So here is the story: Patient with recent throat surgery presents to ER with copious bleeding from throat. No ENT coverage for hospital. Stable H&H and vital signs. Hospital transfer arranged for ENT at hospital approx 45 minutes away. ER physician verbally ordered one unit PRBC's to accompany patient. Paramedics are not permitted to transfuse blood products. Temp outside 90+ degrees. Nurse disagrees with physician order: 1. What nurse in their right mind would transfuse blood sent from another hospital 2. blood would be out of refrig for at least 45 minutes. Physician still ordered blood to accompany patient. Inform supervisor of physician's order and nurse's reluctance to send blood, supervisor stated to do what physican wants. Inform lab of physician's directions and reasons that blood should not accompany patient, lab released blood even with stating they did not have cooler to send blood. Paramedics accepted blood even with nurse's explaination of why they should not accept blood product with transfer. Events occurred on weekend. Monday, nurse calls ER manager and reports incident and nurse's reluctance to follow order and the reasons why. Evaluation given approx 1 month later with good review. Nurse manager stated she told administration that physician insisted blood accompany patient. Risk management comes to ER to discuss incident with said physician. Physician sits in nurses station and discusses event with other nurses. Other nurses soothe phyisican and told physician that he didn't do anything wrong and "they didn't want to use blood, they could throw it away". This nurse listened to encounter totally blown away that no one seemed to have an issue with the safety and ethical issues with event. 2 weeks later, nurse is fired for event. What am I missing with this scenerio??????