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Hofling hospital experiment


In 1966, the psychiatrist Charles K. Hofling conducted a field experiment on obedience in the nurse-physician relationship. In the natural hospital setting, nurses were ordered by unknown doctors to administer what could have been a dangerous dose of a (fictional) drug to their patients. In spite of official guidelines forbidding administration in such circumstances, Hofling found that 21 out of the 22 nurses would have given the patient an overdose of medicine.

A person would telephone a nurse, saying that he was a doctor and giving a fictitious name, asking the nurse to administer 20 mg of a fictitious drug named "Astroten" to a patient, and that he/she would provide the required signature for the medication later. A bottle labelled "Astroten" had been placed in the drug cabinet, but there was no drug of that name on the approved list. The label clearly stated that 10 mg was the maximum daily dose.

The experimental protocol was explained to a group of twelve nurses and twenty-one nursing students, who were asked to predict how many nurses would give the drug to the patient; ten nurses and all the nursing students said they would not do it.

Hofling then selected 22 nurses at a hospital in the United States for the actual experiment. They were each telephoned by an experimenter who identified himself as Dr. Smith, who asked them to administer the drug and said that he would write up the paperwork as soon as he got to the hospital. Nurses who followed the instruction were stopped at the door to the patient room before they could administer the "drug".

The nurses should have refused "Dr Smith's" instructions for any one of several reasons:

Hofling found that 21 out of the 22 nurses would have given the patient an overdose of medicine. None of the investigators, and only one experienced nurse who examined the protocol in advance, correctly guessed the experimental results. He also found that 21 of 22 nurses to whom he had given the questionnaire had said they would not obey the orders of the doctor, and that 10 out of the 22 nurses had done this before, with a different drug.

The nurses were thought to have allowed themselves to be deceived because of their high opinions of the standards of the medical profession. The study revealed the danger to patients that existed because the nurses' view of professional standards induced them to suppress their good judgement.


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