Can a doctor "order" a nurse to not assess something?

RN403, BSN, RN · Sep 20, 2015

Not sure if they can but even if it is ordered we have our own nursing judgement. Like with anything if I feel it isn't safe I am not just going to blindly follow.

The only time I have ever seen something like this though was on a hospice floor and it was more or less a communication in the computer stating "family requests no vital signs."

Not sure what an MD would have against VS or neuro checks? They are done for a reason.

Has something happened that you are asking? Just curious.

SilleLu · Sep 20, 2015

Yes, a doctor told me to "stop it" referring to one of the above assessments. My nursing judgement led me to believe that assessments were called for and my fellow, more experienced, nurses agreed. I discussed with the doctor asking for the assessments to be ordered, but did mention that myself and previous nurses had been doing them even though not ordered. At that point I was told to "stop it." I did not stop it. And I don't think the nurse that followed me "stopped it" either.

AcuteHD · Sep 20, 2015

Not sure what an MD would have against VS or neuro checks? They are done for a reason.

There is no reason for VS or neuro checks if the patient is comfort care only. Not saying that was the case, but there are 2 blues clues indicating it might be the case.

SilleLu · Sep 20, 2015

Patient was not anywhere near comfort care, but good point that there is a reason for not assessing.

SilleLu · Sep 20, 2015

The original situation was regarding AWA. Patient day 4 since last drink. Scoring high enough to require IV meds had they been ordered via protocol as usually happens. Some IV meds available (and given) but frequency not enough to keep scoring down. If patient scored much higher, would have to be transferred to ICU per policy.

Now of course it's the doctor's choice on how to treat, I get that. Might have good reasons for it even (would be nice if shared those reasons with nursing, but that's another thread...).

Regardless of doctor's choice of treatment, I just can't wrap my head around being told to "stop it" when it comes to my assessments.

I included other examples only because they are all assessments I thought we as nurses can perform as we see fit, are there assessments that require a doctor's order to perform?

AcuteHD · Sep 20, 2015

Patient was not anywhere near comfort care, but good point that there is a reason for not assessing.

I didn't expect your pt to be comfort care since you were talking about orthostatic BP's and such, but RN403 was talking about a hospice pt. Sounds like your MD had a good teaching opportunity, too bad s/he blew it off with just a blunt order. I am curious about it.

BrandonLPN, LPN · Sep 20, 2015

Taking the question at face value, no, of course a physician cannot order a nurse to "not asses something".

But this is one of those threads where I can't help but feel some important context is missing. Maybe the doctor ordered the nurse to stop doing neuro checks overnight on a stable patient who needed a good night's sleep. Maybe the nurse was performing clinically unnecessary and intrusive assessments on a patient whose compliance with the medical treatment plan was already shaky.

Of course, without knowing the details, we can't really say one way or the other. But asking something like this, and wording it in the way it was, and then not providing context.... all makes it very much a loaded question.

SilleLu · Sep 20, 2015

Taking the question at face value, no, of course a physician cannot order a nurse to "not asses something".
But this is one of those threads where I can't help but feel some important context is missing. Maybe the doctor ordered the nurse to stop doing neuro checks overnight on a stable patient who needed a good night's sleep. Maybe the nurse was performing clinically unnecessary and intrusive assessments on a patient whose compliance with the medical treatment plan was already shaky.
Of course, without knowing the details, we can't really say one way or the other. But asking something like this, and wording it in the way it was, and then not providing context.... all makes it very much a loaded question.

See, that's what I wanted...can we as nurses be ordered to not assess? Are there some assessments that require a doctor's order? I wanted the answer to the broad question, not just to my specific situation.

When this doctor said that, I was surprised and my thoughts went to, 'if they can order me not to assess this thing (AWA), what else can they order me not to assess?' What is my duty if I feel the assessment is called for but doctor has said not to do it? If I follow the order and stop assessing, even if I feel it needs to be done, am I failing my patient?

quiltynurse56, LPN, LVN · Sep 20, 2015

A Dr. may DC an order for a certain assessment, but if the nurse feels like there is a need for it to continue or to be done anyway, the nurse may do so. Just chart what was going on at the time you decided to do the assessment.

RN403, BSN, RN · Sep 20, 2015

There is no reason for VS or neuro checks if the patient is comfort care only. Not saying that was the case, but there are 2 blues clues indicating it might be the case.

I am aware that there is no reason for VS or neuro checks if comfort care only. Just saying that was the only case where I have seen anyone against VS/neuro checks. :yes:

KatieMI, BSN, MSN, RN · Sep 20, 2015

They can do it, and they do it. Although, a nurse may or may not follow NURSING ASSESSMENT orders, and nobody can stop her to put them into NURSING DOCUMENTATION. Which documentation comes very handy when something happens.

My most memorable case was when several docs explicitly wanted to stop being incessantly called at all times of the day and night about strange "chocking" the patient's was complaining on. The local protocol was to call MD if any swallowing difficulties happen (neuro rehab, specializing on neck/upper spine, so such symptoms were common and warranted speech eval, yet another chest xray, etc.) Luckily, one of the docs happened to be freshly baked resident on call who wanted to get that X+1 xray, and even more luckily, he mistakenly ordered it in side projection instead of A/P. As soon as the xray was out, things got roiling as the problem was that the screws inserted into the patient's spine migrated and were pretty close to esophagus and big vessels. AFAIK, there were no complains about similar calls for quite a long time after.