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Nurse Refuses Order From M.D. / Patient's Family Member: Nurse Exonerated
Legal Eagle Eye Newsletter for the Nursing Profession
Quick Summary: When the physician is a family member of the patient, it is accepted nursing practice for a nurse to refuse the physician's order if it goes against the nurse's better judgment, the court ruled.
A registered nurse was fired from his employment and brought up on charges before the Board of Nursing, following an incident in a hospital involving the care of a physician’s elderly and terminally-ill father.
The Board found the nurse guilty on all charges and suspended his nursing license for one year. The Supreme Court of Nevada overruled the Board as to all but one of the charges.
Pain control for terminally-ill patients was overseen by the anesthesiology department. A morphine drip was ordered for the patient. The nurse obtained the IV bag from the pharmacy and brought it to the floor. The patient’s son, a physician with staff privileges at the hospital, hung the bag himself, set the flow wide open and emptied the bag. His father was still highly agitated and in great pain, so the father ordered the nurse to get a second bag with a similar dose. The patient had a high tolerance, but the two bags together contained an ordinarily fatal dose if given quickly back-to-back. The nurse refused the order.
Instead, the nurse phoned the anesthesiologist on duty, got an order for a smaller dose of morphine, and gave that dose. The nurse got the order at midnight, but back-charted it to 9:00 p.m.
The court ruled the nurse was at fault for back-charting this order. However, the charges of failing to collaborate with members of the healthcare team were thrown out. The court ruled it was accepted nursing practice for the nurse to refuse to carry out an order from a patient's family member. The court said it was not relevant that accepted standards for medical practice in the state did not rule out a physician treating a family member. Nevada State Board of Nursing vs. Merkley, 940 P. 2d 144 (Nev., 1997).