What to do about refusing Dr. orders?

I am being told I will lose by job if I refuse to follow a doctor's order. The doctor ordered a PICC line on a patient just because she might need it for Amiodrome. She was post op open heart and had not been on any drips requiring central placement for over 12 hours. She still had a cordes in that was going to be removed. The patient was currently on saline drip only. She also had veins for a PIV. I did not feel the PICC line was appropriate. When I raised my concerns, I was told to put it in anyway. I was told I could be fired for insubordination if I refused to follow the doctor's order. Because of this, I placed the line. Other nurses have been told the same thing. We are being told that we cannot say no to this doctor even if we feel the ordered treatment is inappropriate. I can not afford to lose my job or my license. Any suggestions on how to proceed would be most welcome.

But I stand by my original point that *disagreement*, in and of it's self, isn't justification for the flat out refusal of an order. It's justification for seeking clarification and consulting with other nurses, of course. But to get said clarification, and then still refuse to carry out the order is a bold step. I'm not saying it's never called for, but it's an extreme measure. We will disagree many of the courses of actions doctors choose. Is that justification enough to refuse? I know this is a nursing message board, but I'd be interested to know a MD's thought on the subject.

30 mg dilaudid would have probably killed that pt. You saved their life. well done.

Just today a pt had last the previous day and K+ was 7. Yes....I said 7 lol. They had gotten kayexelate the previous day and CMP had been redrawn for today and resultss were pending...

Well doc came in the am and ordered more kayexelate based on the 7.0. Well, I did not refuse but I did hold off. K came back 4.7 so obviously I did not carry out that order. Doc came back and said thank you later......

He is an awesome doc btw.....come to think of it...all of the docs at my facility rock.

I am a tough little guy....but when I sit and reflect on our docs I admit I get a little misty eyed....they are absolutely THE BEST. I would walk through a wall of fire for them and I will protect them even if that means upsetting them from time to time......

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
30 mg dilaudid would have probably killed that pt. You saved their life. well done.

Just today a pt had last the previous day and K+ was 7. Yes....I said 7 lol. They had gotten kayexelate the previous day and CMP had been redrawn for today and resultss were pending...

Well doc came in the am and ordered more kayexelate based on the 7.0. Well, I did not refuse but I did hold off. K came back 4.7 so obviously I did not carry out that order. Doc came back and said thank you later......

He is an awesome doc btw.....come to think of it...all of the docs at my facility rock.

I am a tough little guy....but when I sit and reflect on our docs I admit I get a little misty eyed....they are absolutely THE BEST. I would walk through a wall of fire for them and I will protect them even if that means upsetting them from time to time......

*** Your docs obviouslt take their job as LEADER of the care team seriously and actually lead the other members like nurses, for them to inspire such devotion in the nurses.

Nurses are kinda like a herd of cats. You can't stand behind them and drive them with a whip. You have to stand in front of them and lead.

You hit the nail right on the head friend....they are true leaders in every sense of the word....I love all of them dearly and so do their patients

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
You hit the nail right on the head friend....they are true leaders in every sense of the word....I love all of them dearly and so do their patients

*** Ya I too have been and am lucky enouh to work with similar physicians and there's nothing the nurses woulnd't do for them. Still doesn't mean I won't question their orders if needed. Once recieved and order from just such a doc for "baked potato PO BID". I wasn't even sure when I called if he was actually awake. I waited 15 min and called the great doc back to say:

Me: "Hey Brian just letting you know I am holding your last order for baked potato PO BID"

Brian: Oh man I didn't order that did I?

Me: Uh ya man you did.

Brian: How about Lopressor 5mg IV now?

Me: SURE! Will get right on it. BTW thank goodness you said PO cause who knows what I would have done with it.

Brian: LOL!, see you in two hours PMFB.

*** NS at 250 and hour would be a faster maitence IV rate, not a bolus at my hospital. We (the RRT) will run bags of NS with pressure bags or with the rapid infuser through EJ 20ga (usually placed by nurses here). What is the rational for refusing that order?

At the facility I worked at at the time, maintenance fluids were not run that fast. Usually maintenance fluids topped out at around 125 ml (always room for exceptions). Policy also indicated that we were not allowed to run IV fluids through an EJ at a rate of 250 even on an IV pump and that EJs were a physician inserted access. I think our IV team had some RNs with that competency but outside of that, we weren't allowed to do so. That's the thing about policy - you have to define your practice with respect to your policy/procedures. We didn't have the rapid infuser available outside of ICU or OR at that facility. I recognize some facilities allow RNs to stick EJs and some allow fluids to go that fast through them - I didn't work in a place that allowed it on med/surg/tele.

Specializes in Public Health, L&D, NICU.
*** Ya I too have been and am lucky enouh to work with similar physicians and there's nothing the nurses woulnd't do for them. Still doesn't mean I won't question their orders if needed. Once recieved and order from just such a doc for "baked potato PO BID". I wasn't even sure when I called if he was actually awake. I waited 15 min and called the great doc back to say:

Me: "Hey Brian just letting you know I am holding your last order for baked potato PO BID"

Brian: Oh man I didn't order that did I?

Me: Uh ya man you did.

Brian: How about Lopressor 5mg IV now?

Me: SURE! Will get right on it. BTW thank goodness you said PO cause who knows what I would have done with it.

Brian: LOL!, see you in two hours PMFB.

I got an order in the middle of the night for "20cc of saltine crackers." I had called with ABGs expecting vent setting changes for a NICU baby. I paused, asked if they were really awake, and then asked where they kept the saltines in the NICU. This woke them up! I got a laugh, a thanks, and reasonable order.

Specializes in Oncology.

I once received an order for Halaven order (for a man!) that was meant to be Haldol. I also once received an order for Maalox IV. I had to explain to the fellow that Maalox doesn't come IV. He truly thought it did. In the opposite arena, I had to inform another doctor that PO Tylenol wasn't the best choice for someone with severe mucositis (so bad they were considering intubation for airway protection) and a 106 degree fever and that we DO have IV acetaminophen.

Specializes in ICU.
I once received an order for Halaven order (for a man!) that was meant to be Haldol. I also once received an order for Maalox IV. I had to explain to the fellow that Maalox doesn't come IV. He truly thought it did. In the opposite arena, I had to inform another doctor that PO Tylenol wasn't the best choice for someone with severe mucositis (so bad they were considering intubation for airway protection) and a 106 degree fever and that we DO have IV acetaminophen.

As I'm sure you're aware, not everywhere has IV Tylenol...I just saw it for the first time recently...I was like Whoa! Are we in England?

The IV maalox and saltine crackers in response to ABG results are pretty great, haha

I think the confusion in this thread is over what the word "forced" order means.

A hospital can, and will, "FORCE" you to do an order you dont agree with by firing you if you fail to do it. Are they going to send you to jail? Of course not. Are they going to put a gun to your head? Of course not. But they DO have the authority to FIRE YOU if you refuse to follow a doctor's order. Doesnt matter if you are a floor RN or a PICC nurse or whatever. Most of the time it doesnt come to that. If a nurse disagrees, then the doctor either does it himself or finds someone else to do it. The doc files a complaint and then the hospital committees have to figure out what kind of action to take, if any.

There are many shades of gray when it comes to refusing doctors orders. Everybody agrees that the nurse has a duty to refuse OUTRAGEOUSLY WRONG orders such as giving 500mg of morphine. However, in the more "gray" areas such as this, physicians should get more deference. Whether to place a line or not is a judgment call, there is no black/white, right/wrong answer like there is with the morphine dose.

In cases involving "judgment calls" like this, the nurse should ask for clarification first. Most of the time I would argue the nurse should defer to the physicians' judgment on these types of things. Again, there is no clear-cut right/wrong answer, and when that occurs the physician has the extra training to make the final call and generally speaking should be given that deference.

Specializes in Oncology.
As I'm sure you're aware, not everywhere has IV Tylenol...I just saw it for the first time recently...I was like Whoa! Are we in England?

The IV maalox and saltine crackers in response to ABG results are pretty great, haha

Yeah, I'm aware IV Tylenol isn't common. I was really surprised the first time I saw it. It still isn't common. Our pharmacy limits it to NPO patients. The doctor was happy when I told him we could give it IV since rectal also wasn't an option in this patient due to thrombocytopenia.

Specializes in Oncology.

As much as I've been defending the nurses' rights to refuse orders in this thread, I should mention that I probably wouldn't have disagreed with placing a PICC in the above scenario.

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