Carolyn Buppert, NP, JD

Disclosures

May 27, 2004

Question

Can nurse practitioners (NPs) prescribe medications for family members or themselves? Are there circumstances when this would be reasonable?

Response From the Expert


Carolyn Buppert, CRNP, JD
Nurse practitioner and attorney who specializes in the legal issues affecting medical practices and nurse practitioners. She is the author of 5 books. Ms. Buppert counsels clients, and lectures extensively on reimbursement issues, how to avoid malpractice, and contract negotiation. She is also president of Better Life Health Care Systems, which contracts with businesses and educational institutions for nurse practitioner services. Through that company she serves as Director of Student Health at St. John's College in Annapolis, Maryland. Her Web site is www.buppert.com

 

NPs should avoid prescribing legend (prescription) drugs for family members, unless the family member is enrolled at a practice where the NP regularly diagnoses and treats patients. Likewise, it is not a good idea to prescribe legend drugs for one's self. I found no state law expressly prohibiting prescribing legend drugs to oneself. An NP, however, should never prescribe controlled substances for himself or herself or for family members, as it is expressly illegal in many states.

While there may be no law specifically prohibiting a practitioner with prescriptive authority from prescribing legend drugs, such as antibiotics, to family members or oneself, unless an NP or family member is enrolled as a patient at the NP's practice setting, the NP is unlikely to be covered under a collaborative agreement with a physician for diagnosis, medical management, and prescribing. Collaborative agreements are specific to a practice setting. In states where no collaborative agreement is required, an NP who prescribes for a family member is on somewhat firmer ground.

As an example, consider the Arkansas Board of Nursing's position statement on this matter:

 

Prescribing controlled substances and other legend drugs for self and family raises many ethical questions. Prescribing for self and family member has inherent risks related to lack of objectivity. Effort should be made to discuss the condition with the collaborating physician. In addition the Arkansas State Board of Nursing Rules and Regulations, Chapter Four, Section VII.C.3-5 outlines the documentation requirements for prescribing. The Arkansas State Board of Nursing has determined that the advanced practice nurse with prescriptive authority may prescribe for self and family under the following circumstances:

  1. There shall be a medical record on the patient/client to document the prescription of the medication.

  2. The prescription must be within the prescriber's scope of practice.

  3. The prescription shall be documented on the medical record in accordance with Arkansas State Board of Nursing Rules and Regulations, Chapter Four, Section VII.C.3-5, portions of which are reprinted below:
    The APN shall note prescriptions on the client's medical record and include the following information:

    1. Medication and strength;

    2. Dose;

    3. Amount prescribed;

    4. Direction for use;

    5. Number of refills; and

    6. Initials or signature of APN.[1]

The situation is more serious when the drug is controlled. Pharmacy laws make it illegal in many states to prescribe controlled substances for family members or oneself. For example, Ohio law states:

 

Accepted and prevailing standards of care presuppose a professional relationship between a patient and practitioner when the practitioner is utilizing controlled substances. By definition, a practitioner may never have such a relationship with himself or herself. Thus, a practitioner may not self-prescribe or self-administer controlled substances...Accepted and prevailing standards of care require that a practitioner maintain detached professional judgment when utilizing controlled substances in the treatment of family members. A practitioner shall utilize controlled substances when treating a family member only in an emergency situation which shall be documented in the patient's record. For the purposes of this rule, 'family member' means a spouse, parent, child, sibling or other individual in relation to whom a practitioner's personal or emotional involvement may render the practitioner unable to exercise detached professional judgment in reaching diagnostic or therapeutic decisions. [2]

Even if it is not expressly illegal under many state laws to prescribe a controlled substance for a family member, it is always inadvisable. If a pharmacist receives a prescription for a controlled substance for a patient with the same last name as the prescriber, the pharmacist may suspect that the prescriber is using the drug himself or herself and may report that nurse practitioner to the licensing board, which may investigate. The NP may find himself or herself in the position of having to prove that he or she is not self-administering controlled substances. Furthermore, Drug Enforcement Administration (DEA) numbers are specific to a practice setting, so an NP who prescribes a controlled substance for a family member who does not come to the practice setting may be violating 2 laws.

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