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.

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

I have never been told to not question a doctors order. Our docs in the ER are always right there so if something doesn't make sense or I am curious or what not I ask them directly. I have flat out refused a few orders I felt were unsafe and my management had my back. One of the docs I refused the order was an intern and who later thanked me.

Doctors are people and they can make mistakes sometimes. That's why nurses are taught to have brains too. So that way if something doesn't make sense we KNOW and will question it. It can save a patients life and a doctors rear end. That said there is a way to go about things if that time comes. In the situation you described above I wouldn't have even taken it as you questioning a doctors orders. I would have taken it as you learning which should be encouraged.

[MrsJt]

Thank you for your reply. It is really disheartening, especially for a new nurse that is still trying to figure things out. I really try not to take things personally, but it is hard when you feel like someone is talking down to you like you are an idiot. Nursing is tough in general, let alone being a new nurse that has management and a supervisor that you feel doesn't support you.

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

It is unfortunate. But nursing can be a very rewarding and also a very hostile environment. Don't take it personally and lean on those willing to teach you and stay away from the negative people. It's all you can do. Learn what you can and learn who you can ask questions to. I love precepting for this reason. Someday you're going to turn around and realize new nurses are asking you the questions and just remember how they are probably feeling and try to be someone they feel ok coming too. Maybe if we just keep trying to build others up it will catch on and become the new norm.

[klone, MSN, RN]

As long as you can be held liable, sued, fired, and have your license revoked for your actions as an RN, it's okay to question a physician's orders if they seem wrong, unsafe, etc. In fact, it's your OBLIGATION as a licensed nurse to do so.

[MunoRN, RN]

I'm wondering if you misunderstood your supervisor since I find it hard to believe that any licensed nurses wouldn't be aware that it's our legal responsibility to question MD orders when appropriate.

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

As long as you can be held liable, sued, fired, and have your license revoked for your actions as an RN, it's okay to question a physician's orders if they seem wrong, unsafe, etc. In fact, it's your OBLIGATION as a licensed nurse to do so.

THIS^^^^

I was working with a newer nurse once and she asked me to verify insulin with her. Asked her what the patients blood sugar was and she didn't know, they didn't have a finger stick. So I question that and ask her why she is about to give 10units insulin IV to a pt and she hasn't done a finger stick on. So I pull up the patients chart and the CMP and see the patients sugar was 86. So I ask her why this patient is even getting insulin. The K is 4.3 She says "the doc ordered it" The doc put the order in the wrong patient. When I went to check with her she was about to give 10 units of insulin to this patient. She had an order, she verified the med, she verified the pt, she verified the dose and the time. But she didn't stop and question the order because she had the mindset that "we aren't here to question the orders" The doctor was VERY THANKFUL that the order was questioned.

Docs get interrupted CONSTANTLY and make mistakes. In the cases I refused to carry out the orders it wasn't a mistake they made but the orders were not safe and I was not going to put my license on the line to carry them out.

[RNKPCE]

In a case like this where I work the patient would have to be cleared by our Infectious Disease nurse by showing a negative culture, swab etc. This is our hospital policy. Reading progress notes to see why isolation status is removed or even simply asking the physician is a first step. Patient and employee safety should always be a primary concern not whether a physician is going to be upset that you questioned their order. You were right, your supervisor was wrong.

[MrsJt]

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.

[MrsJt]

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"

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

I'm wondering if you misunderstood your supervisor since I find it hard to believe that any licensed nurses wouldn't be aware that it's our legal responsibility to question MD orders when appropriate.

I have met probably a dozen nurses through the years under the belief that our roles are to follow doctor orders and would never think of questioning anything. They weren't supervisors thankfully.

Granted I have also met nurses that are new nurses and state they got into nursing to marry a doctor. I didn't even know that was still a thing. :|

[klone, MSN, 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"

You don't need to put a patient on isolation precautions for a UTI.