Reply To: Supplements, Oils

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#42936

Hello Everyone:

It looks like there is some great conversation here. I hope more will see the robust interaction of this forum and realize the value to their practice.

Please allow me to respond with the knowledge and experience that ACN (Association of Camp Nursing) has from years of working in this space. Medication management is one of the most common activities performed at camp and licensed nurses are the only healthcare provider with the training, education, and background in this complex area of practice.

What do we know:
1. Every nurse has to follow their state nurse practice act. I encourage everyone to know their practice act, especially if you are working in a state different than your home state.
2. There is a standard of care that we all must consider. The standard of care is “what any reasonable and prudent person with similar training and experience would do”. Therefore the standard of care is different depending on nursing educational level, years of experience, and comfort in providing a service. Stacy is correct in that the nurse, as a licensed healthcare provider, is accountable for their actions. Example: If a nurse receives a medication order and the nurse recognizes that the dose prescribed is 5x the normal limit, is he/she supposed to administer? No, the nurse is accountable to verify that dose, confirm the rationale for the high dose, or help get the dosing corrected through communicating with prescriber. We would expect the same thoughtful consideration for anything being given at camp.
3. All medications have to be given per a prescriber order – prescription medications and OTC medications. Most camps do this by having medical standing orders that are signed by a licensed prescriber in that state. If you don’t give a tylenol in the hospital without an order, then the same rules apply at camp. Just because the setting is different (camp and not hospital) the same state regulations apply. Nurses should not give medications or other products under the direction of a parent. In many cases, that would be practicing outside your scope and could be grounds for losing a license.

This is where the challenge comes with homeopathics, herbals, vitamins, and other rememdies that a parent wants their child to take. A camp nurse who has been a camp nurse for 20+ years may have developed some comfort in giving these agents, while the new nurse most likely will not be comfortable. Remember, the comfort comes from education and experience so practice patterns between nurses will vary for this reason. We all still have to follow state law and that too can vary some from state to state.

So, in response to the question about giving homeopathics, here are some considerations:
1. Ask a prescriber (MD, NP, PA) for a prescription for the agent outlining the five things a nurse needs for med administration (right person, right drug, right dose, right route, right time). This will at least meet the standard of most state laws.
2. Talk to the parent about the need for the agent as a life-sustaining or life-saving product. Some parents will be willing to just restart that product when the camper returns home.
3. Decide about your standard of care. What is your experience with a product? What is your comfort level? It is OK to remind parents and camp leadership that your job is to set campers (and staff) up for success and one of the best ways to do that is to make sure all the medications being administered are within your area of expertise.

Keep up the good conversation. For camp leadership, this can become somewhat of a “turf war” so try and approach the situation focused on caring for staff and campers to the best of your ability.

Take care
Tracey Gaslin