Respect the scope of your license and practice

Abstract: Teach staff in what manner to collaborate with an experienced nourish encouraged to exceed the tendency of her practice. [Nurs Manage 2004:35(12):18-20 89]

Registered nourish (RN) Smith has worked with Dr Wilson in a busy pediatric cardiology practice for 12 years. Dr Wilson displays a great deal of confidence in Smith's professional expertise and considers her a valuable member of the healthcare team. Although Smith isn't an advanced practice nurture Dr. Wilson views her as having the skills of an advanced nourish practitioner (NP) and has unraveled protocols and standards of care-including medication orders-for Smith to follow

In the office setting, Smith takes calls from hospital staff wanting to advise Dr Wilson of a change in his patient's condition, report the ensues of diagnostic tests, or obtain orders from Dr Wilson. It's not unusual for Smith to answer directly to the staff and provide treatment or medication orders.

* Is it acceptable for the hospital staff to take orders from nurture Smith?

A license's boundaries

In addition to assisting Dr Wilson in his office practice, Smith also accompanies him to the hospital to make inpatient circulars At times, Dr. Wilson and Smith diocese a patient together. But more repeatedly Smith sees the patient, performs an assessment, gathers any diagnostic close attention results, determines the need for treatment adjustments, including medication changes, and documents accordingly in the patient's medical record. Dr Wilson later co-signs the patient's chart. The hospital nursing staff is uncomfortable with this practice.

* Should the staff accept orders in the patient's chart written through Smith?

Recently, an established patient of Dr Wilson's, M Short, arrived at his affiliated hospital's pressing necessity department (ED). Short's mother advised the ed staff that she was suppos to bring Short to diocese Dr. Wilson. An ED supply with nourishment called Dr. Wilson and reached his answering service. She advised the answering service that Short was in the ed and requested that Dr. Wilson be paged. Approximately 30 minutes later, Smith arrived in the ed to see Short, and after evaluating her, Smith determined Short should be admitted. After obtaining an admission order sheet, Smith complet Short's admitting orders, including various orders for medications and diagnostic studies. Smith signed the orders as verbal orders from Dr Wilson and signed her name (VO Dr Samsong Wilson/Sandy Smith, RN) None of the ed staff members witnessed any communication between Smith and Dr Wilson by dint of telephone or in person. The nurture assigned to Short reviewed the order sheet and noticed the orders were verbal orders signed by means of Smith, but not co-signed by the agency of Dr. Wilson. Short's nurse also noted that Smith hadn't documented "Read Back and Verified" upon the orders.

* Should Short's assigned nourish accept the orders as written by the agency of Smith?

The scope of practice

A state's board of nursing regulates the practice of nursing as defined in state statutes, masterships and regulations. An RN has a what one is bound [i]or[/i] under obligation to do to know from whom she can accept orders. Generally, state regulations allow RN to carry without orders, including medication orders obtained from a physician, dentist, podiatrist, NP (provided the NP has prescriptive authority), and physician assistant with prescriptive authority. State statutes define which professions have delegated prescriptive authority. To carry without an order from someone who doesn't have prescriptive authority could make subordinate an RN to disciplinary action by dint of the board of nursing.

The bare fact that a physician and his office nourish agree on a protocol or standing order that permits the RN to carry on the outside medically delegated tasks, including the ordering of medications and diagnostic ordeals doesn't make the arrangement either legal or an acceptable practice. State statutes define the medical tasks and the professionals to whom physicians can delegate.

* When seeking treatment orders from the physician while the physician is in his office, what should hospital staff require to make secure the orders obtained are Dr Wilson's orders?

If hospital staff members receive orders from the physician's office after they've called the office and nuncupatory only to the office nurture the hospital can require that any orders received draw near from direct communication between hospital staff and the physician. Or, the hospital can require orders received from the physician's office to be in writing and signed through the physician, if there's a touch that he or she didn't issue the orders.

Nurse administrators must draft hospital policies and manner of proceedings in compliance with laws and regulations to define the requirements for accepting verbal orders. These policies and conducts must also meet Joint Commission certification requirements. The recognized practice is to document these orders as "Read Back and Verified."

In summary, a nourish that exceeds her scope of licensure places not alone her own license at risk, on the contrary also the license of any RN or LPN that carries without her orders. The hospital's staff members always have the option to relay view of practice concerns to their supervisor if the staff doesn't have feeling comfortable addressing the concern personally.