Questioning a doctors order

[MrsJt]

Let me begin by stating, I am a new nurse. Been on my own for 3 months now, so I am still learning. However, I was just curious how many nurses out there have been told by management or supervisors that we should not question a doctors orders? I had a situation where a pt was admitted and put into isolation for a possible infection in the urine. Pt had tested positive 2 months prior when they were last admitted. (Pt had a foley on admission). A day later pt was taken out of iso. A cpl days later, foley was removed. Now I had been asked by numerous dayshift nurses why this pt was no longer in iso. No cultures, no urinalysis were done to confirm no current infection. So I decided I would ask and seek gyidance from my nursing supervisor. To only be scolded for asking the question and told that I had no right to question it bc that meant I was questioning a doctors order. Like I stated, I am new. I don't know everything, but that is why I was asking. I felt I could seek some guidance and understanding, but that obviously wasn't the case. The majority of the nurses I work with are great and understanding that I am new and I will have questions. I feel like I have made a mistake now going into nursing bc no one sees the good you do, they only point out what you do wrong.

[cjcsoon2bnp, MSN, RN, NP]

To the OP, I'm sorry that this was the response you encountered to a good question about patient care. As nurses, we need to remain vigilant about checking orders for our patients that are entered by LIP (physicians, nurse practitioners and physician assistants) as well as those from other disciplines (pharmacy, PT/OT, dietary, speech therapy etc. to make sure that they are safe and appropriate. Another user mentioned that many of the tasks that we do can easily be taught to anyone (monkey or otherwise) but the difference is the critical thinking that accompanies the carrying out of these tasks.

Now here is some food for thought, you mentioned that it was your nursing supervisor who scolded you for suggesting that you question the physician's order. I have found in my nursing career that how nurses interact with physician's and other LIPs is highly culturally dependent. Keep in mind when I use the word culture I don't just mean race or country of birth/origin. When I use the word "culture" I'm referring to the total picture that includes: age, generation, race, religion, gender, personal communication style, educational background, institutional politics/hierarchy and other factors. I don't wish to make sweeping generalizations but I have noticed that sometimes nurses from certain cultural groups may be less likely to question the orders a physician because that was how they were raised. I have also noticed that nurses who are from the Baby Boomer generation approach communication and organizational hierarchy differently than Generation Y as another example. We should also keep in mind how someone's nursing education and background may play into this as well. I once worked with a nursing supervisor who was very knowledgeable in our speciality but he often told me that his ADN program emphasized the role of the nurse in carrying out orders and delivering care so he often felt that it wasn't in the RNs role to "challenege" the physician, although he would vocalize his concerns in obvious cases of a mistake on the part of the doctor.

My only suggestion to the OP is when you have a question or concern about an order that you use a little finesse when "questioning" the order. I will review an LIPs progress notes at the time of the order change to see if they have discussed why they are writing a specific order and if it isn't addressed then I will contact them to "seek further clarification" or to "help me understand the rationale for my knowledge/education" and usually it goes over without an issue. I try to ask myself, is this something that I really need to address at this time (e.g. when I worked nights on a med/surg unit I tried not to call at 3 AM for an order that could wait to be addressed when the team did rounds in the morning).

Keep your chin up OP and try to remember that it IS your job to question the safety and appropriateness of orders for your patients (just doing so in a mature, professional way).

!Chris

[CapeCodMermaid, RN]

Then 1950s are calling and they want those nurses back. It is our duty as health care professionals to question orders from doctors and nurse practitioners. They are not infallible. I had been a nurse for about 12 minutes when one of the cardiologists wrote an order for 25 mg of Coumadin. I asked him if he meant to write 2.5mg and he started screaming at me to do what he said. I told him I wouldn't give anyone 25 mg of Coumadin and if he wanted the patient to have that much, he'd have to give it himself. He was belligerent and drunk but the older nurses were appalled I had questioned him. The patient didn't get 25 mg, but the doctor did get his license suspended for practicing medicine under the influence. It's MY license. MY livelihood. MY conscience if something goes wrong.

[angeloublue22, BSN, RN]

I think that's part of our job as nurses is to question, assess, and learn. The reaction you received is counterintuitive to the move in health care to provide team based care. We are supposed to be working interdependently. They seem to have an old way of thinking. Maybe you could print up some studies about modern integrative team based care. As others have said, your license and the patients safety are at risk. I work in Oregon and I would never think about not questioning an order or asking for clarification but when I worked in Idaho, I tried to remind a doctor to write an order that he said he would and my trainer stated, "You NEVER tell a doctor what to do." I couldn't move back to Oregon quickly enough.

[DF-LPN]

First and foremost that is your license, and like so many of us, sacrificed time away from families, your sanity, and possibly your liver from all the Tylenol you took. Spent hard earned money that you most likely didn't have. Cried buckets of tears because you just knew you failed your midterms. Ate tums like candy because someday you'll have ppls lives in your hands. All joking aside, we are educated to take care of ppls medical issues and in a court of law that is how you will be treated, you can't say, "because the Dr ordered it" If that was the case, nursing schools would only teach fundamentals, there would be no CENA, LPN, RN, Bachelor or Masters degree's or any of the other degrees. Bottom line, It's Your License, protect it!

[CG1979]

Your charge was out of line for scolding you.

Asking questions is your job. Investigation is your job. Problem solving is your job.

[vintagemother, BSN, CNA, LVN, RN]

You didn't bore me, lol. Thank you for your input. Yhe pt was an admit from home d/t a fall. Our nursing supervisors are basically on for staffing purposes, placing admissions, and if a pt is going for a surgical procedure the next day, and to be present during codes. Other than that, they really aren't involved much more with the pt. They do rounds on each floor on nights and afternoons. They do not physically see the pts. They are also supposed to be resources for us on nights if we have questions and concerns. The 1 supervisor is great, but this 1 not so much. We don't officially have a charge nurse at night, so I thought the best thing to do before calling to wake a doc up in the middle of the night, was to seek her advice when she rounded. Apparently, she didnt agree.

My Dept works like this, too. We have "Lead RNs" whose job, it appears, is to do admin type of stuff, such as scheduling and arranging rooms for pts admitted. Some are super helpful on the floor...others are either not able to be found or give wrong advice.

I've been working almost a year as a new RN and something's I learned early on were not to rely on them, but to consult the P&P of the facility as well as use my own nursing judgement.

[cgambino70]

The nursing supervisor should have explained to you why or she probably did not know yourself. I am new myself but our docs have no problems explaing why they ordered or did not order something. I caught an error by a doc who ordered an antibiotic that the patient was allergic to. Our system in the ER doesn't alert you if you scan a med the patient is allergic to. I went to the doc and said the patient was allergic to levoquin and he thanked me for catching it and he ordered something different. I am the advocate for my patient and I know the doc can have about 20+. Keep going and hopefully your supervisor sees your questions as learning opportunities.

[klcrn1987]

After 30 years of nursing I have earned one thing for sure....FOLLOW YOUR GUT!!! No matter what...if your "gut" is saying question it....then question it!!!! It is your subconscious telling you that somehow you know this isn't right.

I have questioned doctors, supervisors, state surveyors and family members. Remember, there are "proper" ways to question... "I just want to clarify with you Dr.---you want XXX for Mr. Smith??" ... many times they will catch themselves and change the order or I will ask the supervisor about it and she/he will contact the Dr..... and I have stood nose to nose with a Dr and fought with him for one of my patients and altho it was VERY begrudgingly given... I did finally get a TY for not giving up until the proper treatment was done.

Like others have said...we are all human, we make mistakes....there is nothing wrong with protecting your patient from ANYONE who might be making a error in treatment and no one should shame you for doing so....

[RNGummy40]

I am sorry you experienced this barrier in providing patient care.

May a nurse question a doctors order? The simple answer is YES!

If your nursing supervisor told you you had no right to question a doctors order, they are not following or validating our ethical and legal responsibilities as nurses.

Nurses are PROFESSIONALS! We are not automatons. Legally and ethically we must provide care in the best interests of our patients.

If the doctor gave an order to discontinue isolation precautions, did the doctor obtain evidence supporting their order. Is the doctor following hospital policy? Does your facility have an infection control Manuel with isolation procedures for the specific infection

being ruled out?

Your supervisor should have been able to answer all of these questions and not dismiss your critical thinking.

Below is a great link explaining the legal responsibilities of a nurse and why you absolutely have a right to question a physician's orders.

Nursing Negligence and Malpractice | Robins Kaplan LLP

Keep doing a great job validating and verifying information for your patients!

[Medic/Nurse, BSN, RN]

If the day comes I am unable to question a physician/provider order, my awesome brethren, I will leave this coven of good and purposeful service and simply herd cats. Not that that will be simple. But, damn, at least I'd know the rules and they'd make sense.

Not herd lions, tigers or leopards — oh no! House cats!

Cause see at that point the world will be upended and all these these rogue, rampant kittehs taking over the universe will need herding.

My cat herding skills are tested regularly.

Questioning a doctor's order (or in a few cases even their clinical decision making) is vital to keeping patients ALIVE. I try not to do stupid/contraindicated stuff — that's a biggie.

And if you think "I was following orders" defense absolves you — nice try. Won't work, unless --- nah, won't work. (Even the military doesn't let folks kill/maim people except in direct combat without consequences). You do something Stupid — your share will always be your share.

[ComeTogether, LPN]

I question orders all the time and I hold meds I don't feel comfortable giving until I speak to the MD. I had a patient getting 8 units of novolog at hs scheduled, but his glucose was in the 80's. I held it and called to clarify - doc had me give 4 units with a snack, and the same thing happened the next night. Come to find out he was also getting metformin from day shift and the doc had meant to d/c it.

I've held BP meds for super low readings (

It's not only OK to do, it's my job.

[Kooky Korky, BSN, RN]

I received a patient from ER after a reported suicide attempt driving his car into a utility pole (adult MH/chemical dependency unit). The patient came to the floor in a wheelchair. Since he was covered in a blanket, I couldn't see his legs. He said that his ankles were hurting. When I lifted the blanket, I could see that both ankles were severely swollen and discolored. There was no mention of this in the report from ER. I called them to ask if they had done x-rays of the ankles. The ER physician's attitude was "How dare you question my findings", when in fact he had stopped his assessment as soon as the patient said that it was a suicide attempt. I got x-ray orders from the psychiatrist, and the next morning we sent the patient to surgery for bilateral ankle fractures.

Nurses are worth our weight in gold, always cleaning up after doctors. And often not getting any credit for great catches like this. Really makes me wonder what the ER staff charted about physical exam of the pt.