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Discussion

MDs overriding protocol?

OK, I have only been doing this for about 2 years (nursing) and I fully admit to being very "by the book". I work NOCS in a small community hospital with a very busy OB unit (180/month). We are level one. We have pretty concise and thorough protocols/policies for the things we do often--cervidil/cytotec/pitocin, etc.

Our pit protocol is old and very conservative (I feel due to our level 1 status and virtual inability to do anything STAT--esp a c/s). We start out at 1mu and then increase to 2mu after 20 minutes and then by 2mus each 20 minutes after that up to 20mus. We are usually poorly staffed on nights and in no position to be 'jet-pitting' anyone ever.

Anyway, we have a couple of docs that always want to 'override' our protocols with an order to do it faster/higher. With our staffing and such, I am not comfortable with this most times. Of course the docs don't really care about my feelings :chuckle I just want to know what they can do as far as overriding. How do they stand on this legally? If something goes down the tubes and I am not following protocol because of an order to override where do I stand? It's not just pitocin.

I'd appreciate your thoughts/experiences with this! Thanks!

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Sticky situation for you to be in but pretty clear legally- a doctor's order won't cover you in court if it goes against your facility policy. And if a legal situation did arise where you were "following doctor's order's" but not hospital policy, the hospital wouldn't back you up. Can you get your nurse manager to back you up on this?

by the way, GOOD FOR YOU for standing your ground and keeping your patient's safety in mind! You sound like a great nurse :)

  • Experts

You are correct in feeling apprehensive......you need to follow your unit's protocol, you cannot go over it without administration's approval as far as you titrating it. Sure your doctor can want more delivered, but he needs to be at the bedside doing the titrating himself. Then there is no problem, as it will be only his license on the line, and not yours. Policies are in place for a reason..........

You are in a rough spot. The policies and protocols of a facility are in place for a reason, patient safety. Tell the doctor you can only give pit per protocol, call the supervisor if he increases the rate, or gives you any problem. It is the supervisors job to deal with these issues. Secondly, talk with manager of unit. Tell her this policy is a problem with the doctors. Does it need to be revised? Always remember, out of line with facilities policies means your underwear will be flapping in the wind without a legal ground to stand on if there is a problem with a patient.

  • Author
You are in a rough spot. The policies and protocols of a facility are in place for a reason, patient safety. Tell the doctor you can only give pit per protocol, call the supervisor if he increases the rate, or gives you any problem. It is the supervisors job to deal with these issues. Secondly, talk with manager of unit. Tell her this policy is a problem with the doctors. Does it need to be revised? Always remember, out of line with facilities policies means your underwear will be flapping in the wind without a legal ground to stand on if there is a problem with a patient.

Thanks for the replies. I thought that was the case, but we have a few nurses that are 'pleasers'. I have almost done 'pleaser' things myself for docs I trust and when I agree with the situation, but thankfully I haven't. My husband is an attorney of long-standing and is always very much into rule following. Sometimes I feel like I come across as too anal, but I know that I wouldn't have a roof over my head or food on my table (or a nursing degree!) if things didn't happen and no one was ever sued!

I am soon going to be leaving my facility and going to work for a large teaching hospital (Magnet designated--we'll see if it is worth the hype!) and am interested to see how different the practices are. They actually have fewer births (125) but a very high acuity. That is why I'm going--I need to learn so much more.

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