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When does a nurse have the right to refuse to give a patient medication that a doctor has ordered?

Monday February 11, 2008
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Question:

Dear Nancy,

When does a nurse have the right to refuse to give a patient medication that a doctor has ordered?

Dana



Nancy Brent replies:

Dear Dana,

As you are aware, nurses are the “last line of defense” in terms of protecting the patient when it comes to the administration of medications. The five rights of medication administration are a way in which this obligation can be fulfilled — right patient, right medication, right dose, right route, and right time (and frequency).

There are various situations in which a nurse may be faced with refusing to administer a medication to a patient, and a discussion of all of those scenarios are beyond the scope of this column. However, generally speaking, the obligation to protect the patient from a medication error extends to every medication. When there is a realistic, reasonable, and individualized evaluation by a nurse that to administer a medication to a specific patient could result in injury to or death of the patient, then the nurse must withhold the medication, promptly notify the physician or other healthcare provider who ordered the medication, notify the nurse manager and others pursuant to facility policy, and document the events factually and completely. Any follow up — for example, the physician or advanced practice nurse changes the medication order — must also be documented.

You may want to do some research on this topic. This can be easily done on the Internet, in nursing journal articles and in texts on law and nursing practice and ethics and nursing practice. You should also be aware that there is information available on nurses’ rights when administering medications. For example, “Six Rights of Nurses Administering Medications” might be of interest to you as well. The document can be found at www.massnurses.org/nurse_practice/sixrights.htm.

Cordially,
Nancy





Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.