Ethical/moral issue - page 4

by dee78

6,254 Unique Views | 40 Comments

Background: Patient is inpatient in an acute care facility due to dialysis non-compliance. Patient had to have security called during admission due to behavior. Patient is verbally abusive to staff and threatens lawsuits any... Read More


  1. 2
    In my opinion this is a failure of the discharge planners or whatever you call them in your facility.
    The MSWs should have been all over the readmission risk factors for this guy and setting up a reasonable plan for his DC.

    You did fine. We all forget things and make mistakes, it is a good day when our weaknesses don't kill someone or cause harm.
    Nursing is a profession that requires ongoing learning...you are in the midst of it, so don't be hard on yourself.

    Per the much beloved basketball coach John Wooden..."once you're through learning, you're through"...
    dudette10 and jadelpn like this.
  2. 7
    Sorry you had to learn this the hard way, but most out-of-control, out-of-compliance patients with ANY chronic disease have personality disorders....which is why they wind up blind, with a BKA, or trach, etc. You will this patient again and again, in both genders and with COPD, ESRD, CHF, diabetes and the gamut. They are masters of manipulation and feast on the youngest and kindest nurses. They will claim to love YOU above all nurses, until you say "no", at which time they will become a raving, drooling, screaming banshee, threatening you and world that if they don't get _________, they will sue you, have your license, beat you up....you get the picture. Sometimes a good administration will back you up, but 85% of the time, everyone will cave to the patient, which is exactly how s/he learned that this routine is almost always rewarded.

    I apolgize for being blunt, and lots of decent folks have chronic illnesses.....but this sub-group will take your sanity if you let them. Shame on your charge nurse for putting you in this position. I get these patients a lot, as I am 6'4'', with a shaved head, tats, and I can bench press 400lbs. As a gay man, no one in administration messes with me, lest I be the one complaining up the chain. Wish you luck in learning to deal with these jerks....sorry, honey, but you won't forget this harsh lesson.
    Hoozdo, psu_213, jadelpn, and 4 others like this.
  3. 0
    Yeah that night I had 4 HD pts, 1 was blind, 1 had an AKA, 1 had a partial foot amputation, the other had an awesome wife that took very good care of him to prevent these things. The 5th was a semicompliant type 2 diabetic with acute renal failure due to narcotic abuse. I am all too familiar with this segment of the population.
  4. 13
    This wasn't a failure of discharge planners, social work, case management, ANYBODY at the hospital. This was a grown man who knew he was going home and doesn't realize until he's leaving that he doesn't have a way into the house? And this is the hospital's problem?

    This "realization" at the point of discharge was manipulation to spend another night in the hospital, plain and simple.

    I locked myself out of my house. Realized at WalMart. WalMart didn't put me up in a hotel overnight, I had to figure out how to get into my house. Because that's what you do when you're an adult.
    Hoozdo, Sun0408, psu_213, and 10 others like this.
  5. 5
    Too bad we can't just write patients up for their own failures.
    Sun0408, psu_213, SHGR, and 2 others like this.
  6. 1
    Forget the cab, dc him straight to the ED so he can start the process all over again. These are the folks that keep us employed.
    redhead_NURSE98! likes this.
  7. 1
    We would have sent him on his way. Probably kicking and screaming.
    Discharge = exit the hospital.
    I can see where liability could be an issue.
    Personal responsibility is underrated in this country.
    psu_213 likes this.
  8. 2
    Quote from wooh
    This wasn't a failure of discharge planners, social work, case management, ANYBODY at the hospital. This was a grown man who knew he was going home and doesn't realize until he's leaving that he doesn't have a way into the house? And this is the hospital's problem?

    This "realization" at the point of discharge was manipulation to spend another night in the hospital, plain and simple.

    I locked myself out of my house. Realized at WalMart. WalMart didn't put me up in a hotel overnight, I had to figure out how to get into my house. Because that's what you do when you're an adult.
    With due respect wooh, and I do respect your opinions...
    Getting locked out is different from getting discharged from the hospital, I know that you know that and that you made a good point, but...

    in general to the thread...
    I know these patients are difficult, demanding people (my mother was one of them for quite some time before she died), but they are sick, chronically, and many of them do not cope "well". It is our job to advocate for them and care for them with unconditional regard no matter how unloveable or down right mean they are.

    good discussion.
    jadelpn and grid_iron_gurl like this.
  9. 0
    Quote from dee78
    Background:
    Patient is inpatient in an acute care facility due to dialysis non-compliance. Patient had to have security called during admission due to behavior. Patient is verbally abusive to staff and threatens lawsuits any time he doesn't get his way.
    Do you call the cab and send him on his way to wherever he wants to go?

    Do you call security to escort him to the cab?
    **** him. I hate that we have to deal with *******s like this that dont take care of themselves, then expect the world in return for whatever their woes are. Im sorry but the second you stop taking care of yourself, you lose the right to complain.

    Forget the security, call police. have him arrested for trespassing and enjoy a vacation from him for awhile.
  10. 2
    Glad you didn't get written up. Sounds like a terrible experience. Would have been nice for the charge to step in and handle the admission or discharge. Sometimes when you are right in the middle of a bad situation, its hard to see options. Best of luck to you, you sound like you will be a great nurse.
    BrandonLPN and tewdles like this.


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