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Can an RN in an employee-sponsored clinic provide services ordered on a prescription or letterhead without working with ordering physician?

Friday June 13, 2014
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Dear Nancy,

In an employer-sponsored clinic, if a nurse does not have a professional working relationship with an ordering licensed physician or access to a client's medical record, can the nurse provide services (i.e. maintenance IM meds, lab draws, suture removal, etc.) ordered on as a prescription or letterhead? If not, what is required of the nurse to be able to perform such written orders?

Brianna



Dear Nancy replies:

Dear Brianna,

Your question does not contain a lot of factors that might help with a more detailed response, so some general comments will be made.

It is unclear what you mean by not having a professional working relationship with the ordering licensed physician. What is your policy in the employer-sponsored clinic about carrying out orders an employee presents to the staff? For example, is all care, labs, etc., to be carried out by the physician who works at the clinic? If so, then the physician who works/heads the clinic would have to re-order the script. Also important is what the policy says about orders on a letterhead. It would seem the policy would require a script if staff were able to carry out orders from a physician not on staff or not known to the clinic.

A second issue is the lack of medical records. Does the clinic maintain records on those employees who seek care there? (It should.) What do those records say about this particular patient? Again, what is the policy in the clinic about no access to the employee's records? If nothing else, it might be helpful for the clinic to develop an information sheet filled out and signed by the employee's private physician that asks for pertinent information so staff can provide ordered labs, etc.

You also would do well to check your state nurse practice act to see if any guidance can be gleaned from the act or rules. In addition, your state board of nursing may have published opinions about this type of clinical situation.

Another excellent resource for you would be the American Association of Occupational Health Nurses (www.aaon.org). Review their position statements, practice issues and standards as well as other helpful information on its website.

Sincerely,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.