Request By:
Mrs. Gaynor E. Hatfield, R.N.
President, Kentucky Board of Nursing
6100 Dutchmans Lane
Louisville, Kentucky 40205
Opinion
Opinion By: Robert F. Stephens, Attorney General; Martin Glazer, Assistant Attorney General
You state that the Kentucky Board of Nursing has received several letters and phone calls inquiring about the legality of nurses carrying out orders conveyed by someone other than a licensed physician or licensed dentist, specifically a member of the physician's or dentist's staff. You specifically ask:
"1. May a registered nurse or licensed practical nurse carry out verbal or written orders given to the nurse by an employee in a physician's office?"
You also want to know about orders for laboratory procedures, x-rays. You ask if there is a difference when the situation is one of emergency.
Taking your questions in reverse, it would appear that in an emergency situation a registered nurse or licensed practical nurse may take any procedures which the nurse is trained to perform to save the life of a patient without the necessity of having a physician's or dentist's order. Of course, the nurse will be judged by the factual situation -- that is, is it a true emergency, does she have time to contact a physician or dentist, and is she trained to perform the procedure she seeks to perform?
As you point out, KRS 314.011(5) defines registered nursing practice as including:
"(c) The administration of medication and treatment as prescribed by a physician or dentist licensed in this state and as further authorized or limited by the board, and which are consistent either with American Nurses' Association standards of practice or with standards of practice established by nationally accepted organizations of registered nurses. "
Subsection (9)(c) defines practical nursing practice similarly. Basically, the registered nurse or practical nurse must carry out the orders of a physician or dentist, as the case may be. If these orders come from an intermediary, then it will be up to the nurse to determine in her own mind whether those are the physician's or dentist's orders. It is obvious that it is sometimes impractical for the doctor or dentist to give these orders directly to the nurse and he must give them through an intermediary, such as a clerk or another nurse. When he writes an order on the chart, he is not giving an order directly to the nurse; she still must determine whether the order is written in his handwriting.
If the nurse has a question as to the authenticity of the order, she should check directly with the physician. If the physician has been in the habit of giving his orders through an intermediary and the nurse has no question about the nature of the order, then she is justified in accepting the order through the intermediary. If she received an order through the intermediary for the first time and she is not familiar with the intermediary or the physician she would be wise to authenticate the order and to authenticate the procedure that the physician uses for giving orders through an intermediary.
We do not see any legal impediment with procedures providing for the physician giving orders to nurses through intermediaries as long as they are his orders. If a nurse has doubt about the validity or the authenticity of an order, she should be careful to check it directly with the physician. If the physician is in the habit of giving his orders through other personnel, either verbally or in writing, and no question arises concerning the authenticity of the order, the nurse would be justified in accepting it at face value.
In the practice of modern medicine and dentistry, it is not always practical or possible for the physician to give an order directly to the nurse. He sometimes needs to do so through other persons. The only issue is, is it his order?
We hope that this has answered the questions you have raised.