Ever Refuse a MD order?

Just wondering if anyone has ever had to refuse a MD order??
Not refused as such, but I often seek "clarification" as to the rationale behind an order that seems incongruous...

A terminally ill resident of a nursing home where I once worked was interested in going on hospice. His wife and adult children were also interested in hospice, but his attending physician was refusing to order a palliative care consult. To this particular doctor, dead patients were not profitable, so he preferred to implement heroic measures to keep people alive even though they had terminal prognoses. I went ahead and called a hospice company anyway, and the resident ended up being admitted to hospice per the family's request. The man died exactly one week later. So, no, I refused to follow the MD's order of "no palliative care consult." Making this move was risky, but thank goodness that nothing major arose out of the situation.

Yes a few times I have...I got them to agree with me after I convinced them my way was better and safer for the pt. For example, once had a central line that got pulled out about halfway so that only the distal lumen was still in the vein...MD gave me on order to keep using it...explained to him why that was not a good idea and also offered an alternate venous access that he did not have to come in and place.

Closest I came was on my last placement... One of the registrars asked me for a BP on a 12 yo girl with Downs syndrome, and a major dislike of anything medical! We had already (eventually) managed to get an ECG, a height and a weight from her (her mother, myself and the RN in the room all had to be measured first at girl's insistence). When the reg asked, I asked the girl how she felt about a BP (she didn't want it), I asked her mother how she was with her BP being taken (about the same as everything else), and then asked the reg if it was really needed (he had heard all the above and said he'd check with the consultant). In this case, I would have gone for it if it was really needed but not if it was just something merely nice to have. It definitely helped that I had a good rapport with the reg and that he could see my reasoning

A surgical resident reputed to be incredible in the OR had the habit of responding to requests for pain meds as a verbal order for "suchscynolcholine (sp?) 100 mg iv." One nurse followed it while trauma pt was in CT and he died from respiratory arrest. Over a few years she gave me the same order several times. Each time I tried to verbally shock her into thinking about what she was mechanically saying.

Yes. I let the doc know if wanted an NG tube in a patient with a deviated septum he would need to find someone else to do it as I was not comfortable with it. He was a little miffed and decided to do it himself. He just wanted a sample of gastric contents. Patient vomited as soon as he started. Problem solved

I was assigned a patient that was several days post CVA, speech therapy had evaluated the patient earlier that day and concluded the patient was aspirating and not safe for any form of PO. Patient had IVF's (i.e, wasn't about to dehydrate or starve overnight). Family had finally made it in days after the patient had the CVA. Of course they were going to be all involved now and insisting the patient be fed a meal. The patient was oriented x 1 only and not interested in anything, much less food. Since I wouldn't comply (following the previous order of NPO), the family went over my head and called the MD. The MD called me and gave me a diet order. Now I could see where the MD was coming from: the the patient was very elderly, not likely to recover from this incident and if the family wanted to feed the patient even if it would cause aspiration pneumonia, okay. Thing is, he wasn't changing the code status and ordering comfort measures only. It was well past any scheduled meal times (7p-7a shift) so I told the MD and the family that I could not as a prudent nurse personally feed the patient (and I wasn't about to order an after hours sandwich box) but what they did after being fully informed of the risk was up to them. The MD was pretty furious that I wouldn't comply with his order to "feed the patient". I think we may have had some cultural differences at play here.I don't really recall what happened after that which probably means the family went home, the patient made it fine through the night with IV hydration and mouth care. I'm supposing the next day speech therapy reviewed "aspiration precautions" with the family and the MD. I never heard anything from management so I suppose the MD didn't try to write me up for this incident (that would have been too good).That's the only time I ever recall not being able to discuss things with an MD and come to a safe and legal compromise in the patient's best interest.

Yup. Had a doc in the ED order lopressor and morphine for a patient whose BP was quite low. I didn't give either one.

Refusing, is perhaps too strong of a word.I prefer to use the MD's as tools to circumvent the limitations of my clinical privileges.

Yup. I was on a medical floor with a psychiatric patient who was out of control. The psychiatrist on call ordered - by phone - a medication 10 x the usual dosage. After clarifying that was really want he wanted, I said I couldn't give that. He insisted. I called my supervisor and explained the situation and she said nope, don't give it. It's well beyond the usual parameters, it's a verbal order by phone - just asking for trouble. He could come in to supervise the admin of such a high dose of the drug.I told the psych that, he was Not Happy. Came in and gave the dosage himself. Chances are, if I had had a written order and someone else on the floor or the supervisor had given such a dose before, I would have - but I wasn't doing it on a verbal order with no-one who was familiar with the med.

I agree, the term "refuse" is a little strong. I guess technically, I would have, but its never come to me having to do so.Most doctors I've dealt with are very cooperative if you tell them why you are uncomfortable with executing an order. My concerns have always been addressed.My story: Nurse on the same day surgery center didn't want to fill out D/C papers on a pt. who was going to be watched for a few hours then sent home after...........I don't remember, something very simple was done. It was the end of the day, her shift was over and it was time to go home, she was not going to be bothered with D/Cing the pt. Supervisors solution, send them to a M/S unit to be D/C'd. In report were many messages that this pt. "has to leave right away, the D/C has to be written the second he gets up there."Well, when he got there, I saw why the nurse didn't want to be bothered writing up the D/C papers. HE WASN'T ADMITTED. The whole admiit needed to be done in order for the D/C to be done (can't D/C someone who isn't there). And the pt. was in a hurry to leave, was not going to be bothered with being admitted first (understandably).I informed the doctor I could not write up D/C instructions for someone who was not there. His solution..................and he wasn't angry with me as he did it as I directed him to the right forms and all............................he filled out and signed the papers. Basically, he D/C'd the pt. It kept my name off of everything. I documented that the pt. didn't want to stay for the admit and that the doctor D/C'd him. It was done.

I alwyas feel orders are more suggestions. We are the gatekeepers to ensure harm does not reach the patient. Some order are held or not done because it is not appropriate at the time. A nurse should never blindly follow or we should all be replaced by unskilled labor.When you have slew of residents running around you have to help them out sometimes. They write for some inappropriate things and most understand that we all are working on the same team, but there are ones that develop the early ego syndrome and that is when their senior, fellow or attending can be helpful to ensure patient safety.