If a nurse encounters potentially inappropriate orders for a patient with cancer and clarifications do not resolve the issue, to whom should the nurse first escalate the concern?

• A. The hospital administrator
• B. The patient
• C. Supervising nurse or established chain of command
• D. The patient's family

Answer: (C)

When a nurse suspects an order may be inappropriate and clarifications with the prescriber don’t resolve the issue, the nurse should escalate through the established chain of command to the supervising nurse or nurse manager. This is the appropriate first step because someone with supervisory authority can review the order, assess safety, and coordinate an alternative plan or further clarification with the medical team. This preserves patient safety and follows the unit’s policies.

The patient or family aren’t the immediate channel to resolve clinical-order concerns, and a hospital administrator isn’t involved in day-to-day clinical decisions. If the concern still isn’t resolved after escalating to the supervising nurse, the next step typically involves the on-call physician or medical director, per policy.