When you don't agree with the doctor...

[lm8539]

Hey nurses- have any of you ever been in a situation where you did not agree with the doctor's plan of care? Or a situation where you were asked to do something/ give a med/ etc that you felt would jeopardize your license harm the patient? If this happens I know you should not perform the task, and you should explain to your superior/ the doctor your reasoning, but what if they don't agree with you and want you to do the procedure anyway? Would you just tell them that they have to do it themself? or get someone else to do it?

[Katie5]

I once refused to give Dig to an infant; I felt that the doc had the decimal point in the wrong place, and the dose was 10 times too high. Of course it was night shift, and the night supe 'couldn't remember how to calculate pedi dosages'. This was many years ago, and the supe had to call the attending at home (we staff nurses didn't have that privelege) and she would NOT call. I even showed them how much med would be in the syringe.

I steadfastly refused. The doc gave the med. The baby died. He was extremely ill to begin with, so no one told the family exactly what happened.

About a week or two later, the attending told me that my math was correct.....

Surely, that is not the end of the story?What happened after?

[Warpster]

Happened on my first job, about 3 months in, no preceptor, sink or swim. A doc was using an outdated lab instead of the day's lab and ordered a very high K replacement on a patient with significant cardiac and renal disease. Since he dug his heels in and played Dr. God, I dug mine in and told him he could administer it himself.

That dosage got reduced to something within reason.

I sweat bullets over the writeup, though.

[heron, ASN, RN]

Just a point of interest, as we speak of disagreeing with physicians...

I invite all of you who are not already doing so to check out the twitter on the Texas Whistleblower Nurse Trial. It is a frightening case of a nurse being prosecuted in a criminal case because she reported his medical misconduct to the proper authorities!

FYI, she's been aquitted.

[leslie :-D]

.

4. YOU CANNOT be fired for being safe. The hospital would be in great trouble, and so would the Physician, if you were fired for refusing to administer medication for patient SAFETY. That is number one. Patient safety. If they did try to fire you for this call your union, You are entitled to 30 min free time to discuss this with an Attorney. Also, your Union Representative would love this one.

you CAN be fired for 'other' reasons, though.

suddenly, an exemplary employee is harrassed as a target to be reckoned with and casually discarded.

this happens all the time to nurses who try to do right for their pts.

yrs ago, i reported a facility for suboptimal tx of their (DYING) pts.

an investigation was done, and the facility was in danger of being shut down.

my perfect record (with perfect evals) was suddenly tarnished with bogus, written warnings, one after another...

and then they fired me.

i sued for wrongful termination and we ended up settling.

my point being, me and many others have tried to do what was right, only to be framed, terminated and many have been blacklisted.

so while i admire your ideals of 'we can do this', please (and i mean this respectfully) do so with a caveat.

there are as many evil doers as there are good.

leslie

[meluhn]

Surely, that is not the end of the story?What happened after?

Why didn't anyone run the dosage past a pharmacist?

[Prem Singh]

Defentily it happen with most of us, also i face such kind problem many time, before taking any such stepls it necessary to prove your compentecy, knowledge, skill and your cuncerns towards patient with polietlyn, then any suggestion given in favour of patient which is acceptable by any doctor, if there is any ego problem then we sure discuss with seior nurses/doctor without any hesistations.

If you are dead sure to some thing is going wrong and thigs are out of controle you can take favour of patient by infroming the adverse effect of drug or procdures.

Thanks

[RNforLongTime]

I had a Dr want us to give Amiodarone IV PUSH(instead of IV piggyback over 15 minutes)! I told him we only did that in a code situation...so he took the meds and did it himself!

[suetje]

I tell my staff 'patients first!' Had an incident just yesterday that might apply: 50-ish male, looking septic (and was) getting sicker each day. He got dialysis, and it was just enough to push him over the edge. His heart rate went up to `170's-200's, and the intern comes in, just looking, doing nothing. I asked, 'What meds would you like us to get for him?' He says, 'None, just an EKG. I shut up, but 10 mins later, still taching along, I said, we need to do something.' He does nothing, Just is standing there. I said, 'Let's call your Chief'.' He says, guess you can if you want, not necessary. I said, 'We need to give meds, would you like Cardizem, Amiodarone...what?' He says let's wait for the EKG.'

Well, THAT was not OK. So I page the Fellow, and he comes down. The stat EKG people arrived in 15 mins (really incredible cause usually they are right there.) But I was not about to wait, not knowing if this guy was going to code while we waited for the EKG. We needed intervention right then, not tomorrow! He eventually ordered Cardizem (didn't work) and we shipped the pt to the ICU.

I never hesitate to call up the chain. The pt is the one who suffers.

[platon20]

I also used to work at a teaching hospital and our FP attending just said slap 'em up side the head;).

One time a baby doc came out of a room and wanted to insert an IUD...I ask him if he'd read her Hx??? and I got a puzzled look. I told him to read it and get back with me...again he comes an sez lets do it and I'm goin' ah nope not gonna happen. (The patient had a history of multiple PID's:eek:.) So I waltzed down the hall and got the attending and told him what was going on and he stormed out and reamed him a new one. Apparently the baby doc had just gone to a seminar on IUD's and wanted to "try it out":uhoh3:. He eventually got canned over other apparent fau paux's...GOK where he is now.

I disagree with your approach here. If a resident is screwing up, the correct response is to explain WHY you think he's making a mistake, not just some snide comment about "reading the chart." Its unnecessarily rude and hostile and 9 times out of 10 it will make the situation worse, not better.

If the doc is making an error, explain WHY you think its an error instead of getting all rude and huffy about it. Yes, the docs do it too but that doesnt make it right. Better communication = better healthcare.

[MAGGIMAE]

When you don't agree with the doctor you will be taking your license into your own hands. You have to decide what is more important....following orders no matter what or putting your job on the line. I had that experience many years ago working in a "walk-in" facility. There was a person who showed up, fairly frequently and usually after the regular doctor's office was closed, with migraine headaches. Her primary MD ordered a narcotic injection that we were supposed to administer but as time went on we noticed that the dose was increasing to alarming levels, well over ordinary levels for pain relief. We began to carefully observe the patients behavior and demeanor as she was complaining of a debilitating condition and it became obvious to us that she was drug seeking. When the dose ordered was way over what is considered normal a few of the nurses refused to give the injection and voiced our concerns. We discussed it with our nurse-manager and the doctor so they were well aware of our concerns but when the situation arose again...and the doctor said SHE didn't know how to give an IM injection..... the two nurses who stood firm were fired. The irony to me was that just a month previous I had been the "Employee of the Month"!!! It was a shocking and painful lesson to learn after being a nurse for 23 years. We did sue them and they ended up settling with us as the facility was in the process of being bought by a larger company and they wanted to get rid of us. This episode made me feel even more strongly that nurses NEED a union for so many reasons.

[sparketteinok]

So what's everyone's take on this situation?

I had been a new lpn for about a year and had just moved to a peds floor. Two weeks on the floor, and we had students that day. The students brought me an ivpb abx to hang on a baby. It was a special mix from pharmacy, one that they had to mix themselves. There were no total mg on the bag, just ml/hr. Students were and I was uncomfortable hanging it because u had no way to tell if the bag held 1mg or 1000mg.

Long story short, after trying to resolve this myself with rx and getting nowhere, brought to charge rn, who cut me off, didn't listen to what was wrong with it, yanked it out of my hand, and screamed at me, well I'll have to go do ur job for you.

I thought I was following the right chain of command, but later in my eval, floor mgr told me I was insuboordinate, and if charge says hang it, then hang it and document circumstances. That wouldn't hold up for the bon, though, would it?

So was I?

I know this is not doc to nurse, but still different levels of authority.

[ivorybunny]

The stories posted here have been great to read... and I agree with you guys. I've actually learned alot by "questioning" an order in a non threatening way... For me I had a situation where we had to question an order for lasix on a patient because in the chart the doctor commented on her elevated BNP. The problem was the patient never had a BNP done, so I don't know where she got her information from. It was interesting though when the doctor is arguing with me about the most current BNP and I'm trying to tell her there wasn't one done.

And I will say though, as a cardiac nurse, I've seen some doses of medications that I would never understand... until I asked. We have a cardiologist here that has pushed 100mg lasix because the nurses didn't feel comfortable doing, and then he explains why he dosed it that high. Personally, I wouldn't have felt comfortable since their BUN/Creatine were elevated, BP was low... but hey, he's gotta know something I don't right?