Will not take your advice

  1. 0
    What do you do when the caller will not take your nursing advice?

    i.e to make an appointment or .. to go to the Er

    Do you every call 911 against the patient request?

    Share with us your story...
    Last edit by RNinfamily on Feb 8, '08 : Reason: wording

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  2. 16 Comments...

  3. 0
    I thought that unless a person has been deemed incompetent by the courts they had the right to refuse any and all treatments.
  4. 1
    In the UK we have the ability to break confidentiality and send the paramedics if we truly believe life to be in danger. I would rather stand up in a court of law having done something in the best interests of the patient instead of explaining why I did nothing about it and someone died.

    The telephone triage I do is for an advice line - it's their choice to choose whether or not they take the advice - it's annoying when you think they are not going to take the advice, but it's their life...
    XB9S likes this.
  5. 0
    We've only had one case since I've been doing pedi triage that the doc almost called 911 on the parents. They eventually went to the ER but this was after several hours of possible seizures.
    We had one just last night that was advised to go to the ER but they chose not to, they were seen in our after hours and got directly admitted to the ER 12 hours after the night nurse had said go to the ER by orders from the on call MD.
    Some parents just don't get it.
  6. 0
    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.
  7. 0
    Document. Something like: "mom advised that, according to our protocols, child should be taken to ER; However, mom refuses, stating that she will come to PCP's office tomorrow."

    Sometimes I would have parents say they weren't going to do as advised. I would tell them that I could not advise them any differently.
  8. 0
    Quote from RNinfamily
    What do you do when the caller will not take your nursing advice?

    i.e to make an appointment or .. to go to the Er

    Do you every call 911 against the patient request?

    Share with us your story...

    There really isn't anything you can do to make them take the advice. I will usually reinforce why the recommendation was made and why it is so important. I once had a man call who had all the classic symptoms of a heart attack. I explained he should go directly to ER, he was driving when he called, or pull over and call 911. He refused and said "Please pray for me." then hung up. It leaves you sitting there thinking, 'what just happened here'. You do your best to reinforce but it is ultimately up to the caller to decide what they do. Document what they say they are going to do in your call note.

    Mydnightnurse
  9. 0
    I once had a mom call with a kid having an asthma attack. The child was unable to speak. He was around 5, IIRC. According to our protocol, this was a "911" disposition. I told the mom that was what she was to do, yes, really.

    Twenty minutes later, grandma calls back. They are still at home, and she called to argue with me about the 911 call; she just didn't think that he needed to go to ER by ambulance!

    I told her what I'd told mom, that I could not advise them to take him by car if my protocol said to call the ambulance.

    What I wanted to do was to reach through the phone line and slap her upside the head and maybe slap some sense into her. If they had left with the kid by car when I talked to mom originally, they would have been in ER before Grandma called me back! :trout:

    Fortunately they finally did get the kid in and he didn't stop breathing on them on the way! :angryfire
  10. 0
    The company I am with has specific protocol documentation if pt refuses to follow my recommendation. I am only to inform the caller that not following recommendation could lead to loss of life. It is then up to the caller. Now we do have other protocol if it is a "crisis call" but those are mostly Mental Health (suicide intent, etc).
  11. 0
    I get so fustrated at times when I am doing my best to convince the caller to make the right choose for their well being an then they hang up no better than when the converstaion started.

    I sometimes want to say, "So way did you call, if you're not going to take my advice.", but of course you can't and you end up hoping and praying for the best.


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