To Avoid Violating their Scope of Practice, Ohio License Nurses Must Understand Medication Mixing/Reconstituting vs. Compounding
Published: Jul 27, 2026 by Brennan Santa, Law ClerkPrepared by: Jim McGovern, Esq. & Brennan Santa, Law Clerk
What is the difference between mixing (or reconstituting) and compounding a medication? Understanding the difference could impact whether an Ohio licensed nurse exceeds their scope of practice and violates the Nurse Practice Act.
As outlined in an email that the Ohio Board Norsing sent to its stakeholders on July 13, 2026, mixing involves the preparation steps for a medication. When someone is mixing a medication, they are following the manufacturer’s exact instructions. Examples of mixing include adding sterile water to a vial of powdered antibiotic, injecting a dose of liquid antibiotic into an existing bag of saline, or combining two compatible IV medications (like a sedative and a pain reliever) in one syringe for immediate use. Mixing is generally part of FDA-approved drug labeling. Nurses have the authority to mix and reconstitute medications.
As outlined in that same email, compounding a medication is the alteration or customization of medicine. Examples of compounding include creating customized medication by crushing solid tablets into a custom syrup, remanufacturing a commercial capsule without the dye, lactose, gluten or other ingredient that triggers a patient’s allergy, mixing a specialized topical cream for joint pain by combining specific medications and strengths not sold commercially, or flavoring medications for pediatrics or pets. Compounded medications are not FDA-approved.1 They may include safety risks,2 like variable potency or increased contamination potential. Ohio licensed nurses do not have the authority to compound medications. Doing so would exceed the Ohio licensed nurse’s scope of practice and trigger a violation of the Nurse Practice Act that could lead to the nurse’s Ohio nursing license being sanctioned. Thus, compounding should only be done by licensed compounding pharmacies.
Per the Ohio Board of Nursing, Ohio licensed nurses should know the differences between mixing and compounding. Nurses should ensure that they avoid compounding. Compounding alters the medication beyond its labeled use and instructions.
Ohio licensed nurses who participate in compounding may be placing patients at risk. They also risk having their license sanctioned by the Ohio Board of Nursing. If you need guidance regarding this issue / other scope of practice issues, or if you have any licensure concerns, contact Graff and McGovern.
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- U.S. Food and Drug Administration. https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers ↩︎
- U.S. Food and Drug Administration. https://www.fda.gov/drugs/guidance-compliance-regulatory-information/human-drug-compounding ↩︎