Editing Management of Care (section)

=== Chain of command ===
The chain of command is the formal route for escalating unresolved patient safety concerns. A representative nursing chain runs from assistive personnel to the LPN, to the RN, to the charge nurse, to the nurse manager, to the house supervisor or director, to the chief nursing officer. Provider concerns escalate from the resident or the ordering provider to the attending physician, to the department chief, and to the medical director, with risk management and the ethics committee available as parallel resources.

'''Rules for using it:''' address the concern with the person involved first when it is safe to do so, escalate one level at a time, escalate promptly rather than at the end of the shift, document each step, and '''never carry out an order the nurse believes is unsafe or incorrect'''. A nurse who follows a wrong order shares liability with the person who wrote it. The correct action is to clarify with the ordering provider and, if unresolved, escalate.