Editorial – Care provision at your own risk

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"We are constantly operating in a legal grey area, even though we are working in the patients' best interests, " says Janine (name changed by ed.). She is an outpatient care nurse and, in an interview with journal.lu, lists numerous situations in which she has to decide: save a life or obey the law?

Her colleague Susi (name changed by ed.) confirms that this dilemma has also become the norm in everyday hospital life. Doctors are aware of the situation and trust that nurses will choose the sensible option, even if it is not always in line with legal requirements. "You know you're allowed to do that with me, " they'll be told. Because: "If doctors were to issue a prescription every time a nurse in hospital needed one by law, they wouldn't have any time left to operate."

A practical example: a patient with an abdominal aortic aneurysm must under no circumstances suffer from constipation, as this risks rupturing their main artery, leaving them to bleed to death within two minutes. However, the nursing staff are not allowed to administer the anti-constipation medication without a doctor's prescription, whereas any ordinary citizen can buy it over the counter at a pharmacy.

Another absurd example, fitting in light of the recent heatwave: because elderly people often lose their sense of thirst, they become dehydrated more quickly. A tiny catheter under the skin to administer fluid could prevent this. The procedure is extremely low-risk. Even if a patient were to pull out the catheter at night, the worst that could happen is a wet bed. A nurse can assess whether a patient is at risk using simple tests. Yet he or she is not allowed to act without a doctor's prescription, and especially on weekends, it often takes too long for one to come through. In the meantime, patients end up in the emergency room.