Nurses' response to doctors' orders for close observation

Informal observation seemed to show that doctors' orders for close observation were treated in a manner different from other orders for patient care. A subsequent formal study involved 26 nurses over a four-month period. Data was collected by direct observation and through brief interviews with the nurses. A shift or part-shift involving a nurse and his patient on close observation was defined as the observation unit. Only 23% of the 284 observation units complied approximately with hospital policies for close observation. Forty-one percent of the observation units were recorded as totally non-compliant. No observation unit fulfilled the policy requirements in the strictest sense. Nurses provided close observation for almost as many patients on general observation as they gave general observation to those for whom close observation had been ordered. These data suggest that in most cases nurses use something other than doctors' orders to determine the observation needs of their patients. The author suggests that doctors' orders for close and general observation be abandoned and that only orders for constant observation be retained, in conformity with what is already going on.