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How can a nurse be impacted by following an administrator order rather than policy?

Dear Nancy,

A nurse with only one month of experience has to file an incident report for two patients getting into a physical altercation. The nurse did not call the physician because of non-emergent injuries and being told not to do so by an administrator. How can this affect the nurse by listening to an administrator and not calling the physician? One patient was sent to the ED the day after the incident with a negative CT and no new orders.


Dear Sam,

A good result occurred because no patient was injured. However, as an RN with accountability for your actions, this good result may not affect what negative results may occur with you.

The first issue here is deciding to follow your administrator’s admonition not to call the patient’s physician. Despite this direction, if the policy and procedure governing patient altercations requires a full notation in the patient record, the filling out of an incident report and calling the patient’s physician, as examples, then you needed to follow the policy. It is unclear what the administrator’s reason was for telling you not to call the physician, but that should not have been a concern of yours. Clearly, if there are ramifications to you not calling, they will rest on your shoulders.

Moreover, the administrator’s directive may not shield you from any discipline demanded by the physician or shield you from the physician reporting the non-call to the board of nursing for violating patient care policies and placing the patient’s safety at risk. Had the next-day ED visit indicated injuries to the patient, further problems would exist for you.

And there are nursing care implications surrounding this incident. Will there be further physical altercations between these two patients? What should change in each of their plans of care so this does not happen again? What prompted the altercation? Does a medication evaluation and change need to be made for both patients? Should their room arrangements be changed so they are not physically close to each other regularly?

This situation is a good example of issues that arise when following a directive that is clearly contrary to your facility policy and, one would hope, your own concerns over the well-being of both patients who were involved in the altercation. Remember, you are the patient’s advocate and must act to protect the patient’s health and safety at all times. This is not an easy role, especially for a new nurse. But, if you learn it now, it will become much easier to fulfill in the future.


By | 2015-08-14T14:25:48-04:00 August 17th, 2015|Categories: Nursing Careers and Jobs|0 Comments

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Barry Bottino
Barry Bottino is a freelance writer and editor who has more than 25 years of experience at various newspapers and magazines.

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