Should an RN obtain physician orders for a registered nutritionist consultation recommendation?
Nancy Brent replies:
A licensed RNs scope of practice is defined in the state nurse practice act and its rules. Generally speaking, a licensed RN cannot order medications, treatments or consultations unless there are standing orders or protocols granting that authority to the RN. An advanced practice nurse (APN) can order medications, treatments, consultations and the like because of his or her advanced education, certification and legal authority by way of the state nurse practice act and/or rules.
Despite the above restrictions on an RNs scope of practice, an RN who is concerned about his or her patients well-being can, and should, act as an advocate for the patient. Also, keep in mind that included in an RNs scope of practice is teaching the patient and family about health information the patient may need in the future to avoid further health problems.
The nurse can, and should, discuss concerns about the patient with the physician and others on the health team. Informing the physician and team members about your concern for the patients need for a nutritional consult would be important. The information about the patients current eating habits and current nonuse of nutritional supplements, obtained during the nurse-patient relationship, would be a perfect fit with the RNs legal and ethical responsibilities to the patient.