Ever Refuse a MD order?

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Just wondering if anyone has ever had to refuse a MD order??

Specializes in Medsurg/ICU, Mental Health, Home Health.

Well, I for one don't think "refuse" is too strong of a word!

I cut my teeth in Perioperative Services (tech), and did my first nursing job on a Post-Op floor. I was taught to use nursing judgement at all times, and always felt that I was part of an interdisciplinary team. I worked WITH the surgeons, not against them or under them. They trusted our judgement and listened to us.

Now I'm on a medical floor, same health care system, and the medical attendings act like we're puppets. Anyone who questions an order is a troublemaker!

I've received some fun orders in my day, and I've walked up to the doc, chart in hand, and said, "hmm, no, this isn't acceptable." I am really tired right now...wish I could think of a few examples.

I had a patient sort of flip out on me, but she was an older lady and a small dose of Haldol did her in. After she was knocked out, I was on the phone with her attending, who tried to give me an order for another "NOW" dose of Haldol (after she was knocked out!) and I flat-out refused. My words - "I'll get you the supplies so that YOU can push it." Guess what happened!

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Ok I have a question. I'm only a student so please don't yell at me, but what do ya'll mean when you say prudent nurse?

Thanks

An excellent question to ask, bravo!

The "Prudent Nurse" standard is a legislative catch all phrase used to determine whether or not there is culpability on your part in a malpractice claim. The standard essentially compares your actions to those of a similarly trained "Prudent Nurse" under the same circumstances.

What one "Prudent Nurse" would do over another for the purposes of this thread is in itself, a likely subject of debate. However, consider that a Judge (as well as a jury) are in fact laymen where medical issues are concerned.

Therefore, presented with evidence and expert testimony, what the layman would consider prudent, is your safest bet.

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Specializes in Emergency & Trauma/Adult ICU.

On the rare occasions where *discussion* and *clarification* fail to interject some sanity back into the conversation, there's always "No, we're not doing this." :smokin:

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Specializes in psych nursing.

I would hate to say but yes I have declined an order. We had a visiting MD come to our small psych facility who would write the most ridiculous orders.This gentleman once ordered an 800 calorie diet for one of insulin dependent diabetics. My favorites were always the ones that were written for psych drugs when he was not the psychiatrist.

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Specializes in LTC Rehab Med/Surg.

Eight month old baby was admitted onto our floor. We are a small rural hospital and have no Pediatric unit. No pediatric nurses. Doctor was not a pediatrician. I questioned a med dose, then refused to give it when the MD would not reduce the dose. What saved my job was management recognized that nurses have the right and responsibility to question a med dose that is out of range of what is recommended. The MD wanted me fired. The doctor treated me like a mule who just needed to be kicked to get moving. No rationale, no reassurance. JUST DO IT.

I read the posts here about nurses being able to question an MD about meds, and it's like we're on different planets.

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Specializes in ER/EHR Trainer.
Eight month old baby was admitted onto our floor. We are a small rural hospital and have no Pediatric unit. No pediatric nurses. Doctor was not a pediatrician. I questioned a med dose, then refused to give it when the MD would not reduce the dose. What saved my job was management recognized that nurses have the right and responsibility to question a med dose that is out of range of what is recommended. The MD wanted me fired. The doctor treated me like a mule who just needed to be kicked to get moving. No rationale, no reassurance. JUST DO IT.

I read the posts here about nurses being able to question an MD about meds, and it's like we're on different planets.

So sorry this has been your experience, as far as I am concerned safety not egos are the name of the game. There is never anything wrong with questioning an order and discussing why something is being done. If everyone is on a "team" they should be on the same page. If not, let the doc administer his irrefutable orders...with noted protestation of course.

I only know ER nursing and the need to be on my toes constantly-no one is stable, all histories are questionable and meds are available quickly and without double check from the pharmacy. WE ALL have to be on the ball when it comes to giving them out! Two days off of new nursing orientation I had a doctor tell me if a patient coded due to high K+ it would be my fault-I held out for the real test and the potassium was on the lower side of the normal range. If we had treated through IV meds-we may have initiated an arrthymia...I will never forget that and I always impress it upon my orientees when I precept.

Caution, double checking, knowing our meds, and that gut feeling have their place in patient care along with the word "no".

M

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Absolutely........I am responsible for my actions. I remember one particular time a very unstable post open heart that was being dialyized and had no BP......I called the Nephrologist and he screamed at me that I was killing the patients kidney's with the gtts that high and to "DC them immediately" I finally had had enough :devil:and reminded the MD that I would not dc any gtts because if the patient had no BP she was going to die and her kidney's would go with her!!!!!!! . After several moments of utter silence I got the dc dialysis order and he came in and offered an apology (very rare):lol2: and to see the patient. There have been very few I have had to flat out refuse and suggest (gently of course):rolleyes: that the MD give it themselves because I was not going to give the med because of xyz............

But if I had a penny for everytime a MD asked "What is your name" or "Do you know what time it is?", "Don't call me back" and my favorite "I'll have your job!" I'd be richer than Warren Buffett!:cool:

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Specializes in Maternal - Child Health.

But if I had a penny for everytime a MD asked...my favorite "I'll have your job!" I'd be richer than Warren Buffett!:cool:

My favorite resonse to that one: I'd gladly give it to you, if only you were qualified!

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Specializes in Emergency & Trauma/Adult ICU.
I read the posts here about nurses being able to question an MD about meds, and it's like we're on different planets.

I'm sorry this has been your experience.

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One time I was caring for a lady (LTC) who was complaining of constipation; I assessed & I knew she was obstructed with her abdomen being so large & tympanic. She was so miserable & anxious with the pain. So I called the doctor to let him know I wanted to send her to the ER; he did not want me to send her to the ER as this lady had a history of "crying wolf" but instead he wanted me to give her an enema. I told him I could not do that, that I was calling 911. I sent her to the hospital, she was admitted with a bowel obstruction. The doctor was upset with me on the phone of course!

thx,

Jerenemarie

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The standard to meet is if the situation is obvious to the layman which is the basis for the Prudent Nurse Standard. Otherwise it becomes an issue of Medical Opinion which is a losing proposition for a nurse.

Absolutely not. By the time you're in court you've been out of a job for a long time, and your kids are starving.

So the "standard to meet" is everything and anything that convinces those in your immediate environment.

Yeah, I did diagnose the previously-undiagnosed medical condition, but the purpose was only to establish my street cred. It wasn't substantial to the main (legal and ethical) problem. The sizzle, not the steak.

Also I didn't deliver it as a diagnosis. It was in a nurse's note listing all pertinent data, which had not been previously assembled, and it was delivered as a simple journal article cite. "For more info, see this."

The argument and presentation weren't developed for the courtroom. They were, in fact, developed in such a way as to let the culprits know that if it ever made it to a courtroom, whatever happened to me, they'd be toast.

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Specializes in Med/Surg, LTC/Geriatric.

Not refused an order, but here's an interesting story...

Post op surgery pt (don't remember the surgery) had previously been on a narcotic (I think it was oxycodone, but I honestly don't remember. I know it was a common drug, not one that was totally unheard of).

Ordered narcs were cutting it for pain. Regular narc worked. Called the surgeon to let him know that this narc worked for patient previously. He said "oxycodone? what's that?" :eek: I just about fell off my chair. This is a highly experienced, well respected physician. I kinda stumbled as I was dumbfounded. I said "um...it's a narcotic...." He said, "oh, ok, what's a good dose?" I said "well, the patient was on 10mg q4h..." and he said "ok, go with that".

Strangest call to a doctor, EVER.

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