Should we refer to physician care plans as "orders?"

Should we refer to physician or nurse practitioner care plans as "orders?"

In the popular media, especially Hollywood products, nurses often follow physician "orders" automatically, as if they were mandatory military orders. In fact, this use of the term "orders" is a misnomer which should be discontinued, as nursing leader Lydia Hall suggested a half century ago.

Nurses are autonomous professionals who view physician and advanced practice nurse "orders" as "care plans" or "prescriptions" which nurses must evaluate before implementing, in order to determine if they will benefit the patient. If a nurse believes that a care plan is not in a patient's best interest, he will act as a patient advocate in discussing the plan with the colleague who made the plan, and if necessary negotiating for something better.

Nurses commonly question physician and advanced practice nurse care plans, and in general the health care workers reach an understanding as to what appears to be best for the patient. On those rare occasions when there is continued serious disagreement about a plan, nurses decline to implement the plans.

One example is the giving of medications. Nurses have an independent responsibility to determine whether the drug, dosage and method of administration is appropriate. If it is not appropriate, nurses are ethically bound to advocate for the patient and to obtain a more appropriate drug, dosage or route.

last updated September 20, 2005