Nurse S Orders
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Nurse S Orders
Amanda Bucceri Androus, RN, BSN | Updated/Verified: Aug 5, 2022
Amanda Bucceri Androus is a Registered Nurse from Sacramento, California. She graduated from California State University, Sacramento in 2000 with a bachelor's degree in nursing. She began her career working night shifts on a pediatric/ med-surg unit for six years, later transferring to a telemetry unit where she worked for four more years. She currently works as a charge nurse in a busy outpatient primary care department. In her spare time she likes to read, travel, write, and spend time with her husband and two children.
Latest posts by Amanda Bucceri Androus, RN, BSN ( see all )
Home / Nursing Articles / Does a Nurse Always Have to Follow a Doctor’s Orders?
In short, no a nurse does not always have to follow a doctor's order. However, nurses cannot just randomly decide which order to follow and which not to follow. Unless there is a safety concern or an order that conflicts with personal or religious beliefs, failing to carry out orders can be grounds for discipline by the employer as well as the board of nursing, as it could be deemed "neglect."
Safety concerns are one reason why nurses might not follow a doctor's order. One of the most common concerns surrounds medication. One of the rights of medication administration is "right medication." If the nurse performs a safety check and finds that a medication is not indicated, he or she has every right to question the doctor's order. If the doctor still insists on administering the medication, the nurse may go up the chain of command and speak to a higher-level physician and must also notify his or her supervisor. The alternative would be administering the medication and the patient experiencing a negative outcome, placing his or her license at risk.
Another safety concern is when physicians ask nurses to perform a task that conflicts with a facility's policy or protocol. For example, a physician may ask the nurse to take a verbal order when the facility has EMRs. The nurse may feel it is unsafe due to a potential transcription error.
If nurses encounter orders that they feel are unsafe, they should first consult with a peer or charge nurse. Bringing it to the supervisor or manager's attention is also mandatory. If they still feel unsafe, they should escalate higher up the chain of command.
Declining to follow orders based on personal or religious beliefs is another reason why a nurse would not follow a physician's order. For example, participating in end-of-life care, pregnancy terminations, etc. might conflict with moral beliefs. Nurses should report such conflicts to managers or supervisors and hand off the patient to another nurse if possible.
As one can see, there are times when nurses must decline to follow a physician's order. The nurse has the responsibility to inform a supervisor as well as the physician immediately to prevent patient care delay. Failure to do so may constitute negligence. Nurses might lose their job and face discipline by the board of nursing if the proper steps are not followed. If unsure what to do or how to proceed, nurses should always check with a superior or, in the case of conflicts with moral or personal beliefs, check with their human resources department about the facility's policy.
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Nurses in North Carolina can now be sued for following doctors’ orders when they cause harm to the patient.
On Friday, August 19, 2022, a narrowly-split North Carolina Supreme Court struck down a 90-year-old precedent that protected nurses from liability. The opinion of the three justices in favor of overturning the ruling stated that because nursing had evolved, the decision was necessary. The two dissenting justices countered that holding nurses accountable for physicians’ decisions would create “liability without causation.” How this latest ruling will affect future cases is unclear. The full legal briefing can be found here .
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This post explains why the judges made the determination, what this ruling means for nurses, and how nurses can protect themselves.
On October 11, 2010, three-year-old Amaya Gullatte was admitted to a Carolinas Medical Center facility for a scheduled ablation procedure. Her anesthesia team, Dr. James M. Doyle, MD, and Gus VanSoestbergen, CRNA, administered sevoflurane by mask. Shortly after induction, Gullatte went into sudden cardiac arrest.
After 13 minutes, Dr. Doyle revived the child with CPR and resuscitation drugs. In the end, Gullatte suffered permanent anoxic brain damage, cerebral palsy, and profound developmental delay. Her mother and guardian ad litem sued the hospital, the doctor, and the CRNA.
The 3-month-long trial ended in February 2016 with a hung jury . Dr. Doyle’s practice settled with the family. Yet, in May 2018, the case against VanSoestbergen and the hospital was retried. This time, the jury found in favor of VanSoestbergen and the hospital, based on the precedent set in a 1932 case, Byrd v. Marion General Hospital .
The Byrd ruling of 1932 held that nurses do not ordinarily have a separate duty of care when working under a physician’s supervision. Except in certain cases of gross negligence, the ruling found the nurse could not be held liable if they were following a doctor’s diagnosis or treatment plan.
Based on that case, the trial judge refused to allow a CRNA expert witness to testify that VanSoestbergen failed to follow the standard of care. Although the court ruled in favor of VanSoestbergen and the hospital, the family appealed the ruling. When the Appeals Court upheld the ruling, they took the case to North Carolina’s Supreme Court.
Justice Michael Morgan, for the majority 3-2 opinion, wrote , “Due to the evolution of the medical profession’s recognition of the increased specialization and independence of nurses in the treatment of patients over the course of the ensuing ninety years since this Court’s issuance of the Byrd opinion, we determine that it is timely and appropriate to overrule Byrd as it is applied to the facts of this case.”
The dissenting opinion pointed to judicial overreach. Justice Tamara Barringer wrote for the dissenters, “In judicially changing this standard, the three-justice majority appears to create liability without causation — allowing a nurse to be held liable for negligent collaboration in the treatment ultimately chosen by the physician. Such a policy choice should be made by the legislature, not merely three Justices of this Court.”
This latest decision calls for a new trial.
Critical care nurse and legal nurse consultant Ashley Hughes told a local news outlet that she fears this decision will negatively impact nurses . “They’re already short-staffed. On top of that, there is the issue of violence against nurses, nurses are being attacked. There’s the issues about the pay nurses not being paid appropriately,” Hughes said . “Along with that, criminally, nurses now are being held more on a criminal level, rather than just civil.”
Recent problems with staffing shortages have put extra burdens on nurses that increase room for errors. Yet, nurses are increasingly finding legal issues to be a part of everyday practice.
Since nurses can be found legally liable for mistakes in North Carolina under the new law, including negligence and malpractice, they should consider taking steps to protect themselves.
Proactive professional education and awareness of current standards of care give nurses a strong foundation for practice and can steer them clear of danger when it comes to liability.
Here are steps nurses can take to stay current on practice standards.
Nurses practicing in North Carolina may worry about what they should do since this ruling affects nurses in their state. Knowing that the North Carolina Supreme Court has made this ruling, they may need nursing malpractice insurance to cover themselves. Professional nursing liability insurance safeguards nurses from malpractice claims that families may bring. Professional liability/malpractice insurance usually covers attorneys fees and pays the settlement or judgment against the nurse, up to specified policy limits.
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I mean what is a "nursing order"??? Not what is the order. What is an actual nursing order and how is it written.
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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Specializes in Med nurse in med-surg., float, HH, and PDN.
Specializes in NICU, PICU, Transport, L&D, Hospice.
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Hello everyone. I'm a first sem nursing student. I was wondering if someone could explain nursing order to me. Possibly how they are written and so on....? THANKS
Do you mean a nursing diagnosis and then nursing interventions to address the diagnosis?
I mean what is a "nursing order"??? Not what is the order. What is an actual nursing order and how is it written.
And we're saying we haven't heard that term
I know about nursing diagnosis's and nursing interventions.....I haven't been ever heard or have been asked about a "nursing order."
Maybe you could give us some context? Where'd ya find it, is it an assignment, in a sentence in your textbook?
Specializes in Emergency Dept. Trauma. Pediatrics.
Has 6 years experience.
5,259 Posts
I have never heard of a "nursing order" only Doctor Orders, I have heard of nursing diagnoses and nursing interventions.
OK. Its in my objective questions. I can give you the actual questions, maybe that will help. We are talking about the nursing process and i have a different set of questions for each.
under planning-Explain the reason for nursing orders. Compare nursing orders with medical orders
-Discuss how nursing orders are written. Compare requirements with prohibitions
-Examine the relationship between nursing orders and goals/expeced outcomes
There is really no explaination of nursing orders in my book and I can't find much online??
Specializes in Adult Oncology.
247 Posts
Maybe the OP means a verbal/telephone order from a doctor, written by the nurse? Or orders that the doctor writes, meant to be carried out by the nurse?
Oh you responded while I was typing...
I can honestly say i have no idea what they are referring to. Interventions maybe? Independant interventions vs dependant interventions?
I don't think its interventions because thats a different section of questions and they ask about ind and dep interventions
under planning-Explain the reason for nursing orders. Compare nursing orders with medical orders
-Discuss how nursing orders are written. Compare requirements with prohibitions
-Examine the relationship between nursing orders and goals/expeced outcomes
There is really no explaination of nursing orders in my book and I can't find much online??
Ahhh, so now we're getting somewhere. It's a step in the nursing process. I bet it is a nursing intervention. What does your book call the other steps of the nursing process?
If it is a nursing intervention, then it's just what an RN can do once she's/he's identified a specific problem (ie the nursing diagnosis).
So, imagine we have a patient with Congestive Heart Failure (CHF) who, has pulmonary edema and isn't breathing well. There are things we can do that can help this patient breathe better, like making sue to keep the head of the bed raised, teach relaxed breathing techniques to slow down respirations, stuff like that.
If the book isn't getting into independent and dependent nursing interventions, I won't either. :)
Hmmmmm, just wrote what you posted while I was typing....could you maybe tell us what they call the parts of the nursing process?
At the hospital we have clinicals at, the nursing orders are those that do not require a doctor to fulfill. For example, my patient needed lotion for their skin that was not in clean utility, so the nurse wrote a "nursing order" to call it up from supply. Don't know any more than that.
The book goes through assessment, diagnosis, planning, implementing, and evaluating. The nursing order questions were under planning. The book does talk about nursing interventions in the planning chapter but never says anything about nursing orders. But then the teachers asked about interventions in the implementing section of questions?????
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