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.

Refusing a doctor's orders IS insubordination. That's pretty much the definition of the word. Placing a PICC poses no clear or inevitable threat. Therefore you have no right, as a nurse, to refuse the order. That's not your call to make.

There may be no grounds for refusing to place the PICC line. But I think that you are going to far to say that as a nurse you have no right to refuse the order.

We couple of months ago I attended a mock trial presented for the Texas Nurse's Association. The nurse lost her license because she followed a Doctor's order that she had strong doubts about. The nurse had questioned the Doctor twice and the Doctor insisted that she give the Med. The patient died. If you have doubt about an order - QUESTION IT. If after getting an answer you still feel that the order is wrong, refuse to carry it out. If it is a med, make him/her give it. If it is a procedure make him or her do it, or let your charge know.

I also, heard from a the CNO of a major hospital relate a case of two nurses refusing to carry out a Doctor's orders that they knew to not be best practice. Their charge stood by them, their unit manager stood by them, and ultimately the CNO stood by them. The Doctor stood corrected.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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 appreciate you opinion but a nurse has every right to refuse to perform am order. I don't know how close to graduation you are or if you have a medical/legal class yet to go.....but a nurse is help responsible for your actions.

While I agree that if you go around refusing every order you see will get you fired......it is a nurses responsibility to refuse any order that she feels is, unsafe, unethical, and not keeping with in the standards of practice. If a physician tells you to act outside the standards of practice, tells you to give a med that is not appropriate to the patient or at a dosage that is not appropriate and harmful to the patient.......a nurse has an obligation to the patient to question the physician and it is her right to refuse. For at the end of the day.....if you give that drug or perform outside of your scope of practice and the patient is harmed.....YOU will be held accountable because you gave it. YOU are the last safety net for the patient. It is your job to refuse and protect yourself and the patient.

If that MD told you to give 100mgs of MSO4 IVP, you give it, the patient codes/stops breathing and dies.....it's your fault, not the MD's because YOU should have known better than to give that med. Saying the "DOCTOR told me to" will not save you from being fired, sued, held liable, having your license revoked and possibly charged with manslaughter. It is your fault because you gave it and you as the nurse knows better that to give that drug in that amount IVP.

Frankly.......I could care less how much schooling the MD has......I have met a few educated idiots over the years. Physicians.......even the good ones.....they make mistakes sometime and it is our job to make sure they don't kill someone. It is well within my scope, and obligation, to refuse an order that I don't deem appropriate for the patient.

I don't advocate refusing every order you see......but if it is wrong or inappropriate it is my obligation to refuse. I start off sweet, for you catch more bee's with honey, but eventually I will make it clear......If they want it done they need to do it themselves.....That is my final answer.

You may want to question or 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 am still a nursing student but even I know that the doctor's first degree means very little in their scope of practice so that's not really a good arguement in their favor. I've taken pre-med classes and honestly Nursing school classes are a lot harder in general.

That aside, even as a nursing student I have refused to do what the well-learned and well-meaning doctors have ordered, not because the doctors have posed any real threat to the patient but because the doctors hadn't thought the action through completely, and the nurses backed me up. Doctors are stressed out and grumpy have of the time and lose their focus easily if aggravated, as does every human being. Truly not a big deal to disagree with another human even if they are more knowledgable in an area of study. That prompts best evidence based practice and a unified, and respected, health care team. Following the doctor's orders just because he or she is a doctor is silly. And refusing to listen isn't what she was saying. She was saying refusing to insert a PICC because she didn't want to cause more harm than good for the patient and her own beliefs of the patient's best care didn't line up with the doctor's (who refused to listen to her by the way). Therefore the doctor should be held liable for that particular action, not her. If the doctor is as high and mighty as you make him/her to be, why not let him/her place the line?

I don't think it is possible to lose your license for refusing a doctor's order if you can prove that his order was a bad idea. You can lose your license for not refusing an order though, but that goes with causing a death or permanent damage and you'll probably get sued first.

Also, she obviously did place the line sooooooo back off a bit? And what does "by the point" mean? By what point? There wasn't much of a point.

Specializes in Short Term/Skilled.

Recently I was talking to one of my favorite docs about common sense and how some people don't have it...... anyway he said "ya know what they call the person who graduates last in his class in medical school?" I said "no..." He said "doctor"

"No day but today"

Nov 14 by Esme12 Quote from DesireeRN2011

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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.

Hah...if I had a CVC in the IJ or subclavian I so totally would have. We had no other options for access (they had even tried on the pt's feet to establish access in the ED), and I was concerned about the risk of infiltration in the neck with potential for compression/increased pressure on the carotid arteries and/or pressure on the airway. On a neuro unit (like where I worked then), our patients usually had enough issues without potentially jeopardizing respiratory function and/or (greater potential) cerebral circulation. Plus, the facility's policy/procedures for IV fluids/IV medications allowed a rate of up to 100 ml/hr for maintenance fluids on an IV pump and/or a rate not to exceed 150 ml/hr for medications/fluid boluses. At least, that was where peripheral cannulas in the IJ were concerned.

In the past I have had the same problems with a doctor ordering PICC lines on patients that were on no IV medications, being discharged home on no IV medications (the PICC line would have been in less than 12 hours) patients that were contracted and for one time use for a CT. I also was told that even if the patient refuses the PICC line I had to place it because the doctor wrote the order. I also was told that I would be fired. When I told management that it was against the nurse practice act and the patients rights, I was told to product the nurse practice act and show a law, rule or regulation that would be violated. What law rule or regulation would be violated?

Brandon you are very wrong. There are a lot of risk with placing a PICC line and the risk after a PICC line is placed.

....... I also was told that even if the patient refuses the PICC line I had to place it because the doctor wrote the order. I also was told that I would be fired. When I told management that it was against the nurse practice act and the patients rights, I was told to product the nurse practice act and show a law, rule or regulation that would be violated. What law rule or regulation would be violated?

Whoever told you that is flat wrong - ask them to produce written confirmation of what they told you....and that they might want to consult the legal dept.

In the U.S., a patient has the absolute right to refuse any test, treatment, medication or procedure as established by all or part of the 1st, 4th, 5th, 8th, 11th, and 14th amendments to the constitution, and has been repeatedly upheld by case law.

To proceed anyway after a patient's refusal is an act of battery and is a criminal act in all 50 states. Anyone who does so opens themselves to the potential of both criminal prosecution for the battery and civil action for the rights violation.

I have never seen anyone fired or otherwise disciplined for complying with a patient's right to refuse - I have more than once, however, seen an employee fired or disciplined for attempting to force something on a patient that they have refused. Attempting to coerce or intimidate a patient is also a major violation of CMS rules governing patient's rights, and can result in the facility being penalized.

I may be brash and I haven't read all the comment. But why would you work in an environment where you cannot question a doctor? Sounds toxic. I would quit. TeamSTEPPS anyone? Same team same fight.

Specializes in Critical Care, ER and Administration.

You need a very good reason to refuse a physician's order. You should first talk with the physician along with your concerns. If you still feel you cannot follow the order, you need to start climbing that leadership ladder. Talk with your charge, manager and supervisor. If needed your manager or the supervisor have access to the medical chief of staff. Document everything. Refusing an order is a big deal.

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