Was told telling a patient to hold a bp med for bp <90/60 is practicing medicine

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So I am a home care RN. I felt it was within my scope of practice to tell a pt not to take their bp med lisinopril if their bp was

Please update me.

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Specializes in Complex pedi to LTC/SA & now a manager.

Sounds like patient education.

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LOL!

Why the hell does your boss think you went to school for a long time, spent tons of money on books, studied for a hard ass test, and then became licensed for?

If they want a pill dispensing robot then they can buy a pill dispensing robot.

Educating a patient on their treatments and medications is a PRIMARY FUNCTION of registered nursing. Scratch that, a PRIMARY DUTY of registered nursing.

I do not say this often but your boss is dumb. Run...run far away.

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They are correct. It's not your call to make. The correct response is if the physician did not give a hold range, call the physician and ask if you should hold it and then ask for a hold protocol in the future.

No matter how obvious it is...it's ok to delay when a BP is that low, but outside of an order you still have to call the physician if you don't give a medication for any reason.

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They are correct. It's not your call to make. The correct response is if the physician did not give a hold range, call the physician and ask if you should hold it and then ask for a hold protocol in the future.

No matter how obvious it is...it's ok to delay when a BP is that low, but outside of an order you still have to call the physician if you don't give a medication for any reason.

So I am a home care RN. I felt it was within my scope of practice to tell a pt not to take their bp med lisinopril if their bp was

It is ALWAYS the nurse's call to whether they give a medication or not...always. We are a separate profession from medical doctors, we are not the hands of medical doctors. But either way this was a patient education scenario where the patient was notified that clarification from the physician would be needed.

Now the nurse needs to clarify the order but if the orders conflict with the nurse's professional judgment of safe practice then the nurse is duty bound to take immediate measures to protect their patient. It is always, always, always, the call of the person who actually gives the med.

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Specializes in LTC Rehab Med/Surg.
It is ALWAYS the nurse's call to whether they give a medication or not...always. We are a separate profession from medical doctors, we are not the hands of medical doctors. But either way this was a patient education scenario where the patient was notified that clarification from the physician would be needed.

Now the nurse needs to clarify the order but if the orders conflict with the nurse's professional judgment of safe practice then the nurse is duty bound to take immediate measures to protect their patient. It is always, always, always, the call of the person who actually gives the med.

I have no HH experience, but in the hospital I'm always fully aware that if I dispense a med r/t a questionable order, I'm the one who's going to be hung out to dry.

I actually work with nurses, usually the younger ones, who'd give anything without question. They're under the assumption that following a doctor's order protects them.

HH is a totally different animal than working in the hospital. A lot of autonomy. I see nothing wrong with what the OP did.

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Specializes in Oncology.
They are correct. It's not your call to make. The correct response is if the physician did not give a hold range, call the physician and ask if you should hold it and then ask for a hold protocol in the future.

No matter how obvious it is...it's ok to delay when a BP is that low, but outside of an order you still have to call the physician if you don't give a medication for any reason.

That's exactly what they said to do. Not take it UNTIL the physician could be contacted.

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Patient education directed at checking BP before med and holding for BP lower than universal standards and/or symptoms and calling MD asap is prudent and reasonable however what I would focus on in my documentation is the MD notification in timely manner.

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When my pt's BP is low I give him water(no fluid restriction) .It rises usually.If not tell mom about it document and usually mom gives it anyway if it's higher than 90/60 but lower than 100/70- the doctor range.

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It is ALWAYS the nurse's call to whether they give a medication or not...always. We are a separate profession from medical doctors, we are not the hands of medical doctors. But either way this was a patient education scenario where the patient was notified that clarification from the physician would be needed.

Now the nurse needs to clarify the order but if the orders conflict with the nurse's professional judgment of safe practice then the nurse is duty bound to take immediate measures to protect their patient. It is always, always, always, the call of the person who actually gives the med.

I can tell you right now that if you hold a med without notifying anyone you are in deep trouble in a hospital setting and if you are right hoorah for you but if you are wrong and something happens to the patient....congrats, you are guilty for practicing medicine without a license. That tends to not turn out well for the nurse.

I like to err on the side of caution.

I think I've been a nurse long enough to know the difference between a nurse and a physician, but thanks for covering what my MSN may have missed.

Go back and read my answer. I never said hold it forever. I said hold and then notify the physician and get a clarification. That way if he doesn't call back you can document you were waiting for a response, but it shouldn't take all day for him to call back....meanwhile I would step up the monitoring.

I think it's pointless to assume the physician would disagree with the hold when the physician hasn't even had the opportunity to respond.

I stand by my answer.

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

I think it's all in the delivery. Politics is a real issue in nursing. If you, as a nurse, are aware of hold parameters and teach a pt about the potential effects of taking certain meds (ie anti hypertensives) d/t certain s/sx (ie low BP) that is okay and is in the best interest of the pt.

However, if you directly say, "don't take this med if you have xyz symptoms", this could be interpreted (by over zealous superiors) as practicing medicine W/O a license, which we, as nurses, can't do. (Unless the prescribing order says to hold the med in certain situations) therefore, if hold parameters aren't in the order, we nurses, can't be the ones to add them.

I'd advise the pt to contact the MD r/t taking the meds if certain s/sx were present. I'd explain htn, hypotension, the related s/sx of each. I'd explain the potential ramifications of taking meds if certain s/sx were present. Then I'd follow up with: contact your MD if you feel you have certain s/sx because ur routine meds could cause certain ramifications.

You did the right thing, but we have to tread lightly as nurses.

This is my, quite verbose, opinion.

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So I am a home care RN. I felt it was within my scope of practice to tell a pt not to take their bp med lisinopril if their bp was

Please update me.

Your boss sounds like the type of stupid manager who would be the first to throw you under the bus if you had the patient take the medication because the doctor didn't order hold parameters.

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