Nurses writing Scripts for Doctors

[fawnsternurse]

I have been a Nurse for over 23 yrs .Every once in a while I come across a facility( I am a travel Nurse) where the R.N. writes scripts out for the Doctor or calls in Scripts to a pharmacy and then the Doctor comes in later and just signs the scripts. Same thing with Discharge orders and writing the medications out.

I really do not know the policy for New York State but somehow this does not seem ethical to me.

I doubt very much this is within our scope of practice and frankly it smacks of "handmaiden mentality" and Nurses covering Doctors who are too lazy or feeling overworked.

Any thoughts on this and how can I find out absolutely for certain?

Thank you~

[Double-Helix, BSN, RN]

Contact the New York State BON and ask. Or look up the state's Nurse Practice Act, but I think it's unlikely you'll find this specific issue spelled out in the NPA.

Best bet is to call the NY BON.

[CapeCodMermaid, RN]

The last time I went to the doctor I needed a script for pain medicine. Instead of writing it himself, he went to the secretary's desk. He asked her for the prescription pad. She took it out of the drawer.....there was a whole pad of scripts already filled out with Percocet. All he did was enter a number to dispense.

I thought it was a bit hinky and I hope at least the drawer is locked at night.

[roser13, ASN, RN]

That happens everywhere that I've ever worked. Quite frankly, there have been some docs who were much better off with that practice. I actually find nothing wrong with it.

Here's something that will curl your hair: Now that MD offices no longer routinely hire nurses, the MA's are doing the writing out and the calling in.

[Nikki 1984]

As an LPN in S.C. I admit patients all the time and in doing so I write out all of the doctors orders from the discharge paper released from the hospital. I too have wondered about my UM writing various orders whenever she see's fit too. She actually questioned why the other nurses don't take it upon theirselves to write more orders, why does she have to do it all? I questioned her several times about this issue, she seems to think it's alright to just write an order when she thinks it's necessary and then have the doctor sign it later. I don't have a problem writing standing orders of the facility, but anything else I call and get the doctors approval for first. Protect your license!! They won't!! It's up to you.

[Mrs. SnowStormRN, RN]

I will type an order (via the computer system) for a lab, like a BMP if I have a dialysis patient about to have surgery (and I will draw that lab too). Several times I've drawn a HCG on menarcheal patient who didnt have an order for it, I know a pregnant surgical patient is baaaaad news, and I just put in the order. Or MD didnt put the IV order in, I know they need fluids before surgery, so as long as the fluid isnt contraindicated (like giving LR to a renal patient would be an epic fail, so I will put in the order for NS) in periop this is the standard (so its really a standing order but still the MD has to put it in for each individual patient). Of course I check allergies, patient history, etc.... I do not write orders for medications or such... I use my nursing judgement when it comes to certain things, and I notify the MD asap. Havent had an issue yet. You make a valid point though. It's been going on for years!!!

[vampiregirl, BSN, RN]

I briefly worked for a office where there was very specific refill criteria for most non-controlled substances. I believe that it stipulated the patient had to be in good standing with a visit within 6 months, the physician was the original prescriber for the med, all appropriate labs up to date, verify that it was time for a refill and several more criteria. All this criteria was available in written form, so I was fairly comfortable with this since there was an established protocol. If they met all the criteria, then we could authorize a refill or print out a script for them. Otherwise it had to go to the physician for approval.

[eslvn]

Im confused..do you mean these nurses just decide what order they want and write it down, and hope the doc says ok. Or do you mean they get a telephone or fax order and write it down? In California, we can take verbal, phone, or faxed orders and the MD has 24 hours to sign it....which is their responsiblity.

[mappers]

I briefly worked for a office where there was very specific refill criteria for most non-controlled substances. I believe that it stipulated the patient had to be in good standing with a visit within 6 months, the physician was the original prescriber for the med, all appropriate labs up to date, verify that it was time for a refill and several more criteria. All this criteria was available in written form, so I was fairly comfortable with this since there was an established protocol. If they met all the criteria, then we could authorize a refill or print out a script for them. Otherwise it had to go to the physician for approval.

This is what we do. We check to see if current, check to see when last filled, read the last dictation, etc. If there is any question, we ask the docs about it. We are an oncology office so there have been times when there has been something like chemo induced hypertension where the doc prescribes a BP med. But if they have been out of treatment for a while, the docs will tell us to have the patient see their PCP for this.

In the hospital, I never wrote out my own orders and then asked a doc to sign. I'd write VO all the time, but the doc really gave me the VO.

[PediNurse3]

Are you saying that the nurses decide what the patient needs to be on and the dosage and has the doctor ok it at the end of the day?

We are given physican delegation in our clinic so we are able to authorize refills without consulting the physican if they meet certain criteria, and use our nursing judgment/discretion. We also send new prescriptions (the dr may say order this, change that, etc) and order labs and imaging studies. We would never just put a patient on a medication because we (as nurses) thought that they needed it.

[sunshine1216]

I work in a pediatrician office....nurses write the scripts and give them to the dr to sign....they review them first. We do call in scripts but only AFTER the dr tells us to. And this is in NY

[Good Morning, Gil]

I would never do that. I value my license. I will do a T.O.R.B. or a V.O.R.B (only in an emergency per policy or I will ask the doc to write it down right away; verbal orders are risky b/c it's your word against theirs). If I need an order for a patient, I just ask the doc to write it or give me a telephone order. I write orders only in that I am writing down the order that they gave me by phone; I am not prescribing. Doesn't take long at all, and the rules are in place for a reason. I am smart, but I did not go to medical school, so I feel it's inappropriate for me to just write an order for a patient, and it's illegal. I will "suggest" to the doc what I think a patient needs. We have a job to do; they have a job to do. I have had no problems with this. If a doc just expected me to write an order that he would normally write (on an as needed basis rather than calling) and then tell me he would sign it later, I would politely refuse, and have no problem explaining why. Maybe the one time I "write' an order that he would normally order, my pt goes into vtach or something from said order before he signs it. Do you think the doc would really back me up?