The nursing law and rule does not prohibit a registered nurse in making a decision to crush or split medications without an order. A registered nurse can use nursing judgment. The employer may have policies or guidelines about crushing or splitting medications. The registered nurse should use the Scope of Practice Decision Tree to determine if crushing a medication is within the registered nurse’s regulatory and individual scope of practice. The registered nurse should make the decision whether or not to crush or split the medication based on patient needs, prescribing information by the provider, and safety of the medication being administered in this form. The registered nurse administering the medication is responsible for ensuring the medication is safe to crush or split before giving it. Follow-up with the prescribing provider is warranted if a medication order states to crush or split the medication is necessary but it is not recommended. Other alternatives may be necessary such as a liquid medication. The Institute for Safe Medication Practices (ISMP) is a good resource for determining whether a medication is safe to crush. Splitting medications may result in dosage errors. Not all medications may be split. The registered nurse needs to determine whether the medication can be safety split to ensure proper dosage. The registered nurse should consider consulting with a pharmacist and follow current guidance or standards and/or contact the prescriber or pharmacist to see if there is another alternative, such as liquid form or getting the medication in the appropriate dose.