It was just a bit over 50 years ago – in the summer of 1966 to be exact – when a psychiatrist by the name of Charles K Hofling thought it would be interesting to see just how willing nurses might be, to carry out dangerous instructions by doctors. So he hit upon a rather sneaky idea: He’d have ‘pretend doctors’ call in to hospitals by telephone, and direct the nurses who answered to do whatever they were told to do. Wow. Now how about that?
Hofling’s findings were more than a little bit shocking, even for the 1960s. Because even though hospital protocols forbade drug administration in such circumstances (an unknown physician over the telephone) the experiment revealed that almost every nurse directed to give patients what would have been a drug overdose – did so.
A man, unknown to the nursing staff, calls in to a hospital and says he is a physician. He identifies himself with a fake name, and tells the nurse it is important to administer an immediate 20 milligram dose of a fictitious medication called Astroten, to a specific patient. He says he will sign the patient’s chart for the drug order tomorrow morning. A small bottle of Astroten (actually harmless sugar pills) has been secretly placed in the drug cabinet where the nurse normally works.
Now, not only was there no such drug as Astroten in the whole wide world, (so no nurse or anybody else could possibly be aware of potential side effects) the fake label on the vial clearly stated that 10 milligrams was the only safe dosage. To double the dose of nearly any hospital-strength drug is dangerous, and a serious breach of medical protocols.
Oh, and here’s another little aspect of the Experiment worth noting. Prior to the test, 12 nurses and 21 nursing students were assembled and told of the plan to test nurses at random. They were asked to predict how many nurses would actually administer the medication, knowing it was wrong to do so. Only 2 of the 12 experienced nurses – and none of the 21 nursing students – believed the nurses who took the call, would actually follow the “doctor’s” order.
Hofling then chose 3 unidentified American hospitals and picked 22 nurses at random. They were each telephoned by a member of the experiment team who identified himself as “Doctor Smith,” who directed them to administer the drug. The man on the phone said that he would, “sign the drug order on the patient’s chart when I get to the hospital.”
Each nurse who obeyed the dangerous order was stopped at the door to the patient room, before they could actually administer the “drug”.
Now, as you may or may not already know, any nurse in such a scenario was supposed to refuse “Doctor Smith’s” instructions, on these solid, medical/legal grounds:
- Hospital protocols were clear: nurses were to only take medical directions from MDs known to them. They should not follow orders given by an unknown doctor over the phone
- The drug in question was a complete unknown to the nurses
- Drug orders were to be signed by the MD before they were administered
- The dosage they were instructed to administer was double the safe amount
The Ugly Conclusion?
The Hofling Study revealed that 21 of the 22 nurses would have indeed given patients an overdose of a medication they knew nothing about, ordered by a stranger’s voice on the phone, had they not been stopped. Not one of Hofling’s study team – and only one experienced nurse who saw the plan in advance – accurately guessed the troubling results. The study also found that nearly half of the randomly selected 22 nurses had already given patients medication, ordered by unknown MDs on the telephone in the past. And some had done so numerous times.
What the study exposed is the very real danger to patients that exists, when nurses suppress good judgement for fear of physician bullying. And you’d better believe this kind of intimidation continues to this day.*
Our Question of the Day:
So what do you suppose is going on between the nurses and MDs at your local hospital, in the year 2017, when it comes to physician intimidation? How many modern-day nurses allow themselves to be pressured into mistreating patients? Send us your thoughts and experiences we’ll publish then in a follow-up article.