Office Manager calling in prescriptions without talking to Dr.

[RN819]

I've recently started working in a MD office. The Dr. is out of town and a patient called requesting an antibiotic. The office manager helps take calls, googled a bit and without talking to the Dr. called in a script. She says, "I know what the Dr. is going to order". She has operated as his assistant doing patient care at times when the Dr. was without a nurse. Talk about practicing medicine without a license!! I was shocked! Problem is, I think the Dr. may be OK with it. I definitely want to talk to the Dr. about it. Might not even matter if I tell the Doc. If he doesn't do anything about it I will definitely leave and report it to the appropriate agencies. He would then know that I was the one who reported him and I'm afraid will destroy my nursing career by bad mouthing me. I'm thinking I should bail and leave the job to protect my nursing license. I'm concerned I could go down with the office with this kind of thing going on there. It is my understanding that I am mandated to report this type of thing to the state. There have been some other questionable things occur as well. I've heard her on the phone with patients clearly advising them out of her scope of practice. She doesn't even have a scope of practice. She is working under supervision of MD. I have a license to protect. What a mess! Thoughts and recommendations please!! MUCH APPRECIATED!

[sallyrnrrt, ADN, RN]

Sometimes these practices are pre arranged, "ie do this when I'm not here"

not on best practice.......

sometimes non clinical or lis., perceive a comfortable familarity

still not best practice

[nursel56]

For assisting in patient care, you'll need to check applicable laws pertaining to medical assistants. If your state is one that doesn't require any formal education, or certification for MAs, and he/she is trained by the doctor and under his/her direct supervision, there would be nothing specific to report. This would not be true in every state though. You can check with your state Medical Board or Dept of Public Health for that info.

On the matter of ordering antibiotics over the phone, it would be more problematic. Usually a state will prohibit unlicensed personnel from telephone triage and anything that can be construed as "assessment". I would personally want to make sure I understood the details of the arrangement before resigning or reporting the doctor to the authorities. Is there any reason you would not bring your concerns to the doctor before proceeding? Anyway, hope it all works out for you!

[RN819]

Thanks. That's a good idea. I have thought about it and plan to talk to the Dr. first. Will post back with an update.

[caliotter3]

I would tread lightly if you don't like the doctor's response. You don't want him to get his hackles up over you questioning his status quo, if that's the case.

[RN819]

nurseI56.... as far as the assistant working under the doctor's supervision, I thought that would entail the doctor being in the office and consulted about prescribing medications? It is being done without the doc knowing. I do know that I need a job. I am in such turmoil as to what to do. Thanks all for your input!

[nursel56]

nurseI56.... as far as the assistant working under the doctor's supervision, I thought that would entail the doctor being in the office and consulted about prescribing medications? It is being done without the doc knowing. I do know that I need a job. I am in such turmoil as to what to do. Thanks all for your input!

If the doctor doesn't know this person is basically diagnosing and treating I think you need to let him know about it.

I didn't understand that when I replied before. Sorry you're facing this situation, but you could be stepping in and potentially preventing harm to both a patient and the physician who's name is being used without his permission.