move out to the boonies- where there is a shortage of doctors- if you live in any type of metropolitian area you are beat- I have always wondered why it is OK for people up North- in isolated communities- but in busy hospitals- where docs and NP's could work side by side in busy ER departments- they have continually denied it- WAIT- now that I think of it- money has something to do with it...........doesn't it always?? The docs here threatened to walk out it NP's where allowed in the hospitals. NP's can not bill our government directly- the way docs can- so they either move to a remote location or work in a doc's office ( the doc's office is low paying so I have heard). So where is the incentive to become a NP? Just not there- yeah you can write a prescription but so what?

LaurieCRNP2002, MSN, RN, APRN · Jun 10, 2001

At our hospital (at least on the telemetry units), meds like Tylenol, MOM, Maalox are part of the PRN orders, so we don't have to call the residents for them. As for emergencies, many of these are covered by our "emergency med" protocol. The doctors, both attendings and residents, pay attention to us b/c they know we're the ones with the patients all day. In that respect, I am very fortunate. If only management valued us as much as the medical staff!

Mijourney · Jun 10, 2001

Hi. I agree with the previous poster about having standing orders for administering meds. But, as nurses we are responsible and accountable for ensuring that even if we're administering meds per standing orders, that we don't fall into a routine with it. We have to make sure that we are providing individualized care with or without standing orders.

kennedyj · Jun 17, 2001

I worked in an ER before and depending on which doc was on we would have everything ready for when they cam to that patient (IV, cbc & other blood work, Xrays, Pain meds Morphine, neb treatment, all that) I don't see anything wrong with experiences nurses writing prescriptions. However when everyone does it, there are some people out there who should not be doing it that can get into trouble. You know who I mean there are always a few in every unit.

Jared

Mijourney · Jun 17, 2001

Hi. Another comment on this topic. Nurses should also realize that if we're given prescription writing rights that pharmaceuticals will never leave us alone. Do we all really want to be a part of that circus unless we choose to by becoming NPs or PAs?

lalaxton · Jun 18, 2001

Just a note to JMP- NP's in Ontario no longer just work 'up north'. I have seen many jobs for Primary Care NP's advertised in urban areas like Toronto and Hamilton. Go to Medhunters.com and see their many listings for NP's in Ontario or go to the NPAO (division of RNAO) web site . Many of the jobs are also for Acute Care NP's that are now becoming much more popular in large urban centers, in areas like critical care, ER and Cardiology. These jobs are paid for by the hospitals who see that NP's can actually SAVE them money by giving better care even without billing OHIP for NP services (which has yet to happen anyway). If you thought of becoming an NP look a little deeper in where we are going, you may be surprised!

I know because I have just accepted a job as an ACNP in a southern Ontario hospital. So will soon be moving home after 12 years in the US.

Feel free to email me if you want more info on NP's in Ontario...

Lesley

janleb · Jun 18, 2001

when I did my rotation on same day surgery the nurses there could administer some antiemetics, antianxiety and a few others without bothering the doc every time.