What to Do When you Disagree with a Doctor’s Treatment Plan

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Doctor’s orders. The bane of nursing existence. And these days, orders may not just come in the shape and size as from the MD’s script pad. There are many providers on the team that prescribes orders.

Well, what if you do not agree? What if the order being offered up is not in the best interest of the patient? Or conflicts with another order that the patient is already on? What is the nurse to do?

This is a sticky situation. There are several things that I will recommend here; however, this list is not all-encompassing and cannot be seen as an “every situation” type of thing. In fact…

Step One

Assess the situation as an individual event. Just because you may have had issues with a particular provider in the past, does not mean that all orders this provider writes are incorrect or not to be followed. If you have had difficulty with a particular provider, you need to address that outside of this order writing event. Sit down and talk with this person. Bring in a third (and outside, if possible) party. Clear the air so that future orders written can be approached professionally.

Step Two

Once this is checked off and the fact still remains that you do not agree with an order written, get an outside opinion. Think about it- maybe you are on your fourth 12 hour shift in a row. Maybe you are hungry and tired and thinking unclearly. Ask a trusted confident or nurse colleague. Take it to your manager and get their opinion. Just check in with another person on the nursing team, before you question the order.

​​​​​​​Step Three

Get your facts in line. Providers speak and answer to data. They want quick information and thrive on values and numbers. If you do not have all of your ducks in a row, they will be less likely to hear your concerns.

Step Four

Keep your emotions out of it. Stay calm and use “I” statements. Keep the patient and their safety at the forefront. Ask questions and approach the situation with curiosity. Maybe you can even learn why the provider is placing a particular order in this specific case.

Step Five 

Go up the chain of command. If you feel that your patient is in imminent danger and the person writing the order is just not listening to you- then use your organization’s policy and go up the ranks for support.

Step Six ​​​​​​​

And this step does not necessarily happen when in the situation. Build rapport with the providers, if possible, outside of the stress. Get to know the providers writing orders in your workplace. Invite them to nursing events. Offer an interesting article that you found in a literature review. If you build the human-to-human relationship outside of “nurse-provider” hierarchy, then you will feel much more confident when it comes time to question an order.

Let’s hear from you! What would you do if you had to question a doctor’s order? Be sure to tweet me @ElizabethScala or leave a comment below. Thanks for reading! ​​​​​​​

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Keynote speaker and bestselling author, Elizabeth Scala MSN/MBA, RN, partners with hospitals, nursing schools, and nurse associations to transform the field of nursing from the inside out. As the host of the Nurse’s Week ‘Art of Nursing’ program, Elizabeth guides nurses and nursing students to a change in perspective, helping them make the inner shift needed to better maneuver the sometimes challenging realities of being a caregiver. Elizabeth received her dual master’s degree from Johns Hopkins University. She is also a certified coach and Reiki Master Teacher. Elizabeth lives in Maryland with her supportive husband and a playful pit bull.