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.

Specializes in Med Surg.

Not totally on topic, but IV tylenol is great stuff. We use it on some of our post op ortho patients and it helps tremendously with pain control.

As far as the whole "are nurses subordinate to doctors" question, I am terribly naive and old-fashioned: I believe that, for the much greater part, we are, and that in the majority of cases, healthcare, when it works properly, works like this).

It's a common lay error to confuse the legal responsibility for a registered nurse (and via delegation, LPN/LVN and CNA) to implement certain parts of the medical plan of care, which we do have, with nurses being subordinate to physicians, which we are not. Physicians do not hire, manage, or evaluate nurses (except the ones they hire in their offices, for example). Anyone who says nurses are subordinate to physicians is someone who does not understand the scope and standards of RN licensure and practice, which, personally, makes me crazy to hear out of the mouth (or fingertips) of an RN.

Nothing could be farther from the truth. This really awful mistake flies in the face of the ANA Scope and Standards of Practice that do, in fact, govern the practice of nursing in the US regardless of the state nurse practice under which you are licensed.

Nurses, real nurses, know the difference (or should go look it up right away and never forget it), and should never miss an opportunity to educate those who do not.

Specializes in Occupational Health.

Well said Brandon

Specializes in Med-surg, IP surgery.

Hell, I got the best commendation from our CEO for doing just that. The MD kept telling me to DC the telemetry because the pt kept showing RVR and had NO hx of heart probs. Over and over I refused his orders and the RVR reports kept coming in. Told my charge RN and my floor manager. Put the dude off until another MD from the group came on and the person went straight to ICU! Cheers for me, they lived! First time I felt like a REAL nurse! Sometimes we just know.

Specializes in ICU.
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.

You may want to question double check with the doctor about the order, and perhaps question the reason behind it. But to refuse to listen to the doctor?? You are a nurse and go to school for 4 years or less. The doctor went to 4 years of college while taking pre-med classes, which are alot harder than the pre-reqs taken for nursing. Then he goes onto medical school for 4 more years, then a minimum 3 years of residency, and by the point, he knows more than a nurse will ever know. And you have the nerve to refuse to listen to him? You should be fired if you continue this behavior.

Specializes in Critical Care.

A good Nurse, when absolutely appropriate and necessary, does not follow all Doctor's orders. You as the Nurse are ultimately responsible for any orders you follow, the MD who wrote the order is typically less responsible than you for an inappropriate action related to an order.

MD's definitely have more knowledge and schooling than an RN in a general sense, although you'd be incorrect in assuming MD's know more than Nurses on all patient care topics. Good MD's know where their expertise ends, and typically a PICC RN is more knowledgable about PICC's than any MD. There's a reason why the Doc's I work with write "Pressure ulcer care per Nursing", they wouldn't know where to begin with that. That doesn't mean they know less, it just means they're expertise, and our expertise, lie in different areas. For the vast majority of MD's, an assertive Nurse is very much appreciated.

I'm always concerned when I hear a Nurse say we should never refuse an order, that's where most of our value to patients lies. No court or BON will show you any mercy because you say "it's not my fault, the Doctor ordered it". I don't think asserting your legally required obligation to clarify, question, and ultimately refuse bad orders is a reason to get fired, failing to do so on the other hand is. That's the service you provide to patients, if you're not doing that then you're failing your patients.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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The only thing I refused - was in person having a discussion with a physician. Physician (momentarily forgetting pt's IV access and refusal for line placement) orders the standard fluid bolus for hypotension - 500mL over 2 hours through a peripheral IV cannula (20g) in the patient's external jugular (placed by a physician in the ED because the patient had literally NO other veins)... Otherwise it's more of a conversation. PICCs have some up sides and have some down sides. As a floor nurse they were amazing for a lot of patients - the ability to do lab draws and run antibiotics long term was a huge blessing - for patients and floor nurses. Some people have no options and need access and become a candidate for a central line. Others, it's convenience (like my grandmother - the PICC she had for 6 weeks was convenience more than anything).

I'm curious...why couldn't you bolus saline through the jugular?

Ha! Never mind! I should have read a little further..my bad.

Specializes in Oncology.
You may want to question double check with the doctor about the order, and perhaps question the reason behind it. But to refuse to listen to the doctor?? You are a nurse and go to school for 4 years or less. The doctor went to 4 years of college while taking pre-med classes, which are alot harder than the pre-reqs taken for nursing. Then he goes onto medical school for 4 more years, then a minimum 3 years of residency, and by the point, he knows more than a nurse will ever know. And you have the nerve to refuse to listen to him? You should be fired if you continue this behavior.

Respiratory therapists have 2 years of schooling, but I always get a crack out of watching any doctor other than a pulmonologist or intensivist write vent settings.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
You may want to question double check with the doctor about the order, and perhaps question the reason behind it. But to refuse to listen to the doctor?? You are a nurse and go to school for 4 years or less. The doctor went to 4 years of college while taking pre-med classes, which are alot harder than the pre-reqs taken for nursing. Then he goes onto medical school for 4 more years, then a minimum 3 years of residency, and by the point, he knows more than a nurse will ever know. And you have the nerve to refuse to listen to him? You should be fired if you continue this behavior.
Doctors make mistakes too. They don't know everything about every situation with every patient. I they did they wouldn't always be asking me the starting rate for dripps.
You may want to question double check with the doctor about the order, and perhaps question the reason behind it. But to refuse to listen to the doctor?? You are a nurse and go to school for 4 years or less. The doctor went to 4 years of college while taking pre-med classes, which are alot harder than the pre-reqs taken for nursing. Then he goes onto medical school for 4 more years, then a minimum 3 years of residency, and by the point, he knows more than a nurse will ever know. And you have the nerve to refuse to listen to him? You should be fired if you continue this behavior.

This god-like, all-knowing, all-wise status bestowed by a medical degree and residency will come as a huge surprise to anyone who has actually spent time in a major academic teaching hospital working with them, and ought not to come as a surprise to someone in a non-academic community hospital with docs who have been out of training and away from cutting-edge for any period of time. Suffice it to say that physicians don't know all there is to know about medicine, and they sure as heck don't know all there is to know about patient care.

More than a nurse will ever know? Speak for yourself, because you aren't speaking for the brilliant and experienced RNs I work with.

Specializes in Pedi.
You may want to question double check with the doctor about the order, and perhaps question the reason behind it. But to refuse to listen to the doctor?? You are a nurse and go to school for 4 years or less. The doctor went to 4 years of college while taking pre-med classes, which are alot harder than the pre-reqs taken for nursing. Then he goes onto medical school for 4 more years, then a minimum 3 years of residency, and by the point, he knows more than a nurse will ever know. And you have the nerve to refuse to listen to him? You should be fired if you continue this behavior.

I have refused countless orders from residents over the years. In my old hospital, the surgical service had "pre-residents" who were mostly foreign-educated doctors who could not get into a residency program and were used as slave labor. 4 years of medical school does not create an all powerful, all-knowing MD. I have had residents tell me that a patient was "fine" when I knew they weren't... and an hour later we were rushing them to the OR. So yeah, I refused to listen to the doctor (the ADULT resident) who told me that a 2 month old with a HR of 83 was "fine"... her crib was rolled straight into the OR within the hour. I refused to listen to the resident who told me that my patient (who was less than 24 hrs post-op for a complicated shunt replacement and removal of an old calcified shunt) didn't need anything more than Tylenol for discharge. I refused to discharge this patient until I had a prescription for adequate pain relief to give her. I refused to listen to the resident who told me to hep lock a patient 1 day post cerebral vascular surgery (this particular surgery required adequate hydration... usually 1.5x maintenance) when she'd taken in 200 mL PO all day and had vomited several times. I refused to listen to the resident who told me "don't worry about it" when my patient with hydrocephalus developed sluggish pupils, a bulging fontanelle, lethargy, decreased respiratory rate and desaturations. She (same patient as before) was rushed to the OR by morning. If I had just listened to the MD in these situations because he "knows more than I do since I'm Just A Nurse", the outcome could have (and likely would have) been very grave for these patients.

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.

From a student nurse who has much to learn, I would like to say the answer is simple the doing is not so simple. As a former over the road truck driver know the significance of what it cost to get and maintain a license. I often faced the delema of unscrupilous dispatchers trying to force you to do something that was clearly unethical. The choice was easy keep my license and find another job, and yes the threat of being ostersized or blacklisted was always there. However losing your and I stress YOUR licensce means no work at all regardless of situation. It really boils down to your own convictions and having a clear conscience at the end of the day.

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