Can a Nurse Delay a Prescriber's Order?

Carolyn Buppert, MSN, JD

Disclosures

March 23, 2016

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Question

A nurse made a decision to wait to carry out a medication administration order to protect a patient who might be pregnant. But is this legal?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

A nurse wrote in describing another situation related to a nurse's responsibility to fulfill a prescriber's order:

The prescriber in our mental health clinic ordered a medroxyprogesterone injection for a client with schizophrenia. The client has on many occasions said that she was pregnant, but testing always came back negative. At a recent visit with the prescriber, the client stated that she was not pregnant. The prescriber then sent the client to the nurse for the injection. The client told the nurse that she was pregnant. The nurse informed the prescriber, who instructed the nurse to "give the injection anyway." The client did not refuse to have the injection. The client told the nurse that she had taken a pregnancy test recently. The nurse did not give the injection, but told the client to go home and bring back the pregnancy test results. The client left and did not return for more than a week. Was the nurse's duty to have advocated for the client and send her home to get pregnancy test results, or to have carried out the prescriber's order and administer the injection?

The nurse in this scenario should have taken a third tack. It is not known whether this was to be the client's first shot or whether it was a repeat, and if a repeat, whether the client was on schedule. Neither is it known whether the patient was having menses, and if so, where she was in her cycle. Nevertheless, the nurse was outside his or her scope of practice to send the patient away without giving the prescribed injection and without getting the go-ahead to do so from the prescriber.

Yes, a nurse needs to advocate for the clients, but a nurse doesn't have the legal authority to ignore a prescriber's order, even if there is a reason for wanting to do so. It seems to me that the nurse, having concerns that the patient may be pregnant, should have asked for an order for a pregnancy test. It does not appear that the nurse made that suggestion that when the prescriber instructed the nurse to "give the injection anyway." It makes no sense to send a patient home to retrieve the results of a "recent" pregnancy test. What the clinicians want to know is whether the patient is pregnant today, at this hour—not whether she was pregnant yesterday or last week.

The legal principle here is that a nurse who is not an advanced practice nurse with prescriptive privileges cannot decide to not follow a prescriber's order, nor to carry out the order more than a week later. The prescriber would need to rescind the order for the medroxyprogesterone injection for the nurse to get out of the legal responsibility to carry out the order. There should have been more communication between the nurse and the prescriber, rather than sending the patient home without the medication.

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