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  1. Brooke, Penny Simpson RN, MS, JD

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The other morning when I came on duty in the oncology unit, the night nurse told me that one patient's physician had ordered her indwelling urinary catheter removed and that the nurse should teach her how to perform intermittent self-catheterization. But the patient was still feeling so ill from other treatments that she asked to wait. The night nurse said fine, and documented all this. I checked on the patient early in my shift and she was still feeling nauseated and exhausted, so I documented that because of these symptoms, I'd decided to wait until later in the shift to address the catheterization issues.


When the physician made rounds mid-shift, she was furious that she hadn't been told that the patient had refused the indwelling urinary catheter removal and intermittent self-catheterization teaching. I'd documented everything clearly (and so had the night nurse). Since patients can refuse treatments if they wish and this wasn't anything life-threatening, did I do anything wrong?-E.A., kans.


What you've described isn't safe practice. If the patient is somehow harmed because you delayed or didn't provide the ordered treatment, you could be held accountable. True, patients have the right to deny consent for treatment, but you must communicate this refusal immediately to the practitioner. And whenever you don't follow a practitioner's orders, no matter how well-founded your decision, you must contact her to discuss the rationale.

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In this case, you may not understand all the potential ramifications to the patient's health stemming from this delay in patient care. As a nurse, you can't substitute your judgment for the physician's-that would be practicing medicine without a license.


Good documentation is essential, but it doesn't insure timely communication with the practitioner. The night nurse should have called her when the situation first developed. Because she didn't, you should have made the call when you came on shift. Breakdowns in communication harm thousands of patients every year.