The Challenge of Advocacy: When Nurses Must Disagree With A Physician

Many, many times, I have had to disagree with a doctor—especially during my 20 years working with medical residents at various levels of experience. While working at this academic Level I facility, I must admit I had several not-so-smooth disagreements with residents over their plan of care—all because of how I handled it.

In the first few years, I found myself in hot water plenty of times—not for being wrong in advocating for the patient, but because of how I embarrassed the resident. However, my last 16 years as a travel nurse went much smoother because I learned how to communicate with physicians effectively.

A Critical Emergency

One incident stands out vividly. EMS called to notify us they were bringing in a woman who was 28 weeks pregnant, bleeding, and with a foot presenting—a true obstetric emergency requiring immediate intervention to save both mother and baby. Our high-risk labor and delivery team and the Level 4 NICU would be essential.

I immediately contacted the charge nurse in Labor and Delivery, who gave me the faculty obstetrician’s number. The physician confirmed they would have the operating room ready and meet EMS at the elevator. Satisfied with the plan, I prepared to escort the patient from the ER to Labor and Delivery.

A Tense Disagreement

When EMS arrived, I guided them through the women’s module toward the elevator. Suddenly, an obstetrics resident stopped us, demanding more information. After I briefly explained the situation and confirmed the OB and NICU teams were prepared, the resident insisted on performing a vaginal exam in the hallway.

I refused—perhaps too abruptly—and hurried EMS to the elevator.

The Outcome

The emergent C-section confirmed that the baby was breech, with a foot already through the birth canal. Without immediate surgery, the infant likely wouldn’t have survived, and the mother could have faced life-threatening hemorrhage.

The faculty obstetrician later commended me, but the resident filed a complaint, accusing me of being “curt and abrupt.” Despite the commendation, I received a Group B warning for insubordination. The irony? The resident wasn’t my supervisor, and I had followed the faculty physician’s directive.

This experience taught me a crucial lesson: even when you are right, how you handle disagreement matters.

Trusting My Instincts

Another case involved a young woman pinned against a tree by a vehicle. She was walking at the scene and had stable vital signs except for persistent tachycardia, which only briefly responded to fluids. She also complained of back pain—a potential red flag for internal bleeding.

Despite her soft, non-tender abdomen and absence of bruising or pulse deficits, my gut told me something was wrong.

A Life-Saving Decision

She became increasingly agitated, crying that she was going to die. In my experience, when patients say that, they’re often right. Her heart rate remained elevated, and her blood pressure began trending downward.

I expressed my concerns to the chief resident, a fifth-year on a busy trauma shift. Frustrated, he dismissed her symptoms and threatened to intubate her if she didn’t “stop making a crying.”

I knew I couldn’t let it go. Summoning my courage, I paged the faculty trauma surgeon—essentially going over the chief resident’s head. What if I was wrong? Still, I felt certain she needed surgery.

The attending arrived within minutes, assessed the patient, and immediately called for an OR. Hours later, he confirmed she had a mesenteric artery injury and nearly a liter of blood in her pelvis. Without surgery, she wouldn’t have survived.

The resident was furious and treated me poorly for the remainder of his rotation—but the patient lived.

The Duty to Disagree

Disagreeing with a physician—especially a senior resident or attending—can put a nurse at risk professionally. But as nurses, we have a legal and ethical duty to advocate for patient safety, even when it creates conflict.

Key Nursing Ethics

All state Nurse Practice Acts (NPAs) uphold two key principles:

✅ The nurse’s duty is to the patient—not to the employer, physician, provider, dentist, or hospital policy.

✅ The nurse must protect the patient from unreasonable risk of harm—even if it means refusing an order.

If a physician’s order is unsafe or unsupported by evidence-based practice, the nurse is obligated to push back. The key is to approach these situations diplomatically and professionally.

Diplomacy Matters

On a travel assignment at a rural hospital, I faced a similar dilemma. A physician ordered me to give a bolus of IV Propofol. However, in my state, nurses are prohibited from administering Propofol by direct IV push. The nurses at this hospital routinely ignored that regulation, but I knew the risk to my license was too high.

Rather than confronting the physician directly, I approached him calmly with the state board’s position statement in hand.

I said:🗣️ “I’d love to give this, but the nursing board has a statement on this—nurses can’t give Propofol IV push.”

I framed it as a policy issue rather than a challenge to his authority. He backed down without incident.

Balancing Advocacy and Professionalism

Disciplinary action—even a minor one—can have long-term consequences for a nursing career, especially in acute care. However, patient safety must always come first.

Nurses walk a fine line between advocacy and insubordination. The key is balancing firmness with diplomacy—ensuring the patient gets the care they need while preserving professional relationships.

✅ Advocacy is at the heart of nursing, and sometimes it means standing your ground.

✅ When faced with a decision between following an unsafe order or protecting your patient, you have a legal and ethical duty to choose the patient.

✅ The challenge lies not just in knowing when to say no—but in saying it the right way.

Want More Information on Nursing Discipline?

Visit: Expert Nurse Consultants