1. Urubek, Mariea JD, MSN, RN

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MOST NURSE PRACTICE acts state that you have a legal duty to carry out a physician's or dentist's orders. Yet as a licensed professional, you also have an ethical and legal duty to use your own judgment when providing patient care.

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In an effort to deal with this issue, some nurse practice acts give guidance on how to institute prescriber orders and still act independently. For example, the Delaware Nurse Practice Act states that an RN practices the profession of nursing by performing certain activities; among these are "executing regimens, as prescribed by a licensed physician, dentist, podiatrist, or advanced practice registered nurse (APRN), including the dispensing and/or administration of medications and treatments." (This statute permits nurses to dispense previously dispensed and confirmed medications.) Having said this, the Delaware statute defines the practice of professional nursing as "the performance of professional services by a person who holds a valid license," and "who bears the primary responsibility and accountability for nursing practices based on specialized knowledge, judgment, and skill derived from the principles of biological, physical, and behavioral sciences." This wording may be interpreted to mean that a nurse practicing in Delaware is required to follow a physician's or dentist's orders unless those orders are clearly wrong or the practitioner is unqualified to give them.


If a nurse is confused about or questions the safety of a prescriber's order, he or she should ask the prescriber to clarify it. If the prescriber fails to correct an error or answer the nurse's questions, the nurse should notify his or her nurse manager and follow the chain of command until the issue is resolved. The nurse is responsible and accountable for the quality of nursing care given to the patient. This responsibility cannot be avoided by accepting the orders or directions of another person.


A similar problem may arise when nurses work with physician assistants (PAs) and APRNs. For example, Delaware permits APRNs to prescribe regimens executed by RNs. Nurses should find out if the healthcare facility where they work allows PAs or APRNs to give orders to RNs. If it does not, nurses shouldn't follow those orders. If it does, they should find out if these orders must be verified or countersigned by a physician.


Keep in mind that nurses have a legal obligation to practice within the limitations of their state's nurse practice act. A facility's policies and procedures may narrow the RN's scope of practice, but an employer can't legally expand the scope of nursing practice to include tasks or responsibilities prohibited by the act. To protect themselves, nurses should compare their employer's policies with their nurse practice act and board of nursing rules and regulations, and check with the board of nursing to clarify any ambiguities.