In our acute psychiatric facility we cannot make someone take their medications regardless of how delusional they are unless:
1. They are court ordered or revoked court ordered
2. They are actively hurting themselves or another patient and the MD must be called for an emergency NOW IM order first
I believe in your case, the charge nurse made the judgement of the patient being mentally incompetent and should have been held down for the bladder scan that the MD had told you to disregard. Also, I'm assuming that a nurse can not independently deem a patient mentally incompetent in your facility and suggested you force orders.
I'm pretty new myself and very new to my facility. I have been caught in a few political situations and have tried my best to stay under the radar, but occassionally I HAVE to say something, because in the end it is MY patient. Charts will get reviewed, and as nurses, we ultimately need to advocate for our patients.
If you work with that nurse as your direct supervisor in the future, ask for their advice, but call the MD and say something to the effect of: Hello Dr. _____, this is AtivanIM on the ______ unit. I had talked to you earlier about the bladder scan on Mr. _____ in room _____. He is now also refusing all medications, in addition to the bladder scan you decided was not necessary earlier this evening. The reason I'm calling is, I've talked to the charge nurse about the situation with his refusal of medications and he/she feels that the patient is decompensating, may be mentally incompetent, and the medications are necessary. I would like to reclarify Mr._______'s orders with you quickly to ensure we are following the orders correctly.
He is currently taking ---important meds and dosage--- (and list the names of the non-emergent medications.) Would you like to order any of these medications IV or IM since he is refusing all PO medications or would you like to wait until the morning when you can reasses Mr.______ to make this determination?
:::Wait for MD orders:::
Read back orders, then chart either the addition of new routes of medications and administer or the order to hold the medications until the reassessment by the MD during morning rounds....Forcefully giving medications or withholding all medications should be a MD's order.
Ask your charge for advice but not for permission. Your job, your licence.
In addition, chart what time the charge nurse was notified (but do not flame, there is a good chance that they may "review" your notes), when the MD was notified, and a basic description of his orders in addition to the nursing interventions.
One more word of advice, when you call the MD, quickly say everything you need to, only leaving room for an "mmmmmhm" until you give a chance for orders. On night shift, the doc is usually more than happy to take your recommendation on the treatment so they can go back to sleep
Good luck to you!