Do you have to give drugs you do not agree with?

Blee O'Myacin, BSN, RN · Sep 2, 2007

As a nurse, do you have to give drugs you do not agree with; such as Cytotec to induce labor? I am not trying to start a debate here on whether or not it should be used, but I am against it and its off label use during labor. Could I be forced to give it or get in trouble if I refused?

In the example you gave I think that you do have to give the med. It is outside our scope of practice to pick and choose a course of treatment for a patient, like it or not. If it is established facility policy that cytotek is used in this manner, and it is the prescribed treatment, you are obligated to give the med if you accept report on that patient.

That doesn't mean that you shouldn't question a doctor when they prescribe a course of treatment, IMO. In no way should we blindly follow orders without an independent thought. If a certain treatment is against what you feel should be standard of care, do your research and present your opinion - perhaps you can change policy. I don't know very much about the drug in question since I don't work OB, but I am sure you have valid reasons for being uncomfortable and it might do more good to attempt to make a change or at least raise awareness about the risks involved with this particular treatment.

Hope this helps.

Blee

TazziRN, RN · Sep 2, 2007

The only time we can refuse an order is if it will compromise the safety of the pt or is illegal. In the example you gave, you could go to your charge and explain your feelings, and ask if s/he or someone else would be willing to give the med, but you cannot withhold treatment just because you don't agree with it.

HeartsOpenWide, RN · Sep 2, 2007

Well then, if I have to give a drug I do not want to, could I later get into trouble if something when wrong? I know we are taught in school that if there is a med error that the doctor makes and you as a nurse do not catch it you are also liable. I am not talking about a med error here, but the fact that this drug has warning labels that say NOT to use in pregnancy or to induce labor and the FDA does not approve it for this use. There are lawsuit going on over this that I would not want my name associated with for simply being "the nurse that weas just following orders":

http://www.wsmv.com/health/13206378/detail.html

TazziRN, RN · Sep 2, 2007

Ah, you just gave more info! If the warning labels specifically state NOT to use it in pregnancy, then you could refuse to give it. Just make sure you follow your facility's P&P on how to go about it.

If you were talking about, say, giving an antidepressant for sleep, you could not refuse that.

EmmaG, RN · Sep 2, 2007

Nasty, nasty stuff. My daughter's OB used that on her back before the FDA came out with the warnings.

http://www.fda.gov/cder/drug/infopage/misoprostol/default.htm

http://google2.fda.gov/search?client=FDA&site=FDA&lr=&proxystylesheet=FDA&output=xml_no_dtd&getfields=*&q=misoprostol&as=GO

FDA Alert : Risks of Use in Labor and Delivery
This Patient Information Sheet is for pregnant women who may receive misoprostol to soften their cervix or induce contractions to begin labor.
Misoprostol is sometimes used to decrease blood loss after delivery of a baby. These uses are not approved by the FDA. No company has sent the FDA scientific proof that misoprostol is safe and effective for these uses.
There can be serious side effects, including a torn uterus (womb), when misoprostol is used for labor and delivery. A torn uterus may result in severe bleeding, having the uterus removed (hysterectomy), and death of the mother or baby. These side effects are more likely in women who have had previous uterine surgery, a previous Cesarean delivery (C-section), or several previous births.

Just say "no".

ETA: some more info: http://www.midwiferytoday.com/articles/midwivescytotec.asp

Jo Dirt · Sep 2, 2007

Most of the meds I gave in the nursing home I didn't agree with. It was ridiculous the way some doctor's pumped up those old people with enough medication to choke a horse.

erniebobernie · Sep 3, 2007

I fired my midwife in my 36th week of prenancy because she wanted me to take this.

I was having my 4th child and had had 3 nonmedicated, quick lady partsl birth (less than 3 hrs for the first and less than 2 hours for the 2nd and 3rd children). I had just graduated LPN school and knew that drug sounded familiar but couldn't place it until I got home and researched it. I was appauled! My husband was upset too. I don't know what she was thinking. Well, she wasn't.

The drug company will not even make a smaller dosage.

So we hired a CNM to deliver our son at home. It was perfect.

I am curious how nurses would educate the MDs or hospital about the risks and try to get it banned?

Or is that just me being naive?

Newbie nurse;)

leslie :-D · Sep 3, 2007

there are many times i've refused to give that last dose of a potent narcotic, to an already overly medicated, dying pt....

not because i was afraid to, but because i assessed their pain to be well controlled, pt rather 'snowed' and didn't see any medical necessity.

leslie

crissrn27, RN · Sep 3, 2007

As far as I know ACOG still says it is OK to use cytotec. Not that I agree with that, but this is who the doctor is turning to for support (or no support) of the things they do. Seems to me that the first step would be to get ACOG to make a statement that it is not safe. Hopefully that will happen sooner rather than later. Or am I behind times and this has already happened? Anyone know for sure? I think in this situation, you have plenty of ground to stand on if you don't want to administer it!