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.

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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.

RELATED: Can a Nurse Take Orders from a Physician Assistant?

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.

Amanda Bucceri Androus, RN, BSN
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