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Could I be fired or disciplined for performing an action that a physician did not write an order to not do?

Friday April 27, 2012
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Question:

Dear Nancy,

Could I be fired or disciplined for performing an action that a physician did not write an order to not do? It was passed on during nurse-to-nurse report that the physician stated to refrain from wedging the balloon on a pulmonary artery catheter. But a physician order was never written. Unfortunately, I did wedge (inflate) that balloon several hours later as I performed an FICC measurement. Management has informed me that I am in trouble and I await my fate. I am grateful that this did not cause harm to the patient.

Carl



Nancy Brent replies:

Dear Carl,

It is important to remember that, as an RN (and not an advanced practice nurse), it is essential to provide care to patients with either an order verbal or written or standing orders or protocols that can guide you, including advanced or expanded nursing care functions for patients. In this situation, it appears the physician gave an oral order during report. It is assumed that you were present during report and heard this directive from the physician.

If verbal orders are allowed in your facility and, pursuant to established policy, this physician gave this verbal order (and hopefully afterward the verbal order was documented in the patient record by either the physician or a nurse staff member according to policy), then the order would stand as one that would need to be followed.

If such an order is not sanctioned in your facility unless documented, as an example, then you may be able to defend any disciplinary action taken against you.

Other things to think about in this situation are: What did you do when you discovered you inflated the balloon? Whom did you contact? Did you document the incident somehow? What steps did you take to ensure the patient was not harmed?

Sometimes mistakes are made when delivering patient care. No nurse is perfect. Even so, you are accountable for your conduct, both when the balloon was inflated and what you did afterward. If you can defend your actions, which you have a right to do, do so. In the future, checking orders, verbal or written, is important. If a written order is required, ask the physician for one. Also, what is said in report should be carefully followed.

Sincerely,
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.