What to do when a doctor won't let you read back an order

gypsyd8 · Sep 29, 2012

New nurses please take note: Physicians are not your bosses and can not hire or fire you. If you document every time a physician is completely out of line, not every time you are offended, they too are credentialed to work in the hospital. The best backlash is a paper trail that doesn't renew contracts.
( I worked as the assistant director of H.I.M. for many years and handled the physician training & credentialing)
Btw, next time notify your charge nurse, and if response is not quick enough call the Chief.

MD's may not be able to hire or fire a nurse, but if a nurse ****** one off s/he will certainly get chewed out by the NM, written up, or worse. MD's make the money for a hospital. Most mgmt types bend over backwards not to **** them off. I have been 1)verbally counseled because I woke a MD from his beauty rest for a patient in respiratory distress 2) informed that when a certain physician rounds we will bring him coffee and all his patients charts 3) told to get up out of my chair and give it up to the MD making rounds, and 3) told explicitly not to upset the physicians because middle mgmt is sick of hearing them complain and will find a reason to write me up. Numbers 1 and 2 and 3 occurred at three separate facilities. Numbers 3 and 4 occurred at the same facility but with completely different NM's. All this "I'm not going to take that from a doctor" sounds just peachy in nursing school, but in the real world, where a nurse needs a job, is doesn't matter a hill of beans. The charge nurse may or may not be of assistance, and the Chief certainly does not care about the nurse, as s/he is replaceable. The Doctor isn't. In the real world, we explain what happened to any sympathetic ear and ask a senior nurse on the unit what to do in that particular situation with that particular doctor. Most of the time it comes down to taking the senior nurse's order and praying. Be sure to document everything that comes out of the physicians mouth, unless it implicates you, in which case don't.

carl5480 · Sep 30, 2012

If that was me, and I'm being honest, I would have written down the order as I'd taken it and I WOULD have written TORB. You tried to do the right thing and he wouldn't let you. So CYA and let him deal with the consequences. The correct answer would be to call him back and get him to verify it verbally (and he's a jerk for not letting you do so in the first place), but this is the real world and who has the time to hold the doctor's hands and MAKE them do the right thing? I suppose some nurses might, but not on our unit, that's for sure.

artsmom, BSN, LPN · Sep 30, 2012

There was recently another post on here about a nurse in trouble because a PA wouldn't sign a T.O., she says he gave the order, he denied. Doctor's need to follow procedures- like it or not. I have gone head to head with doctor's before, and they have reported me, but I have also reported them. Rules are rules, and when it comes down to it, you are following procedure, and they are not. It will not hold up in front of the board "I didn't want to cause trouble". Always protect yourself.

MPKH, BSN, RN · Sep 30, 2012

I usually say something to the effect of "So you want me to give Mr. Smith two T3s stat and then he can have it q4h prn after that?" or I repeat everything they say after them. "So that's....two T3s stat....and q4h prn...."

It's YOUR licence on the line. Document properly, and this includes getting the read back from verbal/telephone orders!

wooh, BSN, RN · Sep 30, 2012

I repeat everything back fast enough that it's quicker for them to listen than to hang up on me. Unless you're getting a page full of orders, it shouldn't be a problem unless you're dragging things out longer than necessary.

I know a Nurse who had recently went in front of the Nursing Board because a Dr. refused to sign an order he claimed he "did not give"....

Yeah, but claiming you read it back and verified it isn't going to give you any more credibility in a he said/she said.

PunkBenRN · Sep 30, 2012

Depends on how certain/confident you are in the order. If you felt insulted, by all means call him right back and repeat it back.

Whether you call him back or not, you should most definitely follow up with Nurse Manager, Medical Director, Pharmacist, or Safety Committee - this is a safety issue and is there for a reason. I gaurantee you there is someone in your organization that cares enough to follow up with that MD.