As far as discussing this matter with your DON (which was your ultimate question), I should think expressing that you have concerns about specific patients' treatments, facility protocols, MD orders/lack-thereof/interactions, and you wish to better understand rationale, etc., making sure you're open to feedback and want to work within the scope of your practice and the rules of the facility, while ensuring your patients receive appropriate care, should be a good starting point for a discussion. The only reason I'm actually compelled to comment is to actually implore you to never document a diagnosis. As long as you're not an NP, you should not be diagnosing medical conditions. You are assessing patients. You can document all the s/sx of influenza that you've assessed, but it is not in our scope to develop that diagnosis. I know it's sometimes frightening to work in a tertiary care setting, but I'm not necessarily convinced that the patient with atelectasis requires acute inpatient hospitalization. Are they satting well? Are they in distress? Activity tolerance? Appetite? Have they responded at all to the abx? Are they A&O enough to teach deep breathing techniques, etc.? I would take your concerns to another nurse (charge, DON, experienced colleague) and use it as a possible teaching moment. Of course, patient safety is your very valid concern, and you're there with the patient, you have to go with your gut sometimes and what you're observing - I just get the sense that perhaps you could also be over-reacting and you are definitely going to want to avoid documenting new diagnoses in the future.