Monday, April 11, 2011

refusing a doctors order

Can a nurse refuse to carry out a doctors order?

I am getting to the point of no return on an issue. The issue is giving narcotics to people are know drug seekers. They are the people who come to the ER every one to two weeks with some pain complaint, have documented drug seeking behavior and are still given narcotics. This happened this past week with a patient of mine. I am beginning to feel really uncomfortable with it. To the point where I am going to make a stink about it.

Doctors hate these patients just like we do. Many times they will placate them so they will leave. They don't want to have a confrontation. They put the nurse in the position of having to carry out something that is unethical. We continue to enable the patient to keep coming back for more. I am tired of being put in this position. I'm going to bring it to the management. I'll let you know what happens.

Your thoughts on this issue? Have you ever refused a doctors order?


krystina said...

I did once. She left before I could verbally say it to her face. In ICU we have multidisciplinary rounds, so I brought it up with the ICU MD, who was on the case. The patient had been through septic shock and renal failure over the course of a month. a one time dose of 40mg of Lasix was not going to fix his I/O of +30,000 liters (besides, the pt was dry as a bone!). So I questioned it. NO ONE wanted to help me. it was basically "if she said it do it" until I got a hold of the surgeon still on his case. He agreed and canceled her order. He's my hero!

LaceFace said...

I certainly have...I had a resident order potassium replacements on a patient whose last levels were drawn 18 hrs prior...."Okay...her last potassium was 3.2 and you want me to give her 4 runs but we haven't checked her since yesterday morning??" Yeah...I didn't do it. On AM labs a few hrs later she was 3.6 on her own. =)

SaraMichelle said...

I definitely have not carried out a doctors on a couple of occasions. I feel that as a nurse we have to use judgement because it ultimately comes "down on us". It's always the nurse's fault situation. One particular incident was with a seeker as you described. I felt like I was just adding gasoline to the fire! Not to mention that on the shift before me, the patient went into respiratory distress and was giving narcan. So when I saw that the md had ordered 4mg iv dilaudid every 4 to 6 hrs, I freaked!! I said to the doc, I don't feel comfortable giving that because of all the other stuff he is on and what happened the previous shift. He still did not dc it, and I didn't care what trouble I could get in so I didn't give it. Well someone on the next shift decided, okay I'll give it. Well guess what happened! The patient went into distress and died. Needless to say the doc couldn't look me in the eyes for the next few weeks.

dcdeanrn said...
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silence is bliss said...

Hell yeah I've refused to carry out dr's orders! I have refused to bolus a lady with a liter of NS because she had +2 pitting edema and crackles up to her eyeballs in her lungs. Got an order for lasix instead and it fixed several issues including her pressure of 80/30.