What Does a Nurse Do? Part 3/3

This week, we’ve been examining the role of the nurse at the beside. Thus far, we’ve looked at the nurse as advocate and safety net. Let’s look at the nurse/physician relationship.

Here is Part I and Part II.

I work in an emergency department. I would say that I have a symbiotic relationship with the on duty physician. One cannot survive without the other. For instance, say there aren’t any nurses to staff the ED. How well do you think that one physician could provide medical care? What if the physician falls ill? Can the nurses provide medical care? What is the difference?

A physician’s role is to diagnose illness and determine the course of treatment. A nurse’s role is to initiate the medical plan of care, monitor the patient’s response to that medical plan, and educate the patient and family regarding their illness. You can see, one without the other and the ER comes to a halt.

Can a nurse refuse to carry out a physician’s order? Let’s look at one hypothetical example: A physician orders morphine for a child at ten times the normal dose. This is clearly dangerous and could kill the patient. What would a nurse do? First, I would have a conversation with the physician about the order. I would state my concerns and the physician will likely change the order. If that doesn’t work, I would approach another physician with my concerns to see if I can get an ally in re-approaching the ordering doctor. Some professionals will better handle being questioned by a peer vs. who they might consider a subordinate. Regardless of my view of having a symbiotic relationship with the physician, some doctors do view the nurse as a subordinate to just carry out the orders as written. This is becoming more rare. If that doctor to doctor talk doesn’t work, then I would call my nurse manager. If the nurse manager agrees the situation is dangerous, she can begin to pull in the medical director who can address the issue.

Say the order isn’t dangerous but I don’t want to initiate the order. Some medications are dangerous for a pregnant nurse to give but are fine for a non-pregnant patient to receive. If I was pregnant and didn’t want to give the drug for that reason, I would ask another nurse or the physician to do it.

What if the nurse has a conscious objection? What can she do then? Thoughts?

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