Are you a Nurse or Dr?

Nurses can perform tasks that are within their scope of practice. If the tasks involves a medical act, then there must be an order for that task. Nurses sometimes do not realize these boundaries and can find themselves accused of practicing medicine by stepping beyond their scope.

A common example of this is when a nurse is working a night shift and a patient needs Tylenol or an antiemetic. The nurse decides not to wake the physician and goes ahead and writes a telephone order for the medication and administers the medication. The nurse justifies the action by deciding that the physician will cover the nurse with an order in the morning or will sign the telephone order in the morning. By doing these actions the nurse has practiced medicine and committed fraud by documenting a telephone order that never took place. Harm has resulted to patients by the administration of "simple" medications by nurses who were not aware of the treatment plan or that did not understand the patient's disease process or all aspects of the medication. Physicians are understandably upset at being held responsible for an order they did not give and they are speaking up and reporting nurses.

There must always be an order for a medical task. Orders are not required for nursing tasks because those are within a nurse's scope of practice as determined by licensure. If a nurse cannot get assistance for a patient from a physician, the nurse should not assume the role of the physician, but should take the issue up the chain of command until the proper result is obtained for the patient.