When you don't agree with the doctor...

[lm8539]

Hey nurses- have any of you ever been in a situation where you did not agree with the doctor's plan of care? Or a situation where you were asked to do something/ give a med/ etc that you felt would jeopardize your license harm the patient? If this happens I know you should not perform the task, and you should explain to your superior/ the doctor your reasoning, but what if they don't agree with you and want you to do the procedure anyway? Would you just tell them that they have to do it themself? or get someone else to do it?

[highlandlass1592, BSN, RN]

Depends upon the situation, no real cut and dried answer. Each episode has to be weighed carefully and considerately. Yes, I have refused an order from an MD that I felt put the pt at risk and told her if she wanted it done she'd have to do it. (There was a negative outcome for the patient, which was sad.) Risk management got involved, wanted to know why I didn't "stop" the doctor, told them I had done all I could do including involving her superior. You have to walk carefully though cause it could cause you to be fired.

[cookienay]

As a nurse it is not really in our scope of practice to "agree" with the physician's plan of care. However, it is in our scope of practice to be proficient in administering medications and treatments included in the plan of care. If you as the nurse feels the prescribed treatment would jeopardize the patient's well-being or if the patient would not tolerate it then it warrants being discussed with the physician.

For example, Dr. Feelgood orders XYZ medication for diagnosisX. The nurse feels that ABC medication would be a better choice. This is not in our scope of practice to decide. However, on the flip side you also know that XYZ medication can cause a certain side effect and this would possibly harm the patient. THen at that point we would call the good doctor and discuss this, which most definitely is in our scope of practice.

A hundred years ago as a new nurse, I had a physician order a medication for a patient and I was like "What??". FEaring the patient would not tolerate the med, I called the MD and he explained his rationale and the intended effect. Satisfied with his explanation the medication was given and pt. tolerated it fine. Conversely, another patient developed bradycardia and hypotension and the MD ordered Calan 80 mg IV. (I can hear all the older nurses gasping right now). Needless to say, the physician did not know what he was talking about and the RN refused to give the medication. He got angry because the RN "cancelled his order", to which she reminded him that she did not cancel the order, she simply refused to carry it out. The patient then lived to fight another day.

Most physicians are reasonable people (surgeons not included- LOL). IF you approach it as an advocate for the patient, it has been my experience that they will listen to your concerns. Just be sure to document and include your charge nurse in the deal.

[cookienay]

As an addendum-I have also said "I am not doing that. If you want the patient to have that, do it yourself." Sometimes the situation calls for that, but rarely.

[Jules A, MSN]

So far I haven't been asked to do anything I felt was unsafe just a few things I didn't think were optimal. It depends on the Doc and the situation but mostly I would question the order in a non-argumentive way. Something like, "oh I was expecting an order for XYZ" med. Many times they will give me their rationale which allows me to learn more and sometimes we just have to agree to disagree and I defer to their orders and every once in a while they will say, "ok we can go with that". FWIW I would not question an order in an emergency situation unless I was really concerned about it being unsafe.

[PostOpPrincess, BSN, RN]

Often.

I have a good relationship with most of the docs to say, "I'm not comfortable with that and then hand them the med." They don't push the issue...

[Batman25]

If I was uncomfortable I wouldn't do it. Your job is to advocate for your patient and if you truly feel the wrong decision is being made hold firm. Let the doctor or your superior do it if they think it is the right move. I would never do anything I couldn't defend in a court of law or anything that would jeopardize my license. Better to be safe than sorry.

[Willow Moonsidhe]

I have handed medication to a doctor before in trauma when the dose was an overdose on a child with narcotics. I have refused to do things over the years I knew would injury a patient. You have to be nice about it and not a jerk when speaking with the doctor though; unless they insist and become a jerk. Just make dang sure your view point is the right one. Once I can remember being blunt about CPR and intubating a 82 y/o/f with terminal CA and a DNR order. It is what I would have wanted a nurse to do for one of my loved ones. Remember you carry a license same as the MD and you both put pants on one leg at a time.

~Willow

[LiverpoolJane]

I often disagree with the Drs decisions, but then Drs frequently disagree with other Drs decisions. I hate when I can't allow people to die with dignity because some Drs think just because we can intervene we should. I work in renal and have had to dialyse patients in their 90's with multiple comorbidities and I can't think of one that has survived more than a couple of weeks. Rather than be made comfortable, we put CVCs in them and then put their already dodgy heart through another insult. Quite often the patient is too poorly to make any rational decision so the family are often left with the burdeon of accepting treatments they have little understanding of. I don't have right to refuse to dialyse these patients but I am vocal in expressing my distaste of the unnecessary distress we are putting our patients through.

[mamamerlee, LPN]

I once refused to give Dig to an infant; I felt that the doc had the decimal point in the wrong place, and the dose was 10 times too high. Of course it was night shift, and the night supe 'couldn't remember how to calculate pedi dosages'. This was many years ago, and the supe had to call the attending at home (we staff nurses didn't have that privelege) and she would NOT call. I even showed them how much med would be in the syringe.

I steadfastly refused. The doc gave the med. The baby died. He was extremely ill to begin with, so no one told the family exactly what happened.

About a week or two later, the attending told me that my math was correct.....

[TwilightRNurse]

There have been occasions when I knew the doctor wasn't thinking straight and wrote an incorrect order and I've called them to question it and they have been thankful that I was looking out for them.

There have been occasions that I knew the doctor wanted me to give exactly what they had written and I've referred the order on to the nursing supervisor and let her/him deal with it.

[meluhn]

If ever I am in doubt about an MD order,sometimes I call and ask if thats what he really meant. Or I run it past another MD that I trust so that I can either hear the rationale and feel better about it or have the MD talk some sense into the other MD or over rule him altogether. Usually the primary md defers to the consulting one but if something is crazy, they will say, "No way, not a good idea".