I’m going to discuss a couple of questions I know many new nurses struggle with, and that’s “can a nurse hold a medication without having a doctor’s order?” and “can a nurse refuse to give a patient a medication?”
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Can a Nurse Hold a Medication Without a Doctor’s Order?
A nurse has a duty to ensure the safety and well-being of a patient. If you notice a patient has ill/adverse effects from a medication given to them, you have a duty to hold the medication and contact the physician for clarification of orders.
One of the best examples of this is when it comes to giving diabetic medications like insulin or giving blood pressure medications.
Suppose you’re a nurse about to give a blood pressure medication to a patient. By assessing the patient, you notice the patient has an abnormally low blood pressure (or some other factors) that puts the patient at risk for ill effects if you give the medication.
Should you give it? Or not?
In a situation like that, you should probably hold the medication and get clarification from the physician or the provider who wrote the order.
For many instances, especially for medications dealing with blood glucose or blood pressure management, the provider that writes the order will usually put in perimeters on when those medications should be held.
But that’s not always the case. That’s why in nursing school, such an emphasis is placed on nurses thinking critically because you’re often not dealing in a black or white scenario but a grey area of nursing.
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Can a Nurse Refuse to Give a Medication?
A nurse has a duty to ensure the well-being and safety of the patients under their care. If a nurse receives an order they believe will cause harm to a patient based on their nursing judgment, they have a duty to follow their hospital protocol and clarify the order.
I’ve seen and heard of a couple of times that something like this has happened. One time I remember, I think it got so far the chief of nursing and the chief of medicine had to get involved.
The gist of what happened was that the physician gave an order the nurse didn’t think was best for the patient. The nurse took the necessary actions and escalated it up the chain of command.
I don’t remember what happened in that particular situation, but I can tell you from experience that sometimes the physician wins the battle, and sometimes the nurse wins.
Whether the nurse wins or the physician loses is not the primary goal. The main goal is to make sure the patient wins.
What Happens if You Get Pushback From the Physician?
From my experience, this doesn’t happen too often. That’s because, for many medications, there are perimeters in place, or the situation usually doesn’t lead to the nurse getting pushback from the physician.
If you do get into a situation where you feel warrants holding or not giving a medication, you need to do several things. Notify the provider who wrote the order to clarify it. Notify your charge nurse and nurse manager, and make sure to follow your facility protocol.