A physician’s order does not automatically protect a nurse from professional discipline. As a nurse, you have your own legal and professional responsibilities, and those responsibilities remain even when a physician gives an order.
California nurses must practice within the limits of their licenses and follow applicable laws. A nurse who receives unsafe, unclear, or inappropriate orders from a provider should address their concerns, rather than following them blindly.
You should know some scenarios you may encounter as a healthcare professional with the doctors you work with and how to handle them while following the medical standards. Learn how to protect your nursing license by exploring the repercussions of following or questioning a doctor’s orders.
A Doctor’s Order Does Not Remove Your Responsibility
As a nurse, you routinely rely on a physician’s orders to provide proper patient care. A valid order provides important direction for the health of the patient, but it does not relieve you of your professional responsibility.
For example, a physician may order a medication that is the wrong dose or route or is otherwise contraindicated for a patient. As the nurse who is administering the medication, it is your responsibility to adhere to the rights of medication administration in your state. You should also verify that the order is appropriate and safe for your patient’s health.
If a provider orders a medication that is inappropriate for your patient, and you administer it, both of you could face liability. You can’t use the excuse that the doctor ordered it as part of your nursing license defense.
When Should You Question an Order from a Doctor?
You should question an order when you have a reasonable and articulable concern for the well-being of your patient. Medication and drug orders provide the most obvious example. If a dose seems much higher than normal or the provider orders a medication that your patient has a known allergy to, you should question it.
Sometimes, the case may not be so clear-cut. For example, if a provider orders a medication that you are not familiar with, you may not know what is considered a “normal” dose. In that scenario, it is your responsibility to educate yourself about the medication before administering it.
When Should a Nurse Question a Doctor’s Order?
| Situation | Why It May Be a Concern | What the Nurse Should Consider |
|---|---|---|
| Unusual medication dose | The dose appears inconsistent with what is normally administered. | Verify the order and seek clarification before administering the medication. |
| Known patient allergy | The ordered medication may cause an allergic reaction. | Review the patient’s record and raise the concern with the provider. |
| Possible contraindication | The patient’s condition or another medication may make the order inappropriate. | Review relevant patient information and clarify the order when necessary. |
| Unfamiliar medication | The nurse may not have enough information to safely administer it. | Review appropriate medication information before proceeding. |
| Order outside nursing scope | A physician’s order does not expand the nurse’s legal scope of practice. | Confirm that the requested action falls within the nurse’s permitted scope. |
| Patient condition has changed | An otherwise appropriate order may no longer be safe based on the patient’s current status. | Assess the patient and clarify the order when safety parameters are not met. |
| Unclear or incomplete order | Ambiguity can increase the risk of a medication or treatment error. | Obtain clarification before carrying out the order. |
Scope of Practice Still Applies
A physician cannot expand a nurse’s license to include a broader scope simply by issuing an order. For example, a physician cannot instruct an RN to independently diagnose a condition, prescribe medication, or administer certain medications that exceed the RN’s scope.
California’s Nursing Practice Act establishes the legal framework for registered nursing practice. You must adhere to these regulations, as well as the limitations imposed by your organization. Acting outside your scope of practice may trigger a nursing license defense scenario.
Documentation Can Help Protect Your License Against the Medical Board
When you question an order, document it in accordance with organizational policy. At a minimum, creating a nurse’s note can help you document the order in question and how the situation was resolved.
If the order involved the appropriate medication, route, and patient, but the dosage was incorrect, document the changes made to protect the patient. For example, if the provider gave you a verbal order to administer a lesser dose than originally ordered, document the change accordingly.
Refusing an Order Requires Good Judgment
Questioning an order does not mean you should refuse every order that seems unusual. You are generally required by the board to follow valid physician orders that fall within your scope of practice. If you refuse a legitimate order and can’t articulate why, it could create a separate issue that impacts your employment and potentially your nursing license.
When you believe an order presents a legitimate safety concern, don’t escalate the issue. Instead, speak to the provider and seek clarification. If a provider insists on the order after you raise a legitimate concern, use your chain of command.
What Can Put Your Nursing License at Risk?
Carrying out a physician’s order that causes harm to your patient or exposes them to undue risk could put your nursing license at stake. You are also responsible for assessing your patient before carrying out legitimate orders to protect their well-being.
For example, the provider may order you to administer an antihypertensive medication that is generally appropriate. You are responsible for verifying that the patient’s blood pressure and heart rate are within specific parameters so that the medication can be safely given.
When Should You Seek Nursing License Defense?
You should contact a nursing license defense lawyer anytime an incident occurs that could endanger your license or result in disciplinary action. S J Harris Law provides license defense services for healthcare professionals throughout California.
Contact S J Harris Law for a free phone consultation.
