September 2019

Is implementing a medical directive the same as prescribing?

No. Implementing a directive and prescribing are different.

Prescribing is the act of writing an order for a procedure, treatment, drug or intervention. The person who writes the prescription/order is accountable.  

There are two kinds of orders:

  • a direct order is for a specific patient at a specific time

  • a directive may be implemented for a number of patients, so long as specific conditions are met and specific circumstances exist

Nurses who implement directives are not prescribing medication, rather they are using the directive to provide medication to clients, provided the conditions and circumstances outlined in the directive have been met.

It is important to understand where the authority to perform a patient intervention (in this case, providing medication) comes from because it determines the scope of accountability. For example, the person who authorized the prescription (such as, a physician or an NP) is accountable for the order.

Nurses who implement directives are accountable for ensuring that they understand the directive. They must make sure it contains all of the information they need to carry out the order safely. They must also determine if it is an appropriate order by considering the patient, the medication and the environment.

It is also important to have organizational policies in place that clearly outline how to identify the physician or NP responsible for the care of the patient so they can be contacted with questions or to clarify the order for their patient.

Nurses are expected to know their legal scope of practice and the limits of that scope. To learn more about nursing scope of practice, read our article, “Can I do that? Understanding your scope of practice,” in the April issue of The Standard.

For more information on directives and prescriptions, read our Ask Practice FAQ on Directives and Prescriptions as well as the Medication practice standard and Directives practice guideline.


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