Refusing Orders.

As a Critical Care nurse, I once refused to participate in a code. The patient (ventilated with multi-system failure) had clearly expressed his wishes for DNR, but his family refused to support this - so the physician had not written a DNR order. The inevitable happened in the middle of the night. . . (I was charge, it was not my patient). The responding physician and staff had begun resuscitation by the time I arrived. I told the doc that I would not participate.... he looked at me funny but kept on with the code. Sure enough, the pt did not survive. I just knew I was going to be fired. The doc asked to talk to me & I explained my reasons... he just said "I understand and respect your decision". Nothing happened to me. No write-up, no discussion, nothing. I felt good about what I had done.

In Tx, the 'captain of the ship' doctrine that gives the physician absolute control of any clinical situation.... is not supported. RNs are expected to not only question any orders that are unclear/illogical, but to intervene to prevent potential harm to the patient as part of our legally defined "Nurse-Patient Duty" that was established in 1983 as a result of the landmark case of Dorothy Lundsford. Position Statements

Refused....? More like "Clarified". As in "I'm sorry, New Doc Writing Lots of New Orders, but this med is only available as PO (mult. forms) or suppository---not IV. How would you like it given instead?". Clearly giving it IV would have resulted in serious harm to patient.....so I didn't "refuse", I just "informed" :)