questioning md orders

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if an MD asks you to do something that makes you uncomfortable what would you do?

i'm not sure what i would do, but i would certainly talk to him or her about it and ask his or her rationale for the task.

would it be considered safe if i didn't want to do it?

how are these conflicts handled in your hospitals?

i'm just curious, just reading this journal that made me think of this, because I feel so unsafe right now because I don't know what I would do!!! :redbeathe:D:coollook::cry::typing:nurse:

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

i would notify my charge nurse, then take it from there. strength is in numbers!

jess

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Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

Confer with another nurse, directly ask the md if you need, why not I've questioned lots of stuff, made suggestions they are approachable, and yes, I've had a lot of them order things on the wrong patients,they are not perfect. you can also consult pharmacy if its a drug concern or go up the nsg chain, chg, supervisor if off shift or ANM OR NM if they are around, no nurse is an island, you can refuse if it is unsafe, or outside your units p and p.

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Specializes in LTC, ER.
if an MD asks you to do something that makes you uncomfortable what would you do?

i'm not sure what i would do, but i would certainly talk to him or her about it and ask his or her rationale for the task.

would it be considered safe if i didn't want to do it?

how are these conflicts handled in your hospitals?

i'm just curious, just reading this journal that made me think of this, because I feel so unsafe right now because I don't know what I would do!!! :redbeathe:D:coollook::cry::typing:nurse:

What do you mean by uncomfortable? I think that it depends on the situation. Is it a med that is unsafe for some reason? Or is it a personal moral dilemma- like giving birth control, or assisting with an abortion, administering blood, etc. What in the journal article made you feel unsafe?

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Specializes in ER.

Say to the doc directly what you are concerned about- if they are right there.

If they aren't there, run it by someone with more experience, and between the two of you decide if you are going to call the doc to express your concerns.

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Specializes in ER/EHR Trainer.

There are lots of things nurses should not do...for instance, in NJ conscious sedation is performed in the ER...many physicians will encourage the nurse to administer the first dose of diprivan or any other sedating agent. It is against the law and out of our practice....many nurses do it...what if the patient tanks? Do you honestly think the doctor will help out....they'd say we know our scope of practice.

Many medications potentiate each other, or the patient is naive to them, or their vitals and current conditions do not support dosing. I will not give them if I am uncomfortable.

We are the last line of defense for the patient....in that same vein, our license is on the line when we medicate. If I have any questions, I always ask them....check my med book....check with pharmacy....and finally, advise the physician of why and how something was administered or not. No one is infallable...not the doctor...not me. Either way the patient suffers if we don't work together

Maisy

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Specializes in Critical care, tele, Medical-Surgical.

Many times over the years I have asked a physician to explain the rationale for a medication or treatment.

Often it seemed wrong to me but the explanation cleared it up so I could go ahead.

This has been in person or over the phone.

Once i had to call a surgeon at 3:00 am because there was no urine in a ureterostomy tube. He told me to "Flush it vigourously with 30cc of saline."

I told him i could not do that and he was very angry. I woke up the resident who came to the bedside. That MD called the surgeon again. I was then ordered to slowly instill o.5 cc of NS.

Clearly the sleepy surgeon heard ureter and thought urethra.

In the morning he thanked me for not doing what he said.

Of course the charge nurse and shift supervisor were informed. This whole thing took about ten minutes.

PS The urine began flowing at least the 10cc/hour that was the goal.

We must not administer a medication or perform a procedure unles we are competent and know it is appropriate for this patient at this time.

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Specializes in CCRN, ATCN, ABLS.

The last time I question a provider, she had order a patient with terminal CA to be NPO (patient was on calorie counts x 3 days, d/t emaciation-poor intake). She ordered 40 mg. lasix as well.

I often question orders in a way that is not threatening, such as: Could you tell me the kind of test this patient is having tomorrow that she is NPO? She is on calorie counts...

Provider looked at her orders, then her notes, then asked me: Have you given her the lasix yet?

-No

-Great. Let me D/C all these orders. I entered them on the wrong pt. (Computerized order entry here)

Sigh....

When in doubt, ask for clarification. I always ask, even if it makes me look stupid. I have caught many an error and I have also learn a lot about why providers order different things. Good luck. Providers can make a lot of errors. Seen it much to often not to question....

wayunderpaid

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Specializes in RN, BSN, CHDN.

I would run it by my charge nurse and then follow up with the doctor, but I certainly would not carry out an order I felt was unsafe no matter what.

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