Would you do it?

[ShayRN]

I got a call at home tonight from a hysterical nurse (calling from the locker room.) One of the endocrinologist wrote and order to give Humulin R 0.5 units/kg until the Blood Sugar was 40, then give D25 every 5 minutes with blood sugar checks and Cortisol checks at 30, 60, 90 minutes. She didn't want to do it and the charge nurse called the doctor and told him, he wouldn't change the order or transfer the patient to intensive. )He also had a b/p of 70/palp.) She asked if she would get into trouble for refusing to do an order she felt was unsafe. I told her HECK NO would I do it. I then called the house supervisor and had him go up to evaluate the situation. Ten minutes later he called and said the patient refused to let her do it anyway.

Has anyone else ever heard of this? What would be the rationale? FURTHERMORE! Why would a doctor do this on a STEP-DOWN unit? Wouldn't it be safer on a unit there is 1:1 care rather than 1:5 or 1:6?

Would you have done it?

[EricJRN, MSN, RN]

This one made me curious, so I had to look it up. Found several links that talk about insulin-induced hypoglycemia (IIH). Apparently it's a test that can be used in the workup of endocrine issues like Addison's disease.

I think you're right though - sounds like a pretty big gamble to take on a stepdown unit, especially if the physician was not present and this conversation was taking place by telephone.

Here's one of those links I mentioned.

http://www.thyroid-info.com/endocrine/addisons-disease.htm

Now that we have a new Diabetes/Endocrine Forum on here, I'm sure we could get some more informed answers.

[Tweety, BSN, RN]

Our endocrinologist ususally does it in the morning after being NPO all night. I've never heard of doing it that way.

But to answer your question, a nurse who is uncomfortable with any doctors orders does not have to carry it out. In fact you are obligated to use the chain of command, which is what happened. It gets a little hairy when not following the orders could potentially harm the patient, but one must never do something one isn't comfortable with.

[nightingale, RN]

But to answer your question, a nurse who is uncomfortable with any doctors orders does not have to carry it out. In fact you are obligated to use the chain of command, which is what happened. It gets a little hairy when not following the orders could potentially harm the patient, but one must never do something one isn't comfortable with.

I totally agree.. especially with a Voice Order... yikes!

[meownsmile, BSN, RN]

I understand questioning the order and the nurse being uncomfortable doing it on a step down unit. But why did she call YOU at home? Are you their nurse manager/supervisor? Is she a new nurse and was uncomfortable going to the supervisor on duty? I think it would have been handled better if you told her what to do then stepped away if you arent the manager. You shouldnt be pulled into a situation like that while not on duty and if she's a new nurse SHE needed to call the supervisor and get the situation handled.

Im dont mean to sound like im chastising you for helping, im not. But the nurse needed to find her way through this without brining someone from the outside in. I just think you would have helped her more if you gave her support and encouragement and then let her take care of it herself.

[ShayRN]

I understand questioning the order and the nurse being uncomfortable doing it on a step down unit. But why did she call YOU at home? Are you their nurse manager/supervisor? Is she a new nurse and was uncomfortable going to the supervisor on duty? I think it would have been handled better if you told her what to do then stepped away if you arent the manager. You shouldnt be pulled into a situation like that while not on duty and if she's a new nurse SHE needed to call the supervisor and get the situation handled.

Im dont mean to sound like im chastising you for helping, im not. But the nurse needed to find her way through this without brining someone from the outside in. I just think you would have helped her more if you gave her support and encouragement and then let her take care of it herself.

Sorry, I should have stated in my original post, I am the unit supervisor on the 3-11 shift. That is why she called me at home.

[meownsmile, BSN, RN]

K, thanks,, that makes a difference.

[TazziRN, RN]

I would not have done it. I have refused to carry out orders in the past and have never gotten in trouble for it.......possibly because the doctor was.......*gasp*.......WRONG???

[wooh, BSN, RN]

With non-ICU staffing ratios, I don't think anything on a q 5 minute basis can safely be done. (Quite honestly, q 30 minute or q hour is questionable.) You can't leave the room to take care of your other patients. You get called away in the middle of this for another patient, and this could go bad in a hurry. It's one thing with procedures like starting blood where after 15 minutes you're down to periodic checks, but this is going to last a while with almost constant monitoring. MDs have to be made aware that their patient is not the only patient you're caring for. I got a ridiculous order one night with similar time demands and finally just told the unrelenting MD (who luckily was a hospitalist and I had 5 other patients of her's) that I would get started on that just as soon as she wrote orders on her other patients charts that nursing care was unneccesary. That finally got the point across that I could only be in one place at a time.

[penguin2]

Surprising that the patient could refuse (let alone comprehend) the treatment w/a BP of 70/palp......

[lsyorke, RN]

I got a ridiculous order one night with similar time demands and finally just told the unrelenting MD (who luckily was a hospitalist and I had 5 other patients of her's) that I would get started on that just as soon as she wrote orders on her other patients charts that nursing care was unneccesary.

I LOVE that!!