Following Dr.s Orders

Piglet08 · Jan 20, 2012

Wow, that stinks. I don't have advice, really. Just showing support.

zelkonurse · Jan 20, 2012

Thank you piglet08!

nurseprnRN, BSN, RN · Jan 20, 2012

if you can be a little more specific, without revealing details that would identify you or the company specifically, it might be helpful.

KelRN215, BSN, RN · Jan 20, 2012

Please help! I am a wound care nurse at a clinic. I followed my Dr's order today, and I was told I am not allowed to...that I have to follow the company's direction, not the Dr. The Dr. is supporting me and I truly feel I did the right thing for my patient. This is not the first time this has happened. I am very concerned for our patients, and also my nursing license. There is no written policy on this issue, just an unlicensed "corporate clinical manager" who has made it known she does not like nurses. I am the only nurse for this company and I am not sure what to do anymore.

What was the order? It's hard to judge or give advice without knowing a little more. If I followed an order that was against my facility's "policies", I'm sure I'd hear about it too.

zelkonurse · Jan 24, 2012

Basically, we are a lymphedema clinic that has started doing wound care. They hired me just for wounds. I called the Dr. to update on a pt r/t increasing s/s of infection. Just to update. I also let the Dr. know about lab results that she ordered. I'm just not sure if the policy and procedures override a Dr's. order. Have always worked in hospitals. I have a manager with no credentials at all and she is very disrespectful to me. Although the Dr. has written orders to be updated, my manager who is in another city wants me to update her via e-mail and she "might" notify the Dr. It took over 24hrs to hear back from her on several issues. Just frustrated. I really don't like power struggles and I don't know how to protect my patients when I have someone I do not respect/trust to make decisions for these patients. I'm ready to give up, but I love my job and the Dr's I work with fully support me and feel this woman is disrespectful to them too. Thanks in advance for any input.

tablefor9, RN · Jan 24, 2012

As a nurse, you are the advocate for your patient. You are also expected to follow MD orders, when those orders are not harmful to your patient. That's basic.

As an employee, you're expected to follow the protocols put in place by your employer, and submit to the authority listed as your supervisor, when doing so is not unethical, illegal, immoral, or harmful to yourself or your patients. Still pretty basic.

Where it gets complex is deciding exactly how much you hate power struggles, because by your own account, this isn't an isolated incident. Seems to me you've got three choices:

1. RUN. Find another job, because this lady *using term loosely* isn't going to change and one of these days, you're going to be screwed, and maybe sued, for ignoring MD orders in favor of policy or reprimanded, and maybe replaced, for ignoring policy in favor of MD orders. This is a no win situation and leaving may be the only way you don't come out on the losing end all the way around.

2. FIGHT. Document issues with your clinical coordinator, then file a complaint, working your way steadily to the top. Everybody but God's got a boss, or at least an agency providing oversight and accountability. This isn't a comfortable choice, but it may help patients and other staff. Plus, it's satisfying to see a bully get what they've got coming to them.

3. WAIT and SEE. How's that working so far? This is okay in the short term, and perhaps somebody else is already working on OPTION 2. Since you are the only nurse, I kinda doubt it.

Good luck to you!

T

zelkonurse · Jan 24, 2012

Hi tablefor9,

Thank you so very much for your words of wisdom. I have thought the same thing. I'm kind of doing #3 to see what the next move should be. Striving for peace and harmony in the workplace! Its really a soul-searching process, but in my heart, I will always do whats right for the patients to the best of my ability. I document everything (don't we all!!) and I submitted it to the "higher ups" in the company. They are reviewing what I submitted, and I'm waiting to see their response. If I am told to not follow Dr's. orders, I'm going to ask for the policy stating that, and submit to the BON. If they say I can follow that, than I can sleep at night!!

Thanks again for your support

K

Scarlette Wings · Jan 25, 2012

i think my signature line says it all for me. i learned it in my stress redcution classes. good luck.

cheyfire

there are three ways to cope in times of crisis:

leave the environment,

change the environment,

or change your attitude.

leslie :-D · Jan 25, 2012

Although the Dr. has written orders to be updated, my manager who is in another city wants me to update her via e-mail and she "might" notify the Dr. It took over 24hrs to hear back from her on several issues. Just frustrated. I really don't like power struggles and I don't know how to protect my patients when I have someone I do not respect/trust to make decisions for these patients. I'm ready to give up, but I love my job and the Dr's I work with fully support me and feel this woman is disrespectful to them too. Thanks in advance for any input.

this is nothing but pure bs.

you're licensed, she's not.

she has nothing to lose, you do.

yes, update dr as ordered, but make sure mgr is updated as well.

the bottom line is if mgr decides to not update dr, it is YOU who would be penalized by the BON...and not your mgr.

if you update dr (against mgr's wishes), you still may be terminated.

but since she obviously hasn't a clue as to what a nurse's duties and obligations are, it will always be you who is made the scapegoat - because you DO know.

sure you might lose your job.

still, you won't lose your license.

if you do it her way, your license is put at great risk.

you might want to contact your BON and get their input, as well.

they really can be helpful resources for us nurses.

and put everything in writing, even if it's for your own personal viewing.

good luck to you.

leslie

zelkonurse · Feb 14, 2012

Hi Leslie,

I wanted to let you know how much your email inspired me!!

I feel honored to call myself a nurse and I remember why I wanted to be one!!

Thank you for putting it back in perspective for me.

Kimberly

classicdame, MSN, EdD · Feb 14, 2012

another option is to contact the Board of Nursing in your state to see if they have anyone who can advise on practice issues. They won't tell you if you are right or wrong, but may guide you in what the nurse practice act says. For instance, what is the rule if a non-licensed individual directs patient care?