Questioning a doctors order - page 4

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... Read More

  1. by   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!
  2. by   CG1979
    Your charge was out of line for scolding you.

    Asking questions is your job. Investigation is your job. Problem solving is your job.
  3. by   vintagemother
    Quote from MrsJt
    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.
  4. by   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.
  5. by   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....
  6. by   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!
  7. by   Medic/Nurse
    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.

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  8. by   Glycerine82
    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 (<90/60) and I've caught double orders for the same drug but different doses and called to clarify (one was d/c'd)

    It's not only OK to do, it's my job.
  9. by   Kooky Korky
    Quote from Orca
    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.
    Last edit by Kooky Korky on Apr 20
  10. by   PMFB-RN
    I teach my students that a physician always owes them an explanation for any order. If it doesn't make sence to you, question it. Doing so may reveal a mistake, or the nurse may learn something.
  11. by   tyvin
    EBSL when present as a UTI; people are put in a private room or isolation. Now they probably found out that the women wasn't actively infected but colonized...that's all I can think of. Also, a UTI with a catheter is a big "never event" and no one likes to scream and shout about it. You should be using clean technique with any patient.

    As for questioning a doctor's order: that's part of our job. That nurse with the 10 units of insulin had a brush with death. That's why we always check with another RN about insulin dosage before giving. It's called critical thinking skills and it doesn't take that much to start invoking them. Know you scope of practice. Look it up in the Nurse Practice Act of each state (every states is different).

    Don't be afraid to speak out when you know you're right or you have questions concerning patient safety, medication dosage, etc... When you come across a med that you don't know, look it up. If the dosage is more then 2 pills worth, question why. I know a nurse who pulled apart 6 tiny tablets thinking it was one does...it was one dose per day...Think.

    Good luck to you.
  12. by   ~Mi Vida Loca~RN
    Quote from tyvin
    EBSL when present as a UTI; people are put in a private room or isolation. Now they probably found out that the women wasn't actively infected but colonized...that's all I can think of. Also, a UTI with a catheter is a big "never event" and no one likes to scream and shout about it. You should be using clean technique with any patient.

    As for questioning a doctor's order: that's part of our job. That nurse with the 10 units of insulin had a brush with death. That's why we always check with another RN about insulin dosage before giving. It's called critical thinking skills and it doesn't take that much to start invoking them. Know you scope of practice. Look it up in the Nurse Practice Act of each state (every states is different).

    Don't be afraid to speak out when you know you're right or you have questions concerning patient safety, medication dosage, etc... When you come across a med that you don't know, look it up. If the dosage is more then 2 pills worth, question why. I know a nurse who pulled apart 6 tiny tablets thinking it was one does...it was one dose per day...Think.

    Good luck to you.

    The scary part is had she checked with another nurse that simply double checked the dose, she still would have given it because she pulled up the accurate dose. She had a order, she had the right patient, she had the right time and everything. The part that isn't taught in nursing school is to question the WHY. Well some schools it is. But I think everyone understands the point being made. We have to question things and we have to understand the WHY's of what we are doing.
  13. by   CapeCodMermaid
    I don't know where YOU went to nursing school, but I was taught to ask the whys starting on day one. We are not sheep blindly following orders

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Questioning a doctors order