SO mad...and not sure I should be.

[AngelfireRN]

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 safely and therapeutically as we possibly can.

One of those rules is: "If you know you are pregnant or think you may be pregnant, it is your responsibility to inform the clinic. Failure to do so will result in termination as a patient."

Back the first part of last month, we got a fax that a patient, in addition to being a 'guest' of another state, had had a positive hCg at the facility. In cases such as that, we turn care over to the OB/Gyn.

Said patient showed up today, acting as though nothing was amiss, and did not disclose her pregnant state until confronted with it. The conversation ran the gamut of her legal troubles, her 'stress' and her need for her pills. I politely informed her of our policy (did not terminate her on the spot as I probably should have) and asked for the name of her OB/Gyn so that we could contact them to send records of her meds, etc.

That's when I'm pretty sure my blood pressure hit higher than it ever registered before, even counting my toxemia-plagued pregnancy.

"Oh, I don't have one. We're not going to continue with this. It's just not a good time. So, what do I do? I need my pills. Do I just have to bring you proof that it's done and I can have them?"

In a nutshell ( and yes, I'm being judgemental here), she didn't keep her legs together, and now she's just blithely going to terminate a pregnancy so she can get her candy. It's an inconvenience for her. Before you flame me, I consider myself pro-choice. In cases of rape, incest, extreme youth, maternal danger, or a known fetal condition that will result in little to no quality of life, I support the termination of a pregnancy. Not because one had no foresight to take precautions. And yes, we did ascertain that none of the above were a factor. She didn't care to announce it to the entire lobby, triage, and clinic in general.

I was so mad I was shaking. Maybe it's the miscarriage of my first pregnancy followed by a difficult and premature delivery of my son making my hormones run cattywompus, but I could have absolutely ripped her head off. I can't remember the last time I was that mad.

She then had the nerve to hang out in the lobby 'just to see if the doc comes in, so she can go ahead and see if I can have my pills'. The secretary finally had her leave.

My question...am I wrong (or hormonal)? I know ultimately it's her choice and her body, but it just cheeses me off to no end. All she was worried about was the pills! That's all!

Sorry for the rant. Full moon and a bad day. Thank you for reading, and I look forward to hearing your take.

[RNJHUPHL]

"In cases of rape, incest, extreme youth, maternal danger, or a known fetal condition"

Without knowing can you rule out that its not any of the above as her reasoning for terminating the pregnancy? All of those scenarios can be explained into your case except for the extreme youth and congenital condition. Sorry you had a bad day.

[RNJHUPHL]

To also note, many may find that telling hey I'm in an incestual relationship so me and baby daddy decided to get rid of it may be too forward. I don't know of many abuse victims who a) are able to get an abortion b) tell you that they are pregnant because of incest. Maternal danger is a vague term because if I'm dehydrated and can't maintain fluids then it is maternal danger. Incest can cause fetal abnormalities so this could be all in one. Maybe people react the way that they want to react especially if they don't want someone to know about it. Being with abuse victims in the pass women are tough to crack and women will lie most of the time to protect the abuser. It is hard to judge.

[serenitylove14]

I have to agree with RNJHUPHL. I am 30 weeks pregnant right now and this entire pregnancy has been a "Maternal Danger" there is so much that could go wrong that if I wanted to get a abortion simply for the fact that this baby is killing me wouldnt justify me getting an abortion in that respect. What this woman has is an addiction and during my clinicals I saw crack babies and its not pretty or fair to the baby that their mother did that to them because they had issues they couldnt get over.

[traumaRUs, MSN, APRN]

This 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.

[studentnurserachel]

Note 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.

[eCCU]

Culturally 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[2] [3]. 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[8]."

[mammac5]

I 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!!

[dmpearce]

Better she terminate than raise a child in that state.

[BlueDevil,DNP, DNP, RN]

I 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.