Worried That Doctor's Orders Will Hasten A Patient's Death

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So I am not a nurse yet, but I would like to enroll in a community college to become one. My concern is that when a doctor orders me to draw blood 2-3 times a day to an elderly patient, this will hasten their death. Or if he orders me to give them morphine or something which also accelerates a patients death. I am not being cynical or anything. I know doctors are out there to help people. But I just remember a time, where a nurse would draw blood from my grandma three times a day, and the head nurse shouting "this is BS, THE LABS DONT NEED THIS MUCH" And the doctor refused to listen to the head nurse and said the blood is a must for lab work.

I really want to become a nurse, but this has put fear inside of me. As a nurse if I feel it's too much blood to draw from a patient- do i have the right to tell the lab and doctor, "sorry, if we take anymore, the patient's death will be hastened."

plz helps, I'm scared on this.

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The usual amount of blood taken for a CBC is max 7mL, a BMP is 4mL according to our vacu-tubes. This is just shy of one teaspoon of blood. ONE TEASPOON. That will not hasten death. The average woman loses twice that each period.

MORPHINE DOES NOT HASTEN DEATH. get that out of your mind right now.

You only saw a snapshot of an interaction. You have no clue why the nurse was 'screaming' (sounds like there may have been other issues in play I'd she was screaming in front of family). Or why the doctor ordered those tests.

You might want to actually observe a nurse for a day, if possible, because it appears you have some seriously wrong misperceptions of nursing, lab work, morphine, and physicians.

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I have never seen too many blood draws put someone at risk for dying sooner. With those blood draws, they can tell a lot about the patients condition (such as if they need blood) and how to treat what is wrong with the patient. Some labs do need to be done more than once a day, or some have to be timed in order to dose medication so that it is both effective but not toxic to the patient. I do believe that we should try to minimize the times that we have to stick the patient (which there are ways to do this but they have their possible complications as well) if simply for the patients comfort and not feeling like a pin cushion, but the benefits of having those labs are going to outweigh the cons.

As far as Morphine goes, as a nurse you will know how to assess the patient. If they are unsafe to administer the medication then you would call the doctor to see if there was an alternative form of medication that could be given to decrease the patient's pain. If the patient is comfort measures only and is dying, then the morphine should be given for comfort and without regards to their respiratory rate. I do not know how many times in the past I would see a patient in pain and the med was denied because their respirations were too low (this was at a time when more patients became comfort measures only in the hospital and were not always transferred to a hospice house or other facility). I had a doc actually get so irritated by this that they wrote "patient is COMFORT MEASURES ONLY. Give pain medication when needed. Do not hold for decreased respirations!!!".

So, when it comes to if you can refuse to carry out an order, well, yes, if it's dangerous. You would need to contact the doctor and explain what is going on, he/she may or may not agree to change it. If you still feel it is unsafe then you would need to go through your chain of command to see how it would be handled next. You would learn in nursing school what is considered safe and unsafe. You would never do something that is unsafe for your patient, but when you contact the doctor you will need to have a valid reason for questioning the order and if it is still not changed you will need follow up on it per your facility protocol.

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You have no idea how much you just comforted my heart knowing this. I was seriously beginning to fill up with anxiety, because I really want to be a nurse to help others and dont want to hurt them. All nurses feel the same. One more question my dear friend, if hospital staff know the person is dying, will they start to back off from the 2-3 times blood drawing and just do it once daily...? Thank you so much nursespeedy god bless u.

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You have no idea how much you just comforted my heart knowing this. I was seriously beginning to fill up with anxiety, because I really want to be a nurse to help others and dont want to hurt them. All nurses feel the same. One more question my dear friend, if hospital staff know the person is dying, will they start to back off from the 2-3 times blood drawing and just do it once daily...? Thank you so much nursespeedy god bless u.

Can't say. It all depends on why the pt is dying, if it's a reversible process, what the pt's wishes are, and how badly the labs are needed to guide treatment.

Stop worrying about lab draws. If you're still stuck on your grandma, work on that before attempting nursing school. Also, don't be trying to second guess doctors when you haven't even started nursing school.

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Specializes in ICU.

Why do you think drawing labs hastens a death? Because of that one interaction? That nurse could have been stressed over a million other things and drawn my labs again might have pushed her over the edge.

Labs are important. Even in dying people. Morphine is especially important in dying people to keep them comfortable.

I agree that you need to shadow a nurse. You need to see the job and what it entails. I think you have very big misconceptions about nursing as a whole. You seem to have a romanticized notion about the whole thing to begin with, then have anxiety over physicans and what you think they do. Call a local facility and shadow for a day.

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Specializes in Flight Nursing, Emergency, Forensics, SANE, Trauma.

Labs don't hasten death my dear. It's such a minute amount of blood. And if someone is on comfort care, they do back off. But if they are being treated for something, you often have to recheck levels frequently. (blood glucoses, potassium, cardiac enzyme, renal function, WBCS, etc)

There is a rationale. And the small doses of morphine we give won't kill anyone unless they have a severe morphine allergy. In reality in the patient that is actively dying, morphine can make the process more comfortable. It's not a terrible thing.

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Specializes in CMSRN, hospice.

I'm really just here to echo what the folks above said.

Labs are your friend. They provide information to help guide and evaluate treatments. If labs are ordered, chances are the doc had a good reason. They are humans too and not infallible, so there is the occasional discussion a nurse may initiate about why something is ordered, is it necessary, etc. It's a dialogue, and most nurses and physicians work together to make sure the tests being done are appropriate. I have never heard of a case where so much blood was taken for labs that it severely harmed a patient. It is a very small amount that is taken. If a patient is terminally ill and wants comfort measures only, they will generally back off on labs. I have drawn blood from terminally ill patients before because we were trying to determine the cause of symptoms that were affecting the patient's quality of life. Again, small amounts of blood, not going to hasten their death, and for a justifiable purpose.

Regarding your concern about morphine: as a hospice nurse, I just die a little every time someone says that morphine kills people. IT DOES NOT. Used appropriately, comfort care measures such as morphine have been shown to actually extend the life of terminally ill patients in some cases. Their bodies aren't being as worn down by pain, and they have a greater quality of life for their remaining time. I have had several patients who were breathing 40-50 times per minute (normal being 12-20) who received morphine (or Dilaudid, or whatever) specifically to decrease their work of breathing. If a patient's goal is to be comfortable at end of life, morphine is often a very helpful tool to meet that goal.

Please find an opportunity to shadow, or even interview, a nurse. I think it will really expand your view of what nurses do and observe. Mostly, I don't want you to worry that there are all these evil docs writing orders that will harm their patients. Yes, nurses are responsible for following orders, but we are the ones giving the docs our assessment findings and helping administer and evaluate treatments. Most physicians are NOT idiots, have the best interests of the patient at heart, and will work with nurses to take good care of them. In the instance that a nurse feels an order is unnecessary or dangerous, they will talk to the docs and go from there.

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Thanks again for your advice :) . I have stayed overnight and in and out of a hospital with an aunt for 7 months before and with my grandma. Also I have a cousin who is a nurse... but I guess most of the fear comes from family members who have not taken medical studies sadly. For instance I remember my grandma's edema in her feet. And my family refused to acknowledge this. They kept saying it was caused by some kind of herb. And my grandma died like three times in the house, but was revived in cpr. Then when she died at the hospital all the family started saying she had a chance to live and it was because the hospital took off the oxygen that she died, others started saying it was because too much blood was drawn out, others say it was the change in her medicine. No one wanted to acknowledge the old age or that she was diabetic, she had stress issues, and was overweight. I think all they yelling from family attitudes and their lack of knowledge built in me a fear of hospitals. Ive been told since I was young the hospital is a place to die, where the student doctors are just practicing for the money etc etc. And the nurses are vampires. And for a while I started to believe that to hospitals we are just a number and not a patient.

But now I really want to bust all these myths my family instilled in me and begin to educate myself. My family is all on natural medicine and i like natural medicine too, but you need a balance of both alternative and medical areas of study. Whats the point on relying on natural herbs if one is already damaged organs in their body and need medical assistance at the hospital. Doctors arent out there to get us. I really wish to gain knowledge and not be in the dark anymore. So I apologize if my questions seem really negative or stupid. MY family is really supserstituous, phobic people and I dont want to be like that anymore. Reflecting on it now, my grandma wouldve died earlier if the paramedics didnt shock her or do cpr. Hospital staff really do save lives and they mean well. And I want to save lives too one day and be a great nurse. I really want to learn and am interested in cells and how the body works. I want to gain knowledge so that I can prevent my family from going to the hospital in the first place, and to be able to know what to do in case of an emergency. Thank you so much for your comments you always answer me. Thank you i appreciate it.

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Specializes in HH, Peds, Rehab, Clinical.

Oh boy. Your fears are completely unfounded.

So I am not a nurse yet, but I would like to enroll in a community college to become one. My concern is that when a doctor orders me to draw blood 2-3 times a day to an elderly patient, this will hasten their death. Or if he orders me to give them morphine or something which also accelerates a patients death. I am not being cynical or anything. I know doctors are out there to help people. But I just remember a time, where a nurse would draw blood from my grandma three times a day, and the head nurse shouting "this is BS, THE LABS DONT NEED THIS MUCH" And the doctor refused to listen to the head nurse and said the blood is a must for lab work.

I really want to become a nurse, but this has put fear inside of me. As a nurse if I feel it's too much blood to draw from a patient- do i have the right to tell the lab and doctor, "sorry, if we take anymore, the patient's death will be hastened."

plz helps, I'm scared on this.

Up Vote Up Vote ×
Specializes in HH, Peds, Rehab, Clinical.

Step away from the blood draw topic. Far away.

You have no idea how much you just comforted my heart knowing this. I was seriously beginning to fill up with anxiety, because I really want to be a nurse to help others and dont want to hurt them. All nurses feel the same. One more question my dear friend, if hospital staff know the person is dying, will they start to back off from the 2-3 times blood drawing and just do it once daily...? Thank you so much nursespeedy god bless u.
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Specializes in Critical Care.

Hospital-aquired anemia, which is primarily caused by lab draws, is an established risk to patients and can influence outcomes, although this could be better recognized by physicians and nurses. If you want help address this problem then that's all the more reason to be a nurse. Culture's seem to vary, but in general a nurse who doesn't feel that a lab is warranted doesn't draw them, in the ICU we draw maybe 2/3's of ordered labs on patients, we have to agree they serve a purpose in directing care for the patient.

Tackling Hospital-Acquired Anemia - AACC.org

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