1.1. Legal Issues


Only physicians, dentists, and advanced registered nurse practitioners may “prescribe” medication. Physicians, dentists, and pharmacists are licensed to “dispense” medications.

Nurses are licensed to “administer” medications and may delegate the task to administer oral and topical medications to persons who have completed a course such as this. Only licensed nurses can take verbal or phone orders for medications or treatment from a prescribing physician.

 

Role of Non-Licensed Personnel in Medication Administration:

Where delegation is required the non-licensed personnel will perform medication administration as a delegated function under nursing supervision.

The following cannot be delegated:

  • Conversion or calculation of medication dosage;
  • Assessment of an individual’s need for or response to medication;
  • Nursing judgment regarding the administration of PRN (medications are given as ordered) medications.

Non-licensed personnel will be permitted to follow a specific physician protocol for PRN medication and document the effectiveness or ineffectiveness of the medication.

Example: if the physician wrote an order for Tylenol 350 mg for fever >100.0 F and the non-licensed personnel administered Tylenol for a fever of 101.0 then documented a decrease in the temperature or no decrease in temperature. The non-licensed staff is simply collecting information and documenting, not using nursing or medical judgment about an action or intervention.

The non-licensed personnel shall not perform a task that involves an individual who is not in a stable condition.

 

Examples include:

  • Assessment for the individual’s need for medication
  • Calculation of the dosage of medication
  • Conversion of the medication dosage

The non-licensed personnel should NEVER accept a delegation that he/she knows is beyond his/her skill set or knowledge. (example: take orders over the phone). Non-licensed personnel have the right and are encouraged to ask for assistance and/or additional training.

The non-licensed personnel has the responsibility to ALWAYS follow agency policy and procedure to report to the nurse if they have any reason to believe they have made a medication error. This should be reported as soon as possible.

The non-licensed personnel has the responsibility to ALWAYS report (according to agency policy) the following:

  • Signs or symptoms that appear life-threatening
  • Events that appear health-threatening
  • Medication that produces no results or undesired results

This must be clearly identified in the provider agency’s policies

Registered Nurse and Licensed Practical Nurse:

        What’s the Difference?

        Similarities.

 

Both the Registered Nurse and the Licensed Practical Nurse

  • Must complete education requirements from an accredited program;
  • Must pass the National License Exam;
  • Must have ongoing education to ensure competence and complete the required number of Continuing Education Credits each year;

 

Differences

The Registered Nurse:

  • Must complete a higher degree of educational preparation;
  • Has greater responsibilities;
  • Works directly under the direction of physicians, dentists, or advance practice nurses;
  • The License Practical Nurse;
  • Must complete a lesser degree of education preparation;
  • Has a lesser degree of responsibilities;
  • Works both independently of and performs acts prescribed by the physician, dentists or advance nurse practice nurses AND a Registered Nurse.

The non-licensed personnel must be familiar with agency policies and procedures related to medication administration and know where to find them.

Please, review of your agency-specific policies and procedures related to:

  • Storing Medications;
  • Medication Keys;
  • Disposal of Medications;
  • Medication upon admission;
  • Medication upon discharge;
  • Client medication education;
  • Medication Administration Records;
  • Client refusal of medications;
  • Medication errors;
  • Client assessment/Screenings;
  • Monitoring effects of medications/adverse drug events.