NPs: 'Can I Prescribe for My Elderly Father?'

Carolyn Buppert, MSN, JD

Disclosures

May 16, 2016

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Question

To save the trouble of taking him to his own doctor, a nurse practitioner sometimes prescribes medication for her father. Is this legal?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

A nurse practitioner who, for the sake of convenience occasionally writes prescriptions for her elderly father, asks whether this is legal.

It's generally not a good idea to provide medical care to friends and relatives. Yes, it is convenient. Yes, the practitioner has the patient's best interests in mind. And yes, I did it myself in the past. But there is an ethical problem in that the close relationship could cloud the practitioner's judgment. For example, here is what the Texas Board of Nursing says:

Advanced practice registered nurses (APRN) often find themselves in situations where they may feel compelled to provide medical aspects of care or prescribe medications for themselves, their family members, or other individuals with whom they have a close personal relationship. APRNs are prohibited from ordering, prescribing, or dispensing both medications and devices for personal use. When ordering, prescribing, or dispensing a medication or a device for any person, the APRN is expected to meet all standards of care including assessment, documentation of the assessment, diagnosis, and documentation of the plan of care prior to ordering, prescribing, dispensing, or administering a medication or device.

The practice of providing medical aspects of care for individuals with whom an APRN has a close personal relationship raises a number of ethical questions. The Board is concerned that APRNs in these situations risk allowing their personal feelings to cloud their professional judgment and objectivity. It is the opinion of the Board of Nursing that APRNs should not provide medical treatment or prescribe medications for any individual with whom they have a close personal relationship.[1]

Although this statement absolutely forbids an APRN from prescribing for him- or herself, it advises against treating close relatives or friends but doesn't expressly forbid it. So, in Texas at least, the clinician who wants to prescribe for a relative isn't on firm ground but isn't doing anything illegal. Each clinician should check with his or her state's Board of Nursing to see whether there is law or policy on this issue. And depending on which state you are in, there could be a legal problem with respect to your authority to prescribe for someone who is not officially a patient of your practice.

Here's the problem: If a state requires that a nurse practitioner have a collaborative relationship with a physician in order to practice, that collaborative relationship does not usually extend to cover evaluations and treatments performed by the nurse practitioner outside the practice setting. One could argue that any prescribing for patients who are not enrolled in the practice is done outside of the collaborative relationship and therefore without authority to diagnose and prescribe. Although it is unlikely that the relative or friend is going to report the nurse practitioner to the Board of Nursing or that the patient is even going to understand that the nurse practitioner is practicing outside of the collaborative relationship, it is possible that the activities will come to the attention of the collaborating physician, the employer, or the Board of Nursing. If that happens, defending a charge of unauthorized practice is going to be difficult.

In a state where a nurse practitioner may practice without mandated physician collaboration, the major issue is what is best for the patient, and whether the Board of Nursing has any opinion on the ethics of treating a friend or relative. No matter what state the nurse practitioner is in, a nurse practitioner should never prescribe a controlled drug for a friend or relative. No matter what the intentions are, an employer or pharmacist is going to assume the worst—that diversion is going on. Pharmacists are required to report a prescriber whose prescribing is suspicious. When Boards of Nursing hear about a nurse practitioner who has prescribed a controlled drug for him- or herself, a friend, or a relative, they want to discipline, and the defense is difficult. So, to prevent problems for yourself, decline to treat friends and relatives.

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