can a nurse practioner override a doctor and refuse to treat a patient?
If an NP feels that s/he does not have the skills to treat a patient, that the care needed is beyond the NP's level of knowledge and skill, it is only correct to tell the physician that s/he cannot (not will not, but cannot) adequately and safely administer care to a particular patient. This is not "going over the doctors head", but stating an honest assessment of your own qualifications to diagnose and treat. To attempt to give care when you do not have the necessary knowledge or skill is malpractice, and is unethical. Both the general and NP nursing associations in yoru state will support your right to refuse care on that basis, but will also tell you it is your professional responsibility to gain those skills quickly if you are likely to see more patients like that in your practice. If the patient has threatened or assaulted you, or been inappropriate in behaviour with you, you may ask for a medical assistant to be present while you examine and treat the patient. This should be reported to your MD as well as to the director of medicine or nursing, whoever is your direct up-line in the hospital or clinic. No nurse needs to work under those conditions and your state nursing association and state NP association will back you up on that as well. If the issue is that you do not like the patient, that is something for you to deal with, perhaps with a senior NP or mentor who can advise you. Not treating someone because of personal feelings can be misconstrued as patient abandonment in some states. In NY, for example, it could cost you your license to practice any kind of nursing at all.
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