You're on night duty at 3am and want to prescribe a medication. The nurse disagrees, wanting to call the consultant if you do. What should you do?

You're on night duty at 3am and want to prescribe a medication. The nurse disagrees, wanting to call the consultant if you do. What should you do?

• A. Explain your reasoning for wanting to prescribe the medication & consider the urgency of prescribing the medication
• B. Consider patient preferences
• C. Follow or check prescribing guidelines e.g. eTG, AMH, hospital-specific protocol
• D. If you and nurse still cannot come to an agreement, involve the registrar/resident on shift; and if unresolved, escalate to the consultant

Answer: (D)

When there is disagreement about prescribing, patient safety and clear team communication drive the next steps. Start by discussing your plan with the nurse, explaining why you think the medication is needed and the urgency, and review any relevant guidelines or hospital protocols to support your decision. Consider the patient's preferences as part of the discussion, but recognize that a busy night shift may require higher-level input when uncertainty remains. If, after this discussion, you still cannot reach agreement, bring in the registrar or resident on shift to provide senior input. If the disagreement persists, escalate to the consultant. This escalation sequence ensures safer decision-making, respects the nurse’s concerns, and follows the established chain of command, especially during off-hours when timely, authoritative guidance is crucial.

When there is disagreement about prescribing, patient safety and clear team communication drive the next steps. Start by discussing your plan with the nurse, explaining why you think the medication is needed and the urgency, and review any relevant guidelines or hospital protocols to support your decision. Consider the patient's preferences as part of the discussion, but recognize that a busy night shift may require higher-level input when uncertainty remains. If, after this discussion, you still cannot reach agreement, bring in the registrar or resident on shift to provide senior input. If the disagreement persists, escalate to the consultant. This escalation sequence ensures safer decision-making, respects the nurse’s concerns, and follows the established chain of command, especially during off-hours when timely, authoritative guidance is crucial.