Refusing Orders.

[StudentOfHealing]

I'm a student nurse but I've heard many stories from nurses and professors about standing your ground and using common sense.

Name a time when you refused a physicians orders?

My professor was fired for refusing to push dig on a dig toxic patient! Incredible...! I would have refused too.

1. Patients life is first

2. I can get another job not another licence.

So tell me... Have you ever refused an order? How did it all play out?

[SaoirseRN]

Physicians are human and sometimes make mistakes. Always question an order you aren't sure about. That doesn't mean saying, "what the hell are you thinking?"

I approach these things always from a perspective of "doing what's best for my patient", and might say to the physician:

"Dr. SoNSo, could you clarify this order for me?"

"Could you explain your rationale behind this order?"

"I am uncomfortable with this order because of x, y, and z."

Sometimes it's an error, and your critical thinking will catch it from becoming a bigger error. Sometimes, you will learn something new by asking for an explanation and a previously odd order will make sense. Sometimes, a physician might reconsider because of your explanation of why you aren't comfortable with the order.

This can also apply in reverse for a physician who hasn't ordered something you feel would help the patient. Did they forget? Were they unaware of some crucial assessment info that you can provide them? Is there a reason behind why they haven't ordered it, and if so, what is it and does it make sense?

For the one or two physicians who seem to insist on having an unsafe order followed, without listening to your (well-thought out) concerns and without providing any clarity, that's when you go to your charge nurse or supervisor for support. Document everything.

Patient safety is paramount, and while you are also protecting your own butt, as long as you are doing so from a patient advocacy perspective, then you have good ground to stand on.

[HouTx, BSN, MSN, EdD]

As a Critical Care nurse, I once refused to participate in a code. The patient (ventilated with multi-system failure) had clearly expressed his wishes for DNR, but his family refused to support this - so the physician had not written a DNR order. The inevitable happened in the middle of the night. . . (I was charge, it was not my patient). The responding physician and staff had begun resuscitation by the time I arrived. I told the doc that I would not participate.... he looked at me funny but kept on with the code. Sure enough, the pt did not survive. I just knew I was going to be fired. The doc asked to talk to me & I explained my reasons... he just said "I understand and respect your decision". Nothing happened to me. No write-up, no discussion, nothing. I felt good about what I had done.

In Tx, the 'captain of the ship' doctrine that gives the physician absolute control of any clinical situation.... is not supported. RNs are expected to not only question any orders that are unclear/illogical, but to intervene to prevent potential harm to the patient as part of our legally defined "Nurse-Patient Duty" that was established in 1983 as a result of the landmark case of Dorothy Lundsford. Position Statements

[RNsRWe, ASN, RN]

Refused....? More like "Clarified". As in "I'm sorry, New Doc Writing Lots of New Orders, but this med is only available as PO (mult. forms) or suppository---not IV. How would you like it given instead?". Clearly giving it IV would have resulted in serious harm to patient.....so I didn't "refuse", I just "informed" :)