A nurse on the orthopedics floor is asked by another nurse to witness her waste 1 mg of morphine. The nurse draws the full 2 mg dose of morphine into the syringe and tells the first nurse, “This client does not get enough pain relief with 1 mg of morphine, so I just go ahead and give 2 mg to keep him comfortable because the doctor won’t change the dose.” Which is the correct action by the first nurse?

  1. tell the other nurse to call the doctor back and request an increase in the dosage
  2. refuse to sign off on the waste and report the incident to the charge nurse or unit manager
  3. sign off the waste, and suggest that the nurse give it over two separate doses 30 minutes apart
  4. sign off the waste, but tell the nurse to give it slowly to be sure that the client can tolerate the dose
Number 2 is correct.
Rationale: The nurse should refuse to sign off on the waste and immediately report the incident. The nurse is bound by duty, law, and ethics to refuse to cover up for another nurse’s illegal actions. The second nurse is practicing medicine without a license, as it is beyond the scope of practice for the nurse to change a medication dose. The first nurse is also guilty and can be found liable if any harm comes to the patient. While suggesting the second nurse notify the physician for a dosage change is a reasonable action, the first nurse has been informed that the client has already received a greater-than-ordered dose and must report this information. Options 3 and 4 do not negate the fact that the second nurse is breaking the law and putting the client at risk.