Is a Nurse Liable When Questioning Physician Orders?

Carolyn Buppert, NP, JD


February 11, 2013

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What is the liability of an RN case manager who questions a physician on an order that she knows is detrimental to the patient, but the physician is unwilling to change the plan of care or even discuss the options?

Response from Carolyn Buppert, NP, JD
Attorney, Law Office of Carolyn Buppert P.C., Bethesda, Maryland

The case manager could have liability if the patient had a bad outcome. The extent of the case manager's liability depends on whether the patient sued, the extent of the patient's injuries, whether the physician's plan or lack thereof caused the patient's injury, what the case manager recommended, and what the case manager did to attempt to ensure safe care for the patient.

Liability aside, we want to prevent harm to patients. If a nurse or any other member of the team disagrees with a physician's plan of care and believes that a patient could be in danger of being harmed, it is always prudent to do something to prevent harm.

First, make sure that your opinion about the patient's care is evidence-based and is within the standard of care. Second, approach the physician and ask about the rationale for the approach that the physician is taking. For example, you could say, "I would like to understand your thinking about Mrs. X's digoxin dose, given her digoxin level." If the rationale isn't consistent with the standard of care or is unethical, or if the physician declines to discuss it, state that you are uncomfortable with the plan and explain why.

Give the physician time to process the information, if the patient is not in need of emergency services. If the physician does not respond in a timely, safe, and responsible manner, the case manager should present the facts to his or her supervisor, ask for support, and decide together whether to take the matter to the chief of the medical staff.