In an employer-sponsored clinic, if a nurse does not have a professional working relationship with an ordering licensed physician or access to a client’s medical record, can the nurse provide services (i.e. maintenance IM meds, lab draws, suture removal, etc.), which are ordered on an RX or letterhead? If not, what is required of the nurse to be able to perform such written orders?
Dear Nancy replies:
Physician orders, both written and oral, are regulated by the state medical practice act. Likewise, a nurse acting upon those orders is governed by the state nurse practice act and rules. Checking out what each state practice act requires is easily done by going to the respective state board’s website. Once there, access the respective act and rules governing physician orders and nurse responsibilities when carrying out an order consistent with the nurse practice act’s requirements.
Another reference for you to check is what your clinic policies say about physician orders, including verbal orders. Must they be on a specific form the clinic requires? If so, where does the employer and his physician obtain them? What does the nurse do if an order does not comply with these mandates?
It is unclear what you mean by a professional working relationship with the employees’ physicians. Do you mean you know the person’s order is one from a physician with whom you have taken orders from before? It would seem almost impossible that clinic nursing staff would know every physician who writes an order for an employee coming into the clinic for services.
Having access to the employee’s chart would be extremely helpful and in most clinics such as you describe, those charts are readily available. If for no other reason, you would need the chart to document what you had done for the patient, any complaints the patient voiced, vital signs taken and so forth.
Generally speaking, scripts are often used for physician orders when the patient is in an out-patient setting, such as your clinic. Although more rare, a genuine letterhead depicting a genuine order from a genuine physician would seem to be acceptable as well. In either case, both would become a part of the worker’s chart.
However, if you cannot obtain a specific answer to your question from the legal counsel for the clinic, and your outreach other resources, including your nurse manager, are to no avail, you can call the physician who has ordered the test or whatever procedure and obtain verification that the order is the physician’s before carrying out any specifics of the order.
Documenting the call and the verification in the employee record also would be a good idea.