[Tweety]

This is not a rant about staffing, we are horribly short staffed, but normally we are o.k. We're going through a rough, hopefully temporary time right now as some contracts have left.

I'm taking care of a patient who c/o of chest pain and was admitted, only to later refuse telemetry, leaves the floor to smoke. I see he's up at 5AM and ask him to reconsider the telemetry, as he told an aid, not me. I explained as a cardiac patient he needed to be on it.

"I don't like your attitude, just do what you got to do and leave me alone."

I'm tired, stressed, working overtime, caring for patients above and beyond the normal ratios.

So I say, "You're the one who came in here complaining of chest pain. I don't care if you wear the monitor or not. I'll go care for sick patients that need me. "

He said he didn't like my bedside manner. Well excuse me Mr. Customer I ain't in the mood for kissing ass today.

I DARE and DOUBLE and TRIPLE DARE anyone from management to say anything to me if he complains. Just dare them.

Thanks for listening.

[PsychRN03]

lol...So why is he still in the hospital? Unless telemetry has changed over the past yr, it is the least invasive procedure he will endure over the next few days (if he stays). Is he not aware, medical care in the US is usually voluntary? If you don't like what's going on, just sign on the dotted line, get your stuff, and adios amigos. It'd be one thing if hospital stays didn't cost anything and there weren't people out there who are truly ill, needing medical attention. Unfortunately, neither of these are true; plus add to the fact he's taking precious time from you to care for your pt's who are in need of your care.
While what you said might unfortunately get you in a bit of trouble, because it was a tad bit unprofessional (but not like that's always a bad thing IMO) I'm sure I would have gotten in more trouble because I would have introduced him to the lovely world of AMA.

[bellehill]

Good for you tweety! Nothing is more annoying than trying to help a patient who doesn't want help. I too have been tempted to suggest leaving AMA to these type of patients. Sometimes you just have to laugh!

[JacqueOCS]

Bless you Tweety, hang in there. It amazes me that pts will come to the hospital for care, but then refuse it once admitted. Go figure

[zenman]

Sounds like patient education to me or a dose of Reality Therapy. Way to go!

[Nurse Ratched]

I probably would have gone a step further and offered him an AMA form if he didn't want to be treated. (Nicely, of course. ) I am a big fan of being pretty matter-of-fact with folks - something along the lines of, "So you're no longer having chest pain? Does that mean you want to be discharged? I can certainly call the doctor if that's the case."

[BarbPick]

he is one I would chart, patient is non complient with protocol, affect inappropriate, in denial of disease and is a major weenie

[Tweety]

Ratched, I was tempted to say that and should have.

I might add that this week was one of those "Customer Service" memo's from the CEO. Grrrr....put on some scrubs Ms. CEO and give some customer service to people like him.

[PsychRN03]

This reminds me of something that happened recently. We had a pt involuntarily admitted for schizoaffective d/o. She was guarded and was refusing meds. Her primary nurse asked another RN, who recently returned after a lenghty medical leave, to attempt to admin meds. The RN a couple months prior had a severe seizure NOS in the middle of the dayroom one evening, and when he came back to work, he was quite manic. So he returned to the nurse's station and said he got her to take them. He said he told her there was a wait for her room and if she wasn't going to adhere to the treatment plan, she should pack her stuff and he'd call here a cab so they could fill the room with someone who wanted to receive care. Bottom line, she took her meds. Here was the problem.-her hubby is a psychiatrist in a nearby facility and the next morning the pt told everyone who would listen what the nurse told her--including the hubby. The nurse was placed back on medical leave effective immediately where he stayed for another month or 2.
I just don't get it, perhaps the nurse saved this lady a future takedown, and he used no physical force. Seemed reasonable to me at the time.

[LLSRN]

Wow, I think I took care of that same patient about 2 weeks ago.
Turns out the other hospital in our town doesn't want him and just about every cardiologist in town refuses to treat him.
All I had to say to him is if you don't want treatment then why are you here. He didn't like my bedside manner either...called me several "bad names" and continued to refuse treatment.
I got pulled from being his nurse and he ended up AMA in less than 12 hrs. I am a very patient nurse, but there are some patients that test that patience! All I can say is document well and hope that he somehow doesn''t find a lawsuit in this matter.