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Nursing Manual Nursing Orders Within a nurse's scope of practice, as outlined by the Oregon Board of Nursing, is the ability of the registered nurse to write nursing orders, based upon the nurse's assessment and plan of care. These nursing interventions are written to maintain comfort, support human functions and responses, maintain an environment conducive to well being, and to provide health teaching, counseling and client advocacy.Group homes are residential sites that are licensed under the 24 hour Oregon Administrative Rule that requires a signed written physician's (or by his/her designee's) order for any medication, prescription or non-prescription, treatments and special diets, [see OAR 309-049-0075 (6a)]. It may be helpful to obtain PRN physician orders for over the counter medications for expected interventions, such as skin treatments (antibacterial cream for abrasions) and pain/fever medications. There are also certain specific interventions that do not require a physician order by Oregon Administrative Rule, the nurse could address these without physician direction. Examples follow:
Conflicts Nurses may find conflict within the residential services system over nursing orders. Group homes are usually structured so that the house manager, not the nurse, supervises the direct care staff. The RN needs to consider the DD system's values of integration, inclusion and empowerment of the person being served when writing nursing orders to avoid conflict with nursing judgement. For example, a person with a nursing order to only be in a wheelchair for a total of 2 hours at a time may wish to go to a movie that lasts 3 hours.In addition, scopes of practices of various health professionals overlap. For example, both registered nurses and physical therapists may write orders concerning physical management. Clear communication with the other discipline is vital in protecting the health of the person residing in the home. Nurses should discuss with their employer or contractor how these conflicts should be handled. Does the employer/contractor want the RN to write nursing orders? If so, which orders? Who should decide if someone stays home from work sick? What should the RN do when nursing orders are given and not followed? Questions This is not intended to cover all situations or all possible nursing orders. All questions regarding the appropriateness of nursing orders should be referred to the Oregon Board of Nursing. All questions pertaining to the Oregon Administrative Rule that governs the residential site should be referred to the county case manager or to the state Office of Developmental Disability Services. |
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