I would like to know if any of you are seeing this trend where physicians are hiring registered nurses to function in the capacity of an Advanced practice nurse. I know of several situations where a registered nurse is hired by a provider to round on patients and write orders as if they were advanced practice clinicians when in reality they are not.
Please respond with input or personal experience with this problem
How so? Nurses do it all the time. Nothing legally shaky about it whatsoever, as long as they're working off a protocol or order of some kind. I do it multiple times a day in my job in the clinic, and did it all the time as well in OB triage.
That is only legal if there is a note entered into the patient's chart that is then signed by an authorized prescriber, at least that's how it works in my state (though my offices use MAs not RNs). Twice in the past 3 years we have actually discovered scripts that were transmitted that were not authorized.
I also ethically don't think it's right to prescribe by protocol but that's another discussion.
My understanding is that as long as this practice complies with one's state BORN regulations/Nurse Practice Act, it is lawful. In my state, in order for Standardized Procedures to be used by RNs', there are a number of strict criteria that must be adhered to, both in the formulation/writing of the procedures, and in their enactment.
How so? Nurses do it all the time. Nothing legally shaky about it whatsoever, as long as they're working off a protocol or order of some kind. I do it multiple times a day in my job in the clinic, and did it all the time as well in OB triage.
Heck, NON-nurses do it all the time. MA's, CNA's, surgery schedulers all go by protocols in my area to call in all sorts of scripts. Narcotic scripts are written and signed by stamps.
In EMR. We can write orders per protocol or standing order, then MD signs after the fact.
The same is true for home hospice where all patients who are admitted fall under standing orders that are signed upon admission to hospice. If a nurse orders a medication based on standing orders the med still needs to get entered into EHR and is printed out and signed .
If a medication is needed that is not part of standing orders protocol or a different dose that is not in the protocol the MD is called and can give a verbal order that also needs to be documented. Narcotics are written by the MD and faxed to the pharmacy for hospice patients.
Yeah, even calling in a script under a prescriber's name is shaky ground even if a verbal was given for it.
How so? An RN can call in scripts as the agent of a physician. That's how we get our Hospice comfort meds done.
What we CAN'T do is call in any Schedule II drugs. We can get them refilled, but the pharmacy needs the hard copy CII script to fill the initial order. We usually request a two month supply on the script, and our pharmacy sends out a two week supply at one time.
Specializes in Nurse Leader specializing in Labor & Delivery.
That is only legal if there is a note entered into the patient's chart that is then signed by an authorized prescriber, at least that's how it works in my state (though my offices use MAs not RNs). Twice in the past 3 years we have actually discovered scripts that were transmitted that were not authorized.
I also ethically don't think it's right to prescribe by protocol but that's another discussion.
Your personal opinion aside, it's not in any way legally ambiguous, it's totally acceptable in every state and facility I've personally worked at, and it's quite common procedure.
My job as the clinic RN is to make the providers' lives easier by taking off their plates the tasks that I can do, under my scope of practice and facility policy. But if you have so much time on your hands that you're okay with calling in your own scripts for Macrobid, Azithromycin, or OCP refills, knock yourself out!
A prescription for a controlled substance must be dated and signed on the date when issued. The prescription must include the patient's full name and address, and the practitioner's full name, address, and DEA registration number. The prescription must also include:
drug name
strength
dosage form
quantity prescribed
directions for use
number of refills (if any) authorized
A prescription for a controlled substance must be written in ink or indelible pencil or typewritten and must be manually signed by the practitioner on the date when issued. An individual (secretary or nurse) may be designated by the practitioner to prepare prescriptions for the practitioner's signature.
The practitioner is responsible for ensuring that the prescription conforms to all requirements of the law and regulations, both federal and state.
Who May Issue
A prescription for a controlled substance may only be issued by a physician, dentist, podiatrist, veterinarian, mid-level practitioner, or other registered practitioner who is:
Authorized to prescribe controlled substances by the jurisdiction in which the practitioner is licensed to practice
Registered with DEA or exempted from registration (that is, Public Health Service, Federal Bureau of Prisons, or military practitioners)
An agent or employee of a hospital or other institution acting in the normal course of business or employment under the registration of the hospital or other institution which is registered in lieu of the individual practitioner being registered provided that additional requirements as set forth in the CFR are mets
For the nurses in orthopedics, I would hope you are not writing for narcotics or controlled substances.
Your personal opinion aside, it's not in any way legally ambiguous, it's totally acceptable in every state and facility I've personally worked at, and it's quite common procedure.
My job as the clinic RN is to make the providers' lives easier by taking off their plates the tasks that I can do, under my scope of practice and facility policy. But if you have so much time on your hands that you're okay with calling in your own scripts for Macrobid, Azithromycin, or OCP refills, knock yourself out!
In the vein of being non-inflammatory I will just say that people should read their state practice acts.
This, to me, is the problem with protocols. Scripts are being handled in a cavalier manner because the person responsible is not trained to prescribe. It's not just RNs, I feel less concerned about them, it's worse with the use of MAs. I have never seen a written protocol that takes into account the intricacies of the individual patient (age, gender, hepatic and renal function, comorbidity, drug to drug interactions, the local bacterial resistance, recent and past history, formulary coverage, etc, etc.). In this vein why can't the pharmacist just prescribe, as they are trying to do?
Heck, NON-nurses do it all the time. MA's, CNA's, surgery schedulers all go by protocols in my area to call in all sorts of scripts. Narcotic scripts are written and signed by stamps.
Agree. Never did narcs/controlled substances. Narcs have to be signed. But I've done EMR like Jensmom and roser- especially in the OB/GYN clinic, and yes I worked off a protocol or verbal orders that were later signed off in EMR.
Specializes in Nurse Leader specializing in Labor & Delivery.
In the vein of being non-inflammatory I will just say that people should read their state practice acts.
This, to me, is the problem with protocols. Scripts are being handled in a cavalier manner because the person responsible is not trained to prescribe. It's not just RNs, I feel less concerned about them, it's worse with the use of MAs. I have never seen a written protocol that takes into account the intricacies of the individual patient (age, gender, hepatic and renal function, comorbidity, drug to drug interactions, the local bacterial resistance, recent and past history, formulary coverage, etc, etc.). In this vein why can't the pharmacist just prescribe, as they are trying to do?
Then you've never seen our facility's protocols. And I agree that this is outside the scope of MAs. For my argument, I'm talking specifically about RNs, treating common and uncomplicated infections, using their facilities protocols and algorithms, which are backed by research and published evidence.
80% of UTIs are caused by E. Coli, which in almost all cases, is susceptible to nitrofurantoin. It's a safe med, and its use in uncomplicated UTIs is recommended by the literature. They even recommend that a culture is not indicated unless Sx are not resolved with the prescribed med.
BostonFNP, APRN
2 Articles; 5,584 Posts
That is only legal if there is a note entered into the patient's chart that is then signed by an authorized prescriber, at least that's how it works in my state (though my offices use MAs not RNs). Twice in the past 3 years we have actually discovered scripts that were transmitted that were not authorized.
I also ethically don't think it's right to prescribe by protocol but that's another discussion.