I generally had two formats for calling hospitals. One was simply a radio report that was similar to a report I'd give at bedside to the receiving staff. The other was what I'd use when asking for orders, for whatever reason. It was generally clear that I wasn't asking for, nor expecting, orders for care of that patient, when simply giving a radio report.
If you disagree with the MICN's order, should one be given, just make sure you clarify the order in such a way that you're trying to point out why you don't think it's a great idea to do at that time. "Confirm 2 mg Narcan for a spontaneously breathing patient that is protecting their own airway, satting 96% on room air with an EtCO2 of 38?" The MICN might not exactly "like" having to repeat an order, but the restated stuff might make them rethink the order. Also, if there's and adverse event of some sort afterward, you then can bring that up later in a run review... and it's on tape. Or you can request to speak to the Base Hospital Physician about the order. Be polite and professional and if the order won't be detrimental to the patient, you should be able to choose when to "do it" and at what rate. After all, 2 mg Narcan SLLLOOOWWWWWWWWWWW IVP will still result in 2 mg being administered just as a 2mg Narcan bolus does.
Just be very certain what your county's policy is when you are refusing an MICN order. Remember, if the MICN doesn't give the proper order and you carry it out, YOU are the one they'll hang because you're the ultimate safety device. As an RN, if I think a medical provider's med orders (for instance) are unsafe or appropriate for that patient, I have the responsibility to NOT do it and question it.
