Questioning a doctors order

[MrsJt]

Let me begin by stating, I am a new nurse. Been on my own for 3 months now, so I am still learning. However, I was just curious how many nurses out there have been told by management or supervisors that we should not question a doctors orders? I had a situation where a pt was admitted and put into isolation for a possible infection in the urine. Pt had tested positive 2 months prior when they were last admitted. (Pt had a foley on admission). A day later pt was taken out of iso. A cpl days later, foley was removed. Now I had been asked by numerous dayshift nurses why this pt was no longer in iso. No cultures, no urinalysis were done to confirm no current infection. So I decided I would ask and seek gyidance from my nursing supervisor. To only be scolded for asking the question and told that I had no right to question it bc that meant I was questioning a doctors order. Like I stated, I am new. I don't know everything, but that is why I was asking. I felt I could seek some guidance and understanding, but that obviously wasn't the case. The majority of the nurses I work with are great and understanding that I am new and I will have questions. I feel like I have made a mistake now going into nursing bc no one sees the good you do, they only point out what you do wrong.

[MunoRN, RN]

That is why I am so confused by this. No diagnostic testing was done to prove this pt wasn't infected. That why I asked her, bc there was no infectious disease doctor on and no stated reason for discontinuing the iso order. The order just stated, "D/C Iso". All of the dayturn nurses were questioning it in report, I wanted to be able to give them an answer, not just" because the doctor said"

By "infected" I assume you're referring to an infection that would legitimately indicate the need for isolation (VRE in the urine for instance).

[djh123]

Don't get too discouraged too quickly. No one has ever told me not to question a doctor's (or NP's) order, and most people SHOULD operate on the 'there are no stupid questions' principle in this field, because we can all make mistakes, and we all can stand to learn something.

A couple of years ago I did question a NP's orders on the phone, and she got huffy with me. But the situation was this: she had NEVER seen my resident, and I had taken care of this lady for 2 years, and saw her every work day during that time. I knew her new orders were going to cause problems, and sure enough, they did.

[MrsJt]

Wasnt a uti, it was something that warranted isolation precautions. Just dont want to be too specific on here.

[MrsJt]

Yes, I just dont want to be too specific. This is something that warranted the pt to be in iso previously when admitted 2 months ago and this pt is a frequent flyer and is known to have this frequently when admitted.

[Here.I.Stand, BSN, RN]

Like the others, I was always taught to question and refuse if unsafe. As a licensed professional, "just following orders" will never be a viable excuse if something happens.

It's not always an issue of the doc being unsafe, either. A couple months ago, a resident put in an order that made me go "huh???" I can't remember what it was exactly, but it didn't make sense given the pt's clinical picture. I asked about it. Turns out, he entered the order into the wrong pt's chart.

[TheCommuter, BSN, RN]

I will keep my comment short and to the point: prudent nurses will question and/or clarify physicians' orders instead of following them blindly and unquestioningly.

There's an order for 80MEQ of potassium chloride via IV push, so would you give it? Would you question it? I'd give it only if I was employed at a prison and my patient was a confirmed death row inmate scheduled to die via lethal injection that day.

[Julius Seizure]

No, no mistaking... When she said, "Don't question the doctors order. It was Dr. "###", he put the order in". She even said that there should have been a UA or culture done, but it was the doctor that put the order in, so I shouldnt question it. I wasnt the only one that heard her tell me this either.

To me this says "I know the patient shouldn't have been taken off of isolation, but isolation precautions are a pain so I don't mind using the doc as an excuse and pretending that I didn't know the precautions should still be in place."

[~Mi Vida Loca~RN, ASN, RN]

I will keep my comment short and to the point: prudent nurses will question and/or clarify physicians' orders instead of following them blindly and unquestioningly.

There's an order for 80MEQ of potassium chloride via IV push, so would you give it? Would you question it? I'd give it only if I was employed at a prison and my patient was a confirmed death row inmate scheduled to die via lethal injection that day.

I would give it if they pushed the call light too many times!!

I kid I kid!

[~Mi Vida Loca~RN, ASN, RN]

To me this says "I know the patient shouldn't have been taken off of isolation, but isolation precautions are a pain so I don't mind using the doc as an excuse and pretending that I didn't know the precautions should still be in place."

HAHAHA I so badly wanted to say that it's probably no one wanted to deal with the hassle of isolation but they can't just say that. But I figured it was the ER nurse in me because I always would rather take the risk then go through dealing with isolation. Thankfully we don't often have to deal with it because we find out after we have cared for them the whole time.

[SilleLu]

Not questioning doctors orders can be dangerous. Dr. ordered toradol for my patient just last week. Patient's chart clearly states allergy with anaphylactic reaction. Doctor missed it, pharmacy missed it. Nursing didn't miss it luckily. It is so common for doctors to miss things, they make mistakes and they count on nursing to question them. In two short years I can't tell you how many times I've had to question lasix orders with no potassium replacement when potassium is already low, IVF at 150 ml/hr for the dyspneic, wet sounding lungs who is eating and drinking fine, two different docs ordering electrolyte replacement the same pt, same day, Coumadin with no INR check for days, etc.

And plenty of things that I've questioned that Dr had a good reason for ordering that I just wasn't aware of, but rarely have they been upset with me for asking. I've learned a lot from questioning, no matter if the outcome is to confirm or dc the order in question. If the culture where you are is "don't question," I wouldn't want to stay there long personally.

[NurseSpeedy, ADN, LPN, RN]

Yes, I just dont want to be too specific. This is something that warranted the pt to be in iso previously when admitted 2 months ago and this pt is a frequent flyer and is known to have this frequently when admitted.

If this is the case then maybe management needs some clinical education about infection control, especially since there's no confirmed negative results in the chart. And by clinical education I am NOT suggesting you do the educating, so there's no misunderstanding. She also can NOT keep you from questioning the order and contacting the physician. Now, they may not be the most pleasant provider to deal with when you are questioning an order, but this is YOUR responsibility to follow through. If you still find a road block refer this issue to your infection control nurse. You should find some back up there. Most facilities that I have worked require at least one negative. For things like MRSA, up to three separate nasal swabs, three separate admissions.

[Orca, ADN, ASN, RN]

I received a patient from ER after a reported suicide attempt driving his car into a utility pole (adult MH/chemical dependency unit). The patient came to the floor in a wheelchair. Since he was covered in a blanket, I couldn't see his legs. He said that his ankles were hurting. When I lifted the blanket, I could see that both ankles were severely swollen and discolored. There was no mention of this in the report from ER. I called them to ask if they had done x-rays of the ankles. The ER physician's attitude was "How dare you question my findings", when in fact he had stopped his assessment as soon as the patient said that it was a suicide attempt. I got x-ray orders from the psychiatrist, and the next morning we sent the patient to surgery for bilateral ankle fractures.