Confronting Doctors with Wrong Orders - page 2

Confronting Doctors with Wrong Orders We are standing at the counter of the nurse’s station in the ER when I tell Dr. Hanson that his patient in 18 is asking for pain medication. ... Read More

  1. by   FranEMTnurse
    Robin, IMHO, you wrote a seriously needed article. You hit the bulls eye in my case. Here's a little personal history I had with a doc who was assigned to me when I became his new patient. He doubted what I was telling him, and after having me for some time, my illnesses and hospitalizations increased. After giving him a ten year trial as my primary Physician, I left him after I heard him speak loudly to his nurse: "I don't believe you."
    I now have a wonderful Primary Care Physician who believes me when I tell him about how I'm feeling. He has saved my life twice. God Bless him and all of you nurses who are our front lines of defense.
  2. by   Skippingtowork
    Quote from CeciBean
    I think I might have said something like, "We're doing an awful lot of tests on her to find out what's going on, shouldn't we maybe give her some pain meds just in case there really is something? She seems like she's in a lot of distress." There are ways to get what you want without being overly confrontational. Of course sometimes it depends on the doctor!
    The OP knew this doctor well, so her approach was probably in sync with that relationship. Also, when you're in the ER, time is of the essence and everyone is responsible for appropriate communication. The nurse should not have the burden of thinking how to approach this doctor and that doctor. I believe an overall attitude of support and respect will overcome any slights or quips. And sometimes a brunt response results in another brunt response. Everyone is human. Many times I have been told by physicians "good catch, thank you." If they know you have their back, they'll be more tolerant of your approach. Some people are more direct than others.
  3. by   RobbiRN
    Right strategy ... wrong tactics. Nurses and doctors are a team. Particularly in the emergency department, this team works under stressful conditions where mutual trust and respect are critical.

    The reader should consider ... how would an article sound if the title was "Confronting Nurses With Wrong Plans?"

    Crew resource management is a process where everyone on the team is empowered to speak up if a potential hazard is observed. Anyone -- doctors, nurses or techs -- can call a time out if something seems amiss. The focus needs to be on the action that is possibly incorrect -- not on the superiority of one career field over another that was suggested by the comment, "Be kind to nurses. We keep doctors from accidentally killing you." We can all make mistakes, and we all should be watching out for and supporting each other.
    Did you read the preceding comments? The majority of your content has already been addressed. Of course we are all human. Nurses make mistakes, and there are multiple discussions and articles on this site addressing how we can improve. If you are interested in addressing bad care plans, please submit an article. You would likely generate a useful discussion.

    Let me clarify again, the point of this article was not how to confront doctors; it was reminder that nurses--even those who feel intimidated--have an obligation to do it. As I and several others have duly noted, the actual level of familiarity between staff evolves as we work together. No one is advocating disrespect or pitting one profession against the other.

    Yes. We are a team. There is no superiority, but there is hierarchy. Doctors give orders. Nurses follow the orders. Nurses are ultimately responsible for everything we do, and a doctor's order never releases us from that responsibility. Because we are responsible, we become a potential safety net for doctors and a last line of defense for patients. The difference is that because we are the point of delivery, there is no one left to prevent a mistake. Crew Resource Management, Just Culture, and every other theory aside, when we get to the bedside, we are it: educated, capable, responsible, but alone and highly vulnerable.

    Funny thing, several have questioned the nurse for her choice of how to confront the doctor in the shock value, attention-grabbing opening scenario in the article. So far, no one has questioned the doctor for declaring the patient "is just full of BS." Humm...
    Last edit by RobbiRN on Mar 14 : Reason: spelling
  4. by   Roz, RN
    I will always be an advocate for my patients. That being said, the last time I questioned a doctor, I was suspended. I was told that I need to "remember my place as a nurse".
  5. by   RobbiRN
    I will always be an advocate for my patients. That being said, the last time I questioned a doctor, I was suspended. I was told that I need to "remember my place as a nurse".
    Obviously, I strongly believe it is "your place as a nurse" to question a doctor in the situations noted in the article. A lot of the discussion here has been about being respectful, tactful, and appropriate when are are put in a position to prevent a mistake. There has been little notice of the intimidation factor. If you were appropriate in your approach, your case confirms my reason for writing the article. Some nurses are intimidated for good reasons, either by doctors who are condescending, a system that doesn't back the nurse for doing the right thing, or both at the same time. So, now you have a blot on your record and clear conscience, knowing you acted in your patient's best interest. I wish you peace and courage.
  6. by   Skippingtowork
    Quote from Roz, RN
    I will always be an advocate for my patients. That being said, the last time I questioned a doctor, I was suspended. I was told that I need to "remember my place as a nurse".
    That is so unacceptable. I would fight that. Unless you were very inappropriate in your approach, your place as a nurse is to advocate for your patient and bring concerns to the physicians attention. Patients cannot be kept safe if everyone is restricted in speaking up.
    What baffles me is why is everyone referring to the situation being discussed as "confrontational" and why should speaking to a Doctor about a patient's wellbeing be any at all intimidating? What is it about doctors that gets some nurses so on edge? I have come to realize during my years as a nurse that the culture within the medical and nursing profession has fostered an environment where doctors are placed on a pedestal with nurses acting as footstools. I've noticed that some doctors hasten to be disrectful to nurses in various ways and are often allowed to get away with it. When the reverse happens, one never hears the end of it and more often the nurse is written up or punished in some way. I'm not intimidated by no one. The last time I checked we are humans working together for a common cause which is the help our patients as much as possible. Everything else is just fluff and when when we lose sight of the focus a lot of other unnecessary drama plays out. There's no reason for nurses to feel intimated by doctors, none whatsoever! Doctors are trained to do what they do and so are you! Nurses are not meant to be doctors and they certainly could not spend a day in your shoes. Our roles are specific and defined, but we HAVE to work together to get the job done. This is not a competition of who knows more or who is more qualified. Years ago none of us were qualified, we all went to school to become qualified and nothing special about us gave us that privilege except our ambition. So, Nurses, speak up! Speaking up means saving a life and saving the license you have worked so hard for! Doctors are humans too, not Gods and they do and will continue to make mistakes!