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October 2011, Volume 41 Number 10 , p 14 - 15


  • Penny Simpson Brooke JD, MS, APRN


In the hospital where I work night shift, nurses are expected to make certain decisions about medications if neither the pharmacy nor the prescriber can be reached. For example, if a patient can't swallow a tablet, nurses should substitute the liquid form if available. I believe this is beyond my scope of practice. Should I follow hospital policy even if it violates my state's nurse practice act?-J.E., OKLA.The state nurse practice act is the legal guideline that you must follow in your nursing practice. It doesn't give RNs prescriptive authority. Violating prescriptive practice law is a serious breach of the nurse practice act.Employers can't expect nurses to perform duties beyond the scope of their license. Contact your state board of nursing for guidance, discuss your concerns with your supervisor, and go up the chain of command if necessary to ensure that hospital policy is in line with state law. Your employer may or may not know that the policy is unreasonable and probably illegal.If your employer refuses to change the policy, you'll have to decid e whether you should continue working at this facility. I don't recomm end that you ignore facility policy and continue to work as an employee because employers expect employees to abide by their internal policies-but legally, your employer can't require you to work beyond the scope of your nursing license and violate prescriptive practice laws. If you're sued for exceeding your scope of practice, a facility policy that conflicts with state law won't protect you.Under a new policy in the ED where I work, nurses have to follow up on patients who left the ED without being seen (LWBS) or left against medical advice (AMA). The protocol includes requiring nurses to make up to three attempts to reach him or her and document these attempts. We're worried that this will be one thing too many on our plates, and that a patient who really does need the follow-up will get lost in the shuffle because we're so busy with our current

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