Nurse’s Role in Prescriptions

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on March 9, 2010
in Nursing Education
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nursing prescriptionsI remember learning as a nursing student, that if a physician makes an error in prescribing a medication (name, dosage… handwriting) and a nurse administers that medication to the patient, the nurse is held responsible for the error. The math just did not add up.  Physicians have to go to school for at least six years before they can prescribe meds and their total education is closer to twelve.

My BSN program, when all was said in done came out to about four and a half years (with required summer courses). A BSN program typically includes a massive amount of pharmacology and medication training as reflected by all the medication questions on the NCLEX licensing exam. But, I still was left wondering how nurses are supposed to be able to spot a medication error unless we know everything that the prescribing doctor knows about meds.

I soon learned, once on the floor, that the best ways to avoid a problem are to have a current drug reference on hand and to always, always, always ask the doctor if you have any questions or doubts.  As a night shift nurse this took a bit of courage to wake up a physician at three in the morning – but it sure beats being named in a malpractice lawsuit and even more importantly risking a human life.

As reported by the May 5th Oregonian, there is apparently some controversy brewing in Oregon, where the state legislature is debating whether psychologists, who lack the same amount of training as physicians, should be allowed to prescribe “the most dangerous and lethal pharmaceuticals” to patients. The bill does include certain restrictions regarding psychotropic medications (ex. antidepressants, anti-psychotics).

I should note that physicians are not the only one authorized to prescribe medications. This privilege also is extended to doctors of osteopathy, nurse practitioners and physician assistants. Psychologists in America, at this point, do not have universal prescribing privileges – only some are given permission to dole out the meds.

In the meantime, Oregon House Bill 2702, according to recent reporting, is currently stalled in the Oregon house pending review of a medical task force later this year.

Uniformity of Nursing Uniforms

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on February 19, 2010
in Nursing Career
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nurses_7One of the highlights of nursing school for me came during sophomore year when we were given our “shopping list” of things we would need to start clinicals. The list included our very first stethoscope, blood pressure cuff, pen light and yes, the all important nursing uniform.

For school purposes, we were instructed to look as identical as possible – white dresses or white tops and white pants. This way the staff nurses at our clinical facilities would see us coming down the hall and be properly alarmed – “oh no, here come the student nurses!” As a group of about eight students, we looked rather like a process of church acolytes.

However, after graduation, free from school policies, I went shopping again. Now that I was able to branch out beyond all white, the colorful uniform options were almost overwhelming. It was like trading in a black and white television for a color unit. There were flowers, stripes, cartoons and every other type of print under the sun.

Excited by the possibilities, I bought a little of everything. But I also kept my little white dress from nursing school. And, surprisingly, once I started working as a real RN I ended up wearing the white dress more than any of the multi-colored scrub tops and pants. For some reason, I felt a special sense of pride and professionalism when I donned the white dress, white pantyhose, and white shoes and pinned by school BSN pin on the lapel. I felt more like an RN than ever.

I realize that many other nurses do not feel the same way about uniforms and I respect that. There are two basic sides to the “nursing uniform debate.” The first argues that nurses should wear the white or at least agree on a basic uniform so patients will be able to differentiate their RN caregivers from the hospital workers tasked with bring them their dinner tray, transporting them to surgery or drawing blood. The second side argues that comfort, functionality and individuality for nurses trumps uniformity.

In England, the Royal College of Nursing (RCN) recently voted 76 to 24 percent that every nurse in that country should indeed dress alike for exactly the reasons that I cited. Although according to the Department of Health, the RCN vote does not indicate any plans to introduce a “national uniform.”

What do you think about the uniformity of nursing uniforms here and abroad?  I wonder what Florence would say.

New Innovation Standardizes Shift Reporting

Published
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on February 5, 2010
in Nursing Career
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patient information guideThe system I used to organize important information about my patients before and during a shift was not exactly high tech.

My charting system consisted of a clipboard and a sheet of plain blank paper that I would methodically divide into squares with a ruler before my shift. Each patient got a square wherein I would write clinical data such as diagnosis, vital signs, medication times, procedures, IV information and other “need to know” facts to keep my patients straight.

I would continuously update the squares with the most pertinent information throughout my shift. It was like “Hollywood Squares” meets “ER,” and yet it was effective for providing organized, quality patient care. It also kept all my patient information right at my fingertips for a smooth, streamlined shift report to the nurse taking over my patients.

Thank goodness someone has had the good sense to update my little arts and crafts project shift organization system. Actually two “someones” – a pair of RN, BSN sisters from Florida have accomplished this.  The Elson (not Olsen) sisters have invented a product called “RNReport card” to standardize patient note taking and shift reporting. This will especially benefit nursing students and nursing new grads, finding their way through the often daunting process of thorough and accurate patient documentation.

The product is a 5×7 booklet that fits easily in uniform pockets and standardizes how patient information is recorded and then communicated at shift change. It is also useful for having the most critical patient data available in the same standardized format at a moment’s notice to share with physicians or other members of the patient care team.

Standardized tools for reporting patient information also reduce the likelihood of a medical malpractice action due to inaccurate or missing patient documentation. After all, even as I was dividing my sheet of paper into squares at the beginning of each shift, the adage – “If you didn’t write it, you didn’t do it” – was always on my mind.