Nurses Never Diagnose Disease
Nurses never diagnose a disease. Nurses make nursing diagnoses only. They assess the patient, the situation, the health care incident and its risks and they determine an appropriate nursing intervention based on the nursing diagnosis. This is known as the nursing process. It will be discussed in more detail in a later chapter, but this is the premise of the R.N.'s education. LPNs don't assess patients and therefore they don't make nursing diagnoses either, although they may play an integral part in the health care delivery process of the nursing intervention.
Friends and FamilyJust like your nonlicensed medical personnel coworkers, your friends and family will bombard you with medical questions. Sometimes they may ask you to figure out what medication or treatment the doctor gave them in his office today. That might be easier if you knew exactly why they saw the doctor, but you may not be able to ascertain the answer to that question. Put on your thinking cap and pull out your trusty magnifying glass, it's time to draw out all the facts and investigate the situation thoroughly.
Your responsibility as a nurse is to educate and to encourage your family members to seek the advice and counsel of their physician. You do not have a license to practice medicine and indeed you have a license to protect your patients.
You can provide instruction in basic nursing care, but be careful not to prescribe over the counter (OTC) medications and treatments. Nurses don't prescribe either. (Nurse Practitioners are allowed to prescribe medications if it is allowed in the NPA of the state in which they practice. The NPA will spell out the specifics for this.)
This scenario can be especially tempting if the person is constipated or having severe diarrhea. But if you haven't assessed that abdomen yourself, don't suggest a strong laxative. Instruct the person in common sense dietary measures and recommend that he or she seeks qualified medical care. Do, however, use your nursing education and be sure to educate and caution them against trying yet another cold medication or OTC sleep remedy that can contain the same medication they just took. Many OTC medications contain similar ingredients and many contain acetaminophen (the primary ingredient in Tylenol). Overdosing on acetaminophen can be fatal. Most OTC sleeping pills contain diphenhydramine (the basic ingredient in Benedryl) and again overdosing can be harmful. If one brand didn't help, chances are very good another won't work any better.
Refer Them to Their PhysicianIf they are asking you about a diagnosis or prescribed treatment they have received, be sure to ask them first what they have already been told by their physician. You can educate them in laymen's terms, but always refer them back to their physician for medical advice, treatment, and diagnosis.
Your scope of practice is as a nurse. Don't try to play doctor. Know who you are discussing care with. If you don't really know the person, use your gut instinct that tells you to be very cautious. Encourage the person to seek qualified medical care. Remember to do no harm.
Suggest a list of questions or symptoms the person needs to bring to the attention of the physician. Give the person instruction in symptom management and what signs and symptoms to observe that could be cause for more immediate care.
If the person is really confused or perplexed with a situation, offer to discuss it with the physician. Have the person clear any Health Insurance Portability and Accountability Act (HIPAA) restrictions first. If this is not possible, don't second guess or make assumptions. Suggest questions he can ask to help clarify the situation and provide you and him with a better understanding of the situation. Have him let the physician know that his nurse friend or relative is trying to help him understand and the doctor may provide more information to you.
