What would you call "Practicing Medicine"

Nurses General Nursing

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Hello everyone.

Just a curious thought for the day. What examples for a nurse "Practicing Medicine" can you give.:nono:

Ex: Giving meds without a MD order.

Changing med dosage without MD order.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Nurses in my ICU unit practice medicine by proxy all the time. We deal with a lot of surgical residents. When calling them for orders we frequently hear "What should I do?" or "What do you want?". Several times I have seen residents turn to experienced nurses when a patient is crashing and ask for help. I have seen residents write orders word for word the way the RN "suggested" it.

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Specializes in Nephrology, Cardiology, ER, ICU.

Practicing medicine is exceeding your state's scope of practice and/or doing procedures, giving meds, etc that are not covered by specific protocols.

Yes, doing all that bowel work was practicing medicine w/o a license unless covered by a written facility protocol.

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Nurses may not diagnose or prescribe. We are to observe and report departures from normal.

I know it's unrealistic and old-fashioned and paternalistic and frustrating but that's the law. And unless you are going to medical school, learn it and obey. That's how you keep your license and your good name and your income.

One need not attend medical school - remember advanced practice nurses? Sorry, but it's one of my pet peeves that most people seem to forget about midlevels entirely. Finally, some of the television ads have started saying "ask your healthcare professional" instead of "ask your doctor", so MAYBE there is some progress being made.

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Specializes in Utilization Management.
If you are not an N.P., passing, drawing, giving, cutting, sticking anything into anyone.

Woody:balloons:

I'm assuming that you mean "without a doctor's order." Because we do it all the time with a doctor's order.

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I thought the bowel work was going too far. I'm still in orientation, and my preceptor though it was alright.

I guess we should have asked for a more broad order to cover all that we had to do.

Oh my god, the patient felt like a new woman when it was over. All good results!

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Specializes in Utilization Management.

What about information from the chart?

I've had relatives ask me for test results that the doc hasn't discussed with them yet, and supposing that the a/o X3 patient wants to know and wants the relatives to know, just how far can a nurse go in answering questions like that?

Because it seems to me that once you answer one question, it'll lead to another, and pretty soon you're leading them to a Dx, which is way beyond the nurse's scope.

I'd appreciate your thoughts on this.

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Woody,

I think you mean "without a MD order" for these. Correct? Because our SOP allows us to do most of those things with an order. Even if I have an order for cutting someone , I don't think I can do that LOL.

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Specializes in Cardiology, Oncology, Medsurge.

Recently I had a patient who had what I call "Bile City". I mean it was a sea of green coming out of his NG tube residual way above the norm and we had reduced the TF to 10ml/hour. So I took initiative and started the reversal of feeding to LIS and low and behold pulled 600ml out of him. Now, knowing he was weak and lethargic, vomitting and aspirating on this green matter is not good for one's health. We'd then be in Code city! Called doctor soon after starting NG to LIS and received an order for Reglan...

The green bile looking matter when it is in significant quantity coming out of a person is scary and I just wish it would go away when I'm faced with it, period!

So, do I practice medicine? Sometimes especially when the person's life is on the line...that's is all I have to say, really.

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Specializes in Rodeo Nursing (Neuro).

Last night I asked a doc for an order to put an icepack on facial edema. In my state, I need an order for ice or heat. I do think I was within my scope advising the pt how to use the ice--half-hour on, half-hour off.

I did forget to enter the order, though, and I'm sure he didn't bother. Oops.

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Specializes in Spinal Cord injuries, Emergency+EMS.
Nurses may not diagnose or prescribe. We are to observe and report departures from normal.

I know it's unrealistic and old-fashioned and paternalistic and frustrating but that's the law. And unless you are going to medical school, learn it and obey. That's how you keep your license and your good name and your income.

at best it's a semantic arguement like the whole 'nursing diagnosis' bag of poop ....

nurses do 'diagnose' and do 'prescribe '...

except of course i nthe USA where for billing reasons you are required to get a doctors order to carry out nursing interventions

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Specializes in ER.

I get around the diagnosing issue when answering questions by reciting from a book "the troponin level shows.....that most commonly means....but you need to confirm what it means in this specific case with your doctor." I explain it is beyond my license to diagnose and prescribe, but the most commonly prescribed medication for an itchy rash is Benadryl, though if you are concerned you should see your doctor." I can give information and still give myself some wiggle room. But BEWARE of the turkey families that will turn around and claim all sorts of nonsense because the nurse said it was so.

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I work in critical care at a hospital with pages of standing orders and protocols for almost everything. Nurses can order ABGs, basic labs, 12 lead, chest x-ray, KUB, swallow evaluation, advance/hold tube feed, replace and recheck electrolytes, initiate and advance mobility status (i.e. crack the whip and make the patient walk his ventilator down the hall), consult other nursing disciplines, ect. It is all in the order sets. I don't think you find that kind of autonomy often though.

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