When you disagree with the doctor’s orders

Shutterstock | Volt Collection
Shutterstock | Volt Collection

Warning: We’re not here to pick a fight. This is not about who is right or wrong. This is not about doctors versus nurses.

Now that we have that out of the way, let’s discuss a hot topic: disagreements. Disagreements among the healthcare team. When the nurse disagrees with the doctor.

The amount of potential energy this type of subject has is probably at the nuclear level. Everyone has their own opinion, and everyone is usually on the defense.

The scenario is almost textbook: The provider orders such-and-such for a patient or decides on such-and-such action for a patient, and the nurse in charge of that patient’s care does not think such-and-such order is right.

We could be referring to conflicting personal opinion or challenging medical decisions regarding plan of care in this scenario. Regardless of the reason for the disagreement, the disagreement exists.

Here’s the thing. We need to approach this scenario better. We’ve all been approaching it from the wrong angle, with the wrong attitude and wrong agenda.

This is not about who is right or wrong. It’s not about who is “sort of” right or “sort of” wrong. It’s not about you proving yourself. And it’s definitely not about proving the other person is wrong. It’s not about establishing or defining your abilities. It’s not about defending your profession. And it surely is not about proving your intelligence (if anything, the more we argue about this, the less intelligent we all look).

What is it about?

It’s about the patient. Period.

I’ve seen the scenario play out in so many different ways that it boggles my mind. So much time and energy lost. It’s time we approach every disagreement the same way. Here are five suggestions to follow when you disagree with the doctor’s orders:

  1. Patient safety. Are these orders compromising patient safety? If they are, bring it to the provider’s attention immediately and take corrective action with no delay. Speak to the provider in person and find a collaborative solution. Passive-aggressive behavior is not going to help keep your patient safe from harm.
  2. Find common ground (meet in the middle). If you’re passionate about your input, then be sure you have valid reasons. The excuse of “this is how we’ve always done it” won’t cut it anymore. Be a forward thinker. Maybe a decision exists that meets all parties’ needs. Work together and work through it, not around it.
  3. Agree to disagree. Sometimes there is no common ground. Agree to disagree. Make amends to the provider by saying that you don’t agree with their decisions, but will follow the orders (because you have already verified it isn’t causing patient harm). The strongest attribute of a team is being able to collectively disagree on a subject in a calm, professional, productive and effective manner.
  4. Know your role. Here’s the hard pill. At the end of the day, the provider is responsible for the patient’s care decisions that are made. Sure, all members of the team can be charged with a crime and can have legal actions taken against them, but the provider’s name is on the bottom of the chart. While the provider cannot do this job alone, in the end, they must sign the death certificate (a rather morbid concept, but completely true).
  5. Disagreements are a good thing. But make them productive. Don’t let them drain the energy of the team. Don’t let them distract from the overall focus of the team. And absolutely keep the lines of communication open and honest. How else will a team grow and improve their dynamics?

Remember, if your team agrees on every decision ever made, someone is not speaking their mind or sharing their thoughts. And that can be a dangerous thing.

Interested in learning more tips? Check out our Nurse’s Survival Guide!

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2 Responses to When you disagree with the doctor’s orders

  1. tom combs

    Excellent post. As you pointed out these situations can feel like a professional kidney stone or CAN be a productive exchange that is a plus for all(especially the patient).
    Rude or disrespectful behavior by either party assures the kidney stone result.
    I think your points increase the odds for a good exchange.
    If you have a question, uncertainty or fear and have any chance to review/research it before approaching the doctor that is a plus. Occasionally you may answer your own uncertainty (or perhaps reinforce it).
    When you feel the need to question it is, imo, best to state it as a question or a concern rather than a challenge. e.g. “the patient’s diagnoses includes chronic renal failure. Is tobramycin okay for him?” rather than ‘You can’t give tobramycin. He’s got renal failure.” May not be a great example but hope serves to illustrate.
    One thing for sure – if you have uncertainty (especially after reviewing the issue) it is in the patient’s best interest for you to share your question/concern – the professional vigilance of nurses is, without doubt, one of the key safeguards in modern medicine!
    Here is a fictitious example from my book, “Nerve Damage”, where the nurse (Tracy) restates this article’s key point… It’s about the patient. Period.

    [[Drake looked. “This tube has a lot of subcutaneous air tracking around it. Dr. Rainey, did you oversee the procedure? Were there problems?”
    “Ah…yes. Yes, I did.” Dr. Rainey said. “There were no problems.”
    Drake glanced up, finding Tracy staring at the big man with her mouth agape.
    “That’s not right,” she said, shaking her head. “I was in here when your resident doctor did the procedure. You were on the phone. The whole ICU overheard you complaining to the head of surgery about the hypothermia.”
    “Be quiet, nurse. This is between doctors.” Rainey said, scowling down at her.
    “I will not,” Tracy said red-faced. “This is about a patient and his care. I absolutely will not be quiet.” ]]

  2. RN Red

    I was a very experienced CICU RN and my biggest problems were with interns or residents. We often took transfers from the SICU and surgical residents can be very rude and condescending. This particular patient had a heart attack so was transferred. Cardiology was consulted so at that point any issues concerning the heart attack the course of treatment is recommended by them. The patient’s BP was very low a d this particularity obnoxious resident gave me and order to push Lopressor (something I knew we did not do with such a low pressure). I refused and asked him if he had talked to the Cardiologist and that really p…ed him off. He began raising his voice in the patient’s room so I suggested we discussed this elsewhere. He insisted on speaking with my manager whom I gladly pointed her out, them calmly asked for the name of his manager (who I did talk too). Well the patient did not get Lopressor, the Resident was chewed out by the Cardiologist and I don’t know what his manager said but he was never disrespectful to me again, he usually tried to avoid me.