Ask Nurse Jesse: Patient Safety Concern

Anonymous Nurse:
“I recently resigned from my job because one of the physicians on my floor said to ignore a procedure protocol and complete a task in a way that I think could be harmful to patients. All the other nurses are going along with it and it is the norm on the floor to do it this way, but I am concerned. What do I do?”

Nurse Jesse: Per the ANA Code of Ethics, Provision 2, the nurse’s primary commitment is to the patient (American Nurses Association, 2015, pg. 5). Additionally, per Ohio nursing law and rule, nurses have the responsibility to protect patients, and part of this includes questioning any order the nurse believes could potentially be harmful to the patient.

Ohio Administrative Code (OAC): 4723-4-03 states:
(E) A registered nurse shall, in a timely manner:
(1) Implement any order for a patient unless the registered nurse believes or should have reason to believe the order is:
(a) Inaccurate;
(b) Not properly authorized;
(c) Not current or valid;
(d) Harmful, or potentially harmful to a patient; or
(e) Contraindicated by other documented information; and
(2) Clarify any order for a patient when the registered nurse believes or should have reason to believe the order is:
(a) Inaccurate;
(b) Not properly authorized;
(c) Not current or valid;
(d) Harmful, or potentially harmful to a patient; or
(e) Contraindicated by other documented information.
(F) When clarifying an order, the registered nurse shall, in a timely manner:
(1) Consult with an appropriate licensed practitioner;
(2) Notify the ordering practitioner when the registered nurse makes the decision not to follow the order or administer the medication or treatment as prescribed;
(3) Document that the practitioner was notified of the decision not to follow the order or administer the medication or treatment, including the reason for not doing so; and
(4) Take any other action needed to assure the safety of the patient.

OAC 4723-4-06 also states:
(H) A licensed nurse shall implement measures to promote a safe environment for each patient.

If you are concerned about this or any other deviation from standard protocol or your nursing expertise and clinical judgment, and/or believe it could potentially be harmful to a patient – it must be addressed.
Per the above rule, follow the chain of command and/or organizational policy to report this issue and document accordingly.

For more information, check out the following CE course:
Speaking Up for Safety: The Nurse’s Role in Carrying Out Medication Orders

*Please note this information does not constitute legal advice.

The Ohio Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91)