Will not take your advice

Specialties Triage

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rn/writer, RN

9 Articles; 4,168 Posts

Once, when I was the house supervisor at a psychiatric hospital on the noc shift, I received a crisis call from a distraught individual with serious mental health issues. She was delusional, paranoid, and by her own admission, suicidal. Because she was in another city, I ended up having a coworker call 911 on another line and having her ask them to trace the call. Our PD contacted her PD, and I believe they were able to get her some help. Her agitated mental state and self-harm statements trumped privacy issues.

Some other thoughts to consider:

It's advice, not orders.

You may just be standing in for the part of themselves that wants to do the sensible thing. It's just so darn difficult to argue with yourself.

You can only do so much. The presenting problem might be heart attack s/s, but the chief complaint may be chronic stupidity. An MI doesn't improve the IQ.

You never know what seeds you might be planting. Even though the response may not be as timely as it could have been, going in an hour later (after the wisdom of this idea has had time to germinate) can still be helpful.

Sometimes it's good to let go of the tug-of-war rope and appeal to their better nature. "You're a good mom. I'm sure you'll do the right thing." It may be whistling in the wind, but it just might turn an argument into an affirmation of their love for their child.

Document. Then let go. Otherwise you'll burn yourself out.

Jerry 75

171 Posts

Specializes in ER, Psych, Telephone Triage.

As far as calling 911 for pt. the closest I hve cvome to that was alerting PD while suicidal pt. was on the line or calling for a wellfare check for cops to stop by and check on soimeone who just wasn't sounding right but not in need of 911. If someone I was triaging was to week to call 911 or out of it I would first consult with supervisor before doing so.

Jerry 75

171 Posts

Specializes in ER, Psych, Telephone Triage.
I get frustrated when the patient truly needs to call 911 but insists upon having someone drive him/her to the ED.

For the family members who call & want to know how to "make" their loved one go to the hospital, I have to inform them of that person's right to refuse treatment until he/she loses consiousness. I further inform them that once that person has lost consiousness, they can no longer refuse treatment.

I don't let it bother me anymore. You do the best you can to explain your rational it is on tape any your butt is covered!

Jerry 75

171 Posts

Specializes in ER, Psych, Telephone Triage.

So many times I have told the pt. or family to take the pt. to the hospital now. Plus given a laymens level explanation of why it is imperative to do so now. Do you understand this plan of care, do you have any questions?

And yet get the response-

"OK so what your saying is that I can take her to urgent care tomorrow right?"

NOT!!!

Specializes in Case Managemenet.

I have called 911 several times, usually it is for the elderly pt who is confused or trying to do something for their spouse. I mostly do it with approval from the caller. I have called the Police a couple of times on Suicide calls, I have withheld the truth from the pt and called. I am not competely sure of my legal footing but ethically I know I am right on tract. You never know what some lawyer might say, but if someone has taken pills and is talking to me if I get an address out of them I will call in a heart beat to save them. I am taking the phone call as their cry for help, even if they tell me they don't want help. If they really didn't why call the nurse??

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