Refusing Orders.

  1. 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?
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  3. by   JustBeachyNurse
    You are more likely to put your license at risk by blindly following an unsafe order rather than advocating for safe patient care.
  4. by   NicuGal
    Many times! You have to cover your butt. If you are really questioning it, tell them I am not giving doing XYZ. Make sure you go to your charge nurse and use the chain of command. I work with residents and I can't tell you how many hair raising orders I have come across...even from first and second year fellows. We have guidelines for a reason. Your proff could have fought that.
  5. by   missnurse01
    always follow standard of care will keep you safe, as well as hospital policy. There are a ton of things nurses refuse for, additional pain meds when pt's are nearly unconscious or hardly breathing, orders to not call them for any reason, orders to not recheck labs even if a pt is bleeding out, turning a drip off to 'see what happens'...oh, there are a million. It will be clear to you when you start. Good luck.

    Also always check things that don't seem right with charge nurse, preceptor, or mentor. They will help guide you!
  6. by   classicdame
    you need to know what your NPA says about this first, so that the full weight of the BON will be behind you. I have never been in this situation, so have no experience firsthand, but I do know that nurses are the patient's advocate so act accordingly. If someothing goes wrong the MD may say you misinterpreted the order.
  7. by   nurseprnRN
    The ANA Scope and Standards of Practice are pretty inexpensive and would answer this question handily. They apply to every RN and are considered authoritative in court or BoN hearings. Current edition (2010) runs about forty bucks and it will save your bacon in ways you can't begin to anticipate. ana scope and standards of practice
  8. by   Julius Seizure
    Something that comes up in our ICU from time to time is that a doctor will get sterile for a procedure and then want you to push ketamine or propofol for them. We can't do that, not allowed. They get mad, but they can get over it. Our charge nurse and management back us up.
  9. by   lamazeteacher
    I had a situation that resulted in my termination. It was not a doctor's order, but an order from administration which I refused. As the Employee Health Nurse, I sent newly hired employees to an occupational health clinic for drug tests. An email sent to me by an administrator stated that an exception should occur for the spouse of a physician (new physicians weren't required to have drug tests).
    Instead of that new employee having the test, (it was said to be "inconvenient"), I was told to simply note in the new employee's chart that the test was negative!
    Of course I "knee jerk" refused! Now that I've looked at my outraged response many times, I believe that I wouldn't feel as wronged as I do, if I'd simply replied that all drug test lab slip results are stapled to the form I fill out in that regard, and asked how the administrator wanted this one done..... Granted that would have skirted the issue, but I would have placed it back in the administrator's lap...
  10. by   leslie :-D
    lamazeteacher, i agree it gets esp tricky when a non-medical administrator demands totally unsafe and non-sensical orders...
    and more than once, i had been threatened with termination if i didn't follow through.
    my verbal concerns of my licensure limitations (nevermind the lack of ethics) fell on deaf ears.
    to say the least, it was very frustrating...
    and i also acknowledged to myself that even if i was terminated, i would one day be vindicated in a court of law.
    still, who wants to be terminated.
    fwiw, i didn't follow these orders but that is only because he listened to the protests of the DON.

    to answer the question, yes, i have refused drs orders.
    working in inpatient hospice, i have been ordered to administer lethal doses of narcotics.
    these orders were totally irrelevant to the pt's condition at the time.
    to me it was clear that i was being ordered to hasten literally kill someone.
    of COURSE i refused...loudly and veraciously so.

    in the end, a nurse must always refuse orders they know to endanger pt safety/well being.

  11. by   BrandonLPN
    I'm interested to see the responses, too. It seems to me that true honest-to-gosh refusals are pretty rare.

    My "refusals" have usually went along the lines of this:

    2am, I page the doc.

    Me: sorry to wake you, but mr smith has a serum K+ of 6.1
    Doctor: ok, go ahead and give xxmg of vitamin K, stat
    Me: ummmm, what? Don't you want me to give kayexalate or something?
    Doctor: wait, what? Did you say INR or K+?

    In that scenario if i had blindly followed the initial order, obviously I would have been JohnnyBadNurse. Of course I questioned it. But it's not really a refusal.

    In the case that the OP mentioned, why on earth would a physician demand a nurse give digoxin to pt with toxic levels already? How does such a situation even come to pass?

    Surely, most potential refusals are quickly resolved when the nurse clarifies the situation to the doctor?
  12. by   leslie :-D
    i do remember a refusal from a dr, when i was a new nurse in a ltc facility!
    and i was adamant about it too....not so much some other nurses.

    lady with gtube, npo (duh) on comfort care.
    her brother (frequent visitor) wanted to give pt her favorite food, choc chip cookies.
    i told him his sister wouldn't tolerate this.
    long story short, dr gives ok and writes order for "pleasure foods po as tolerated".
    i still refused.
    other nurse gives her cookies, pt aspirates, and dies from asp pneumonia.
    this pt suffered much more than she should have.

    yes i do understand the other side/perspective of the story.
    obviously pt didn't tolerate, and paid the price for it.
    was it really a "pleasure food" afterall?

  13. by   nrsang97
    We had a pt go into SVT gave adenosine one time. Rate slowed and then sped back up into A-Fib with RVR. Resident orders give adenosine 6mg IVP now. We collectively refused. We said give cardizem or amiodarone. The resident insisted again to give adenosine. The 4 of us in the room all looked at her and said NO. We finally got orders for some cardizem IVP and a cardizem drip. The pt converted to SR by the end of the night.
  14. by   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.