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~

[carolmaccas66, BSN, RN]

I used to do this routinely for a GP, but only for repeat scripts (ie: the same script just re-written), and the Dr would sign & check them. I think it's OK cos the Doc is the one responsible for signing them. Any deviations from the norm, the patients had to see the Doc.

[nursel56]

I never wrote out a prescription for the doctor to sign when I worked at any office or clinic. When I first heard about it, I was put off by the idea, too. There could be an error in it, especially if it is written out by an MA. Honestly my reaction at first was "can't you write your own $$%# prescriptions"?

Most of the doctors I've worked with barely glance at the stuff I gave them to sign. I think most could scribble out the Rx much faster than it would take them to read through it filled out by somebody else.

We would OK refills within certain parameters, but never prescribe a new drug without a written/verbal/fax order first.

However, because of the vast differences in ambulatory care practices, what I did in a Family Practice office with no real urgent, emergent cases, worked for us -- so I wouldn't say a blanket edict against it is in order.

[psu_213, BSN, RN]

Something similar happened to me at the doctor's office just the other day. The nurse there (an LPN...no, not an MA or otherwise ) typed up the Rx. on the computer and printed it out. Gave it to the MD who signed it. It was not for a narcotic or anything like that, but similar to the practice you describe.

[cherrybreeze, ADN, RN]

I would check your facility's policy.

I am a little confused with the OP....are the nurses deciding what meds to write for, or is it a verbal order?

At the hospital I worked at, we were able to take a phone order for a med and write the Rx, if the MD was not in the building (plenty of times, the surgeon would write discharge orders but forget the script, or the patient would ask for an additional Rx for a nausea med after the MD had left the unit). We'd have to write it in the orders in the chart, and then on the Rx and sign it as a verbal/telephone order. Patients had no problem getting these filled.

The only meds we could not do this for was Schedule II's (such as Dilaudid or Percocet).

[netglow, ASN, RN]

If it's like how cherrybreeze describes, that's the right way to do it. I shadowed a job where there was no P&P for coumadin patients. The docs were not interested in setting one for the practice or being involved at all in the dose management even initially if I developed protocol. Yup pretty much thought it was not important, and could be just handled by looking for an iphone app formula since it's "imprecise". I wondered what the previous nurse (a very young NG with no prior work exp) pulled out of her butt in managing these patients pretty much on her own? Sure you can get a basic formula if you Google it...

Needless to say that was only one of the reasons I decided not to work there.

You just have to be careful with MDs. Some forget that just because they feel something is beneath them, or just don't feel like doing something, it doesn't mean an RN can do it. I tell ya that if something bad goes on, you will probably find them saying that they "didn't know you were doing that". And, there you sit having thought you were pretty autonomous, huh.

[Nikki 1984]

Eslvw,

I'm saying that there are LPN's out there who are in a unit manager position who write orders that are not faxed, pharmacy fax, telephone orders, standing orders etc... They are just writing orders for medication's such as an antidepressant for a patient without calling the doctor first!! yes, it is going on. So far, the doctor has signed them all. But this very same nurse thinks it's alright to fill in all of the MAR holes at the end of the month for medication's she didn't give . She thinks that it is alright to do this because she was in the building on the day it was supposedly given. However, this very same nurse will write up another nurse for a medication error for any holes on the MARS leading up to the end of the month. What's wrong with that picture?

Nikki 1984

[RVAnurse]

I work in a facility where I witnessed a nurse cut and paste a doctors signature on a standing refill. The doctor forgot to sign the script and the pharmacy faxed it over. Since the doctor is out of the facility the nurse decided to pull the doctors signature and paste it to the script and fax it back to the pharmacy. Some how this seems unethical, but I was told because it is a standing refill there was nothing wrong in doing this. Any feedback??.

[Swellz]

I work in a facility where I witnessed a nurse cut and paste a doctors signature on a standing refill. The doctor forgot to sign the script and the pharmacy faxed it over. Since the doctor is out of the facility the nurse decided to pull the doctors signature and paste it to the script and fax it back to the pharmacy. Some how this seems unethical, but I was told because it is a standing refill there was nothing wrong in doing this. Any feedback??.

No, there is definitely something wrong with forging a prescription. It is illegal. Granted, because it was a standing refill, I doubt the pharmacy would have questioned it too carefully, but that doesn't mean they shouldn't.

I was a pharm tech for several years, and a lot was let slide that should have been verified. Docs not writing dates on narcs correctly (leaving it off and telling pts to write them in themselves, which they always seemed to do in a different color pen), prescriptions clearly written by someone else and then signed by the doctor, etc. Just because you can get away with it doesn't mean it is okay. Not that it isn't also the pharmacy's responsibility to be vigilant.

[BostonFNP, APRN]

ThIs happens in practice; the prescriber is supposed to review the scripts but often doesn't. This is a VERY risky practice. One of my colleagues just had a MA refill a script for a med that was d/c'd 2/2 a major drug-drug interaction with a new med. Big problem.

[anothergrumpyoldRN]

It really is the call of the provider.

I have done that for PAs, NPs, DOs and MDs.

Many wouldn't think of having a nurse or anyone else write their Rx's.

Others, could care not so much.

If it gets me what my patient needs I am happy to do it!

[VANurse2010]

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.

It depends on what it is. Sometimes things may be protocol when you don't realize they are.