SO mad...and not sure I should be. - page 5
Please forgive the length...it's been a bad day. I work in a clinic that dispenses controlled substances. As such, we have various and sundry very stringent rules in place so as to prescribe as... Read More
Aug 2, '12This is not an abortion debate: this is a thread about giving narcotics to pregnant patients. Its much more of a medicolegal debate. Lets stay on topic please.
Aug 3, '12Note to admin, I think this thread has become way too heated, as discussions of abortion are wont to do.
Trying to address original issue here (as I saw it), as a few posters have said, I think it is completely necessary to create mental boxes for work and personal life. It is the only way I can handle taking care of child molesters (but don't worry, none of them did it) and people scamming the disability system for thousands with fake seizure disorder, among other fabricated conditions. I can't take it home with me or I would stew about it every night and weekend. In the same way that you are heated about her life decisions because of your own struggles, I could get pretty heated about my child molesting patients because I have children, honestly, who doesn't get heated by them? I have and still sometimes do fail to close that box when I leave work but I already know that if I don't manage to block it most of the time, I will be burned out in no time.
I wish you the best, at times like this I am somewhat grateful that my state has restrictive practice laws and requires physician "delegation" for me to prescribe and that he doesn't want me ever giving out more than a week of Norco or Tylenol #3 and nothing stronger. I would struggle seeing this kind of patient with any frequency.
Aug 5, '12Culturally competent care is defined as health care that is sensitive to and knowledgeable about the health beliefs and behaviours, the epidemiology and disease risks, and treatment outcomes of specific patient populations . Culturally competent care, therefore, requires that Nurses be:
aware of their own beliefs and values and how these might be affecting patient care knowledgeable about the health care issues facing their patients up to date on appropriate prevention and health promotion practices, and the most effective treatments.
Finally " You must be honest and aware of your own biases and prejudices, and if you feel you cannot provide non-judgemental, compassionate care for the population, then refer patients to someone who can."
Aug 5, '12I fully agree that we cannot control our personal feelings about any particular issue/patient. Feelings are what they are - we recognize them and then carry on. The distinction comes between feelings vs. actions. That said, there are always going to be times in the world of healthcare when we must recognize our feelings, and then act appropriately and professionally.
I believe you did the best you could to recognize your feelings/emotions and where they were coming from in regards to your contact with this patient and your own personal history. At that point, the feelings must be set aside and the policy (which was hopefully set by those who were not in the midst of an emotional moment, but were planning a safe/logical response to a given situation) must be followed. In this case that means just informing the patient that your office has been notified of a positive pregnancy test for her and you are unable to prescribe medications for her, no matter her plans to terminate. Blame it all on the policy - because that's what you're following. Give the patient a written copy of the policy, explain to her that you cannot stray from the policy, and wish her all the best as you move her toward the exit.
Policy and procedures always have a downside and there are times we would LOVE to make exceptions to P&P. But in this case, P&P is your protection legally and all you need to do is take advantage of that.
Then come to AN and vent all you want to burn off your emotional response. We're here for ya!!
Aug 6, '12I don't see the issue here. The patient was going to have an elective abortion, and was trying to clarify what she needed to do to secure her prescriptions. I understand that she wasn't necessarily a charming or likeable individual, and that perhaps she wasn't demonstrating a lot of compos mentis that afternoon in the lobby. I don't think that is germane, but I understand it. All she needed was a direct answer to her query. To be able to provide you with x, we need documentation of y. The exact nature of x and y themselves is really immaterial.
In the end, our responsibility is to our patient. At that moment, she required nothing but information about what to anticipate following a procedure she had already decided she would arrange. She wasn't asking for a referral, an opinion, or a blessing.
If her behavior is frequently inappropriate enough to warrant discharge from the practice, that is a separate matter from her pregnancy. Her independent decision to terminate the pregnancy is entirely extraneous to the real issue(s).
I decided 20 years ago not to get emotional about my patients and their various boneheaded moves. It is why I am still sane.