I am working as palliative nurse practitioner for a hospice and palliative care. I am expected to write recommendations for opiates and pain management in my patient’s chart but not actually write an order for the med. My collaborative physician states that since I’m not writing orders, I don’t need prescriptive authority from a physician. I believe I need delegated prescriptive authority from my collaborative because I can be held accountable for my recommendations especially if the doctor doesn’t amend them in terms of doses. etc. Who is correct?
Dear Nancy replies:
The response to your question can only be found by reviewing your nurse practice act and rules to determine what the scope of your advanced practice nursing is, and whether or not it is required any prescriptive authority be delegated by your collaborating physician. It sounds as though your APN practice is not independent, as is the case in many states, where the APN has the authority to prescribe medications if certain requirements in the act and rules are met. Therefore, prescriptive authority does not need to be delegated by a collaborating physician. If you practice in a state requiring delegation of the authority to prescribe, the question arises if you should even be recommending pain management medications.
Based on the information you included in your question, your best bet would be to seek a consultation from a nurse attorney or other attorney in your state who work with nurses and APNs and can provide you with a specific opinion based on your act and rules and your exact role in your practice setting. This would be particularly important in the setting in which you work, and the fact you are recommending opiates and making recommendations for pain management.
There are many legal and ethical issues to consider in pain management, which are beyond the scope of this column. You can review these issues by placing “legal and ethical issues in pain management” in your search bar and review commentaries on these issues. Professional licensure ramifications for those who are managing patient pain can arise, so you want to be certain you are practicing in accordance with your practice act and rules and with applicable standards of practice in this regard.