A little insight....... (long sorry) - page 2

HI guys! I have been a nurse for almost a year (passed last Feb), and on the unit since December. I got in my first BIG fight with a doc this morning, wondering what you think.... pt was s/p... Read More

  1. by   NotReady4PrimeTime
    Great outcome, cat84! How empowering to be so supported. Keep up the great work!
  2. by   al7139
    Hello again,
    I am glad that you have the supprt you deserve after that incident. I do have to comment on a poster who stated something to the effect of "I hope we have clearer guidelines and docs will start writing clearer orders on pts they feel should stay in the hospital"
    Since nursing school, it has been my understanding that a doctor does not make the determination as to whether or not a pt is incompetent to make their own medical decisions, and that nurses should not follow orders to chemically or otherwise restrain a pt against their will unless the pt has been deemed BY A COURT OF LAW to be mentally incapable of making their own medical decisions (for their safety or potential harm to others), so unless I have a legal medical guardian who I have consulted with prior to giving a med, I will never prevent a pt from leaving AMA. I can't make someone get the treatment I know will help them, it is their right to refuse.
    Amy
  3. by   David's Harp
    Wow - good on you for your grace under pressure!

    I can't picture any of the flock of residents on my floor wanting to be bothered with someone who wants this badly to bolt. There's usually someone who can get that person's bed within the next couple of hours anyway, so if the person is with it it's a matter of treat-OR-street.

    This is a good example for me in the likely event that it comes up, because by my understanding had you forced the IM Ativan it would've been your arse on the line, legally speaking.

    -Kevin
  4. by   patwil73
    Quote from al7139
    Hello again,
    I am glad that you have the supprt you deserve after that incident. I do have to comment on a poster who stated something to the effect of "I hope we have clearer guidelines and docs will start writing clearer orders on pts they feel should stay in the hospital"
    Since nursing school, it has been my understanding that a doctor does not make the determination as to whether or not a pt is incompetent to make their own medical decisions, and that nurses should not follow orders to chemically or otherwise restrain a pt against their will unless the pt has been deemed BY A COURT OF LAW to be mentally incapable of making their own medical decisions (for their safety or potential harm to others), so unless I have a legal medical guardian who I have consulted with prior to giving a med, I will never prevent a pt from leaving AMA. I can't make someone get the treatment I know will help them, it is their right to refuse.
    Amy
    Actually doctors can make the determination to "hold" a patient they feel is imminent danger by walking out of the hospital. However, once that determination is made then they have to contact the Mental health Professionals who must arrive within 4 hours and determine if we are going to continue an involuntary hold.

    The problem occurs is that doctors will "feel" a patient is at risk and order say a one to one sitter to watch them. They will discuss the need for inpatient treatment, but they will not write an order that says "Patient is at risk for self-harm. If they attempt to leave hospital restrain and call immediately so we can begin the involutary hold procedure". They simply expect us to "know" that is what they meant.

    I can read our policy pretty clearly - if the patient presents as A&O, does not make self harm threats or threats against another - then I don't consider them to be an imminent risk and they can go - regardless if they are a one to one or not. However, if the doctor has written an order like the one above - I will call security to stop the patient, and if they can't i will call the police and inform the doctor. We have a duty to protect our patients even from themselves, but the risk has to be imminent in order to do so. Even if you "know" the patient is going to do something stupid, unless they say "I'm going home to kill myself, my ex-wife, etc" you can't stop them.

    So anyway, the doctor can start the hold, but you are correct in that ultimately it is the MHP that will determine if we continue to do so.

    Hope this clarifies my position,

    Pat
  5. by   Danycejw2006
    WOW. Cat. You absolutely did the RIGHT THING!

    The pt. could have sued you and the doc. for giving that ativan.

    It's your license. WHENEVER you do not feel comfortable administering an order....you ALWAYS have the right to say no. It's better safe than sorry.

    Trust me, the doc knew you were right. He/She is trying to save his/her own butt by placing all the blame on you.

    Way to go. It's nurses like you that make healthcare safe and effective!! GOLD STAR!!

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