Nursing practice

This post by Scalpel has opened quite a can of worms.

A couple of the comments really have my back up.

As a nurse I am bound by law, hospital policy, ethics and my states Nurse Practice Act. I am responsible for my own practice just as the doctor is responsible for his. I don't blindly do what the doctor orders. I need to know if the order is appropriate, safe for the patient and within my scope of practice. The physician is not my boss and he cannot fire me any more than I can fire him. We work together collaboratively to provide safe, high quality care for the patient. We are a team - although I have certainly worked with some MD's who don't seem to grasp that concept. I have seen some orders that were blatantly wrong or unsafe and had I carried them out without question would have caused harm to the patient. For instance when the doctor wasn't watching where his mouse clicked and ordered 10mg Norcuron IM for my patient when he really meant Norco. Big difference between relief of sprained ankle pain and complete muscle paralysis and death.

If the physician orders something that is wrong and I carry it out I am liable for the error, he may be sued also but it'll be my ass on the line for actually carrying out the order and causing patient harm.

And for the physician commenter's who suggested 'get rid of those nurses and replace them with some who will follow orders' - I have close to twenty years of Emergency and Critical Care experience, I cannot just be 'replaced.' If I feel something is unethical, immoral or unsafe it is my right to say so, that is part of my job. It is my job to be my patients advocate.

In this particular case, the patient was making homicidal statements toward others. At that point the police need to be called, a 5150 written and the police to stay at the bedside until the patient is not a threat to staff safety which may mean medicating him against his will. The ER staff should not be trying to take care of agitated and threatening people alone. The police are trained and armed. Yes it is inconvenient for them to be called but it is a hell of a lot more inconvenient for me to be injured or killed at work by someone in the midst of a psychotic episode.

When will I medicate a patient against their will? When they are so agitated that there is a very high likelihood that they will injure themselves or a staff member, When I know that transport is coming to take them to a psych facility and I know they aren't going to cooperate (if they are on psych hold.)

Addendum: From a legal standpoint

1. The right to know.

Informed consent means that the patient, after being provided adequate information about their condition and proposed treatment, knowingly and intelligently, without duress or coercion, clearly and explicitly give their consent to the proposed treatment. Cobbs v. Grant, 8 Cal. 3d 229, 502 P.2d 1, 104 Cal. Rptr. 505 (1972).

Before a patient decides to consent or not consent to treatment, the physician must explain the following:

• The patient's right to refuse treatment with antipsychotic medications;
• The patient's right to be medicated over their objection only if there is a legally defined emergency or a legal determination of incapacity;