Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses: a questionnaire survey

Int J Nurs Stud. 2005 Aug;42(6):637-48. doi: 10.1016/j.ijnurstu.2004.09.002.


Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60--71%). Of the respondents, 11--30% experienced problems with and (contemplated) refusals of orders for risky procedures in the previous 12 months. Gynaecologists and internists most frequently mentioned problems concerning the practical performance of the procedure (44% and 30%, respectively). The reason for a problem or a contemplated refusal most frequently given by nurses was that they disagreed with the medication policy (34% and 35%, respectively). The reason for a refusal most frequently given by the gynaecologists, internists, and nurses was that the nurses themselves were of the opinion that they did not have the necessary authorisation (95%, 67%, and 62%, respectively). With regard to certain procedures, the views of professionals are more strict than the current legal regulations.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Clinical Competence / legislation & jurisprudence
  • Clinical Competence / standards
  • Conflict, Psychological
  • Female
  • Gynecology
  • Humans
  • Internal Medicine
  • Male
  • Medical Staff, Hospital / organization & administration
  • Medical Staff, Hospital / psychology*
  • Netherlands
  • Nurse's Role / psychology
  • Nursing Methodology Research
  • Nursing Staff, Hospital / education
  • Nursing Staff, Hospital / organization & administration
  • Nursing Staff, Hospital / psychology*
  • Organizational Policy
  • Personnel Delegation* / organization & administration
  • Physician's Role / psychology
  • Physician-Nurse Relations
  • Professional Autonomy
  • Refusal to Treat* / legislation & jurisprudence
  • Risk-Taking*
  • Safety Management
  • Self Efficacy
  • Surveys and Questionnaires