How would love to hear some of the things coworkers have done at work that just make you mad and frustrated.
For example, the other day we had a lady who was clearly terrified of needles. Now we all have patience claim they're scared of needles. But this lady was a little different. She came into the ER clearly in pain and flat refuse to let the doctors draw any blood work, or start an IV.
She had abdominal pain but would not allow us to do anything that involves a needle. Try to figure out a diagnosis for abdominal pain without being able to do any kind of lab work or use any kind of IV contrast.
Now I'm not the first nurse involved in taking care of this patient. In fact, I actually asked to take over care for this patient because nobody else was getting anywhere. After sitting there and talking to her for 20 minutes I finally got her to agree to let me draw blood do doing finger sticks with micro tubes just like I would have a very small child. So I went to gather up the necessary supplies.
Now I am a new employee and was oriented to the ER. My preceptor took it upon himself to walk in and try to convince the lady to let him start an IV. She's already told for people know she would rather leave. She had even said she would rather go home and die then let someone stick her with a needle and she was crying when she said so.
When I got back she was signing the AMA paperwork and leaving and nothing I could do to stop her.
. I've been a nurse twice as long as he has I just happened to be new to the hospital. I think he was wrong and out of line.
Specializes in Complex pedi to LTC/SA & now a manager.
The pieces of information we don't have:
Was the preceptor asked by management or the attending provider to approach the patient? If so, different scenario.
If so, is this a frequent flyer/regular visitor to the ED? If so, again different scenario. This may be a chronic sufferer with a needle phobia that presents to this ED on a regular basis for the same complaint. The OP being new to the department likely would not be aware
calling a patient ridiculous and immature for a fear of needles is a bit ridiculous. Many people have debilitating, sometimes irrational fears. But if she was working towards trust, her preceptor should have backed off or told her that he wanted to try a new strategy.
Clearly this his lady was in enough pain to go to the ER and wanted care. But clearly her fear was greater. Forcing people to do what we want them to do even if it's in their best interest. Doesn't always work and causes more stress on patients and doesn't necessarily all of a sudden make them more cooperative. Sometimes a little honey and working to build trust with your patient can go along way.
The underlying problem is that you guys didn't talk with each other. If he's your preceptor than you must be working somewhat together.
You could have updated him with your plan and he could have told you he was going in there to push the subject.
As well as check with the physician to see if your negotiation was enough to proceed. Going forward with one major hand tied behind your back is something I'd think would include needing endorsement from the team.
OP, I think you need to decide on whether this is the hill you want to die on. You can easily turn this into a thing. I would keep in mind that squabbling on the job between coworkers can get mighty disruptive. When it affects productivity, aka the bottom line, management gets activated. That's their job.
You're a preceptee. Letting you go is likely the cheapest solution to their problem. Boneheaded, but cheap and sometimes cheap is the priority. How badly do you need this job?
I think I know what you were trying to do. I would want to know the preceptor's reasoning for making a different judgement call.
I ran as far as I could from high acuity nursing years ago, so I couldn't begin to speculate on that.
Fingerstick labs are a very reasonable thing to attempt. If they were really THAT unreliable, we wouldnt use them in pediatrics on a daily basis. With a warm pack, good aim, and gravity you can easily get enough blood for labs. I promise, you only need half an ml or so for a lot of them.
At that point, and with an ultrasound of the abdomen, the treatment team can go from there. Is there something alarming found on the tests that requires immediate intervention? Perhaps a little PO anxiolytic and synera patches or emla can help the patient feel more comfortable with consenting to an IV. As another poster said, if you can provide the patient with real information on why an IV is immediately necessary, that could help them find the courage to try to fight their phobia of needles. Things like calling in "the best IV starter in the hospital" or the IV team can help patients feel more comfortable. You do what you have to do sometimes.
Hopefully everything that could be done was attempted with this patient, and OP I am glad you considered the option of a fingerstick to help this patient. Unfortunately, their decision to leave AMA is out of your hands and I would have to say, just let it go.
I think this goes beyond a patient of sound mind and mental health refusing care. There is a mental health issue at play, and OP was creative enough and used therapeutic communication to actually get some blood from this patient.
This doesn't sound to me like a case of, "want to sign out AMA? Deuces!' situation.
Feeding into this patient's dramatics is not getting anyone anywhere. Getting emotionally invested in attempting to convince someone to stay counterproductive.
She is seen by the MD. MD orders IV, labs, FBS. Patient says "no". OK, then, I will advise the MD. Back to the MD with "patient is refusing" and then the MD makes a call from there.
By negotiating, pleading, etc. it is just escalating an already tense situation. By educating that you have limited choices if she is declining treatment--in a calm matter of fact way, then leaving the exam room, perhaps the patient can reflect on their own choices.
Even a "what is your goal if you are declining treatment" is also a way of figuring out what in the world the person is doing presenting to the ER.
Perhaps the patient is uneducated as to what needs to happen. Maybe the patient is mentally ill. Maybe the patient is homeless and looking for a bed and a meal. Maybe this patient is withdrawing from drugs/ETOH. But none of that is your issue if the atmosphere in the exam room is hysterics.
And interestingly, I am wondering what triage information was gathered. What kind of history this patient had. What other circumstances surrounded this situation.
However, in busy ER's spending large amounts of time feeding into hysterics which at the end of the day--even if you got said blood work, what would you then do--ie: you are dehydrated and need fluids--Nooooooooo etc. etc. you couldn't do anything with that. The co-worker may have been sent in to clear the room if the patient was unwilling to be treated. And suggesting IV access would be the way to prevent another round of phobia bingo by at least having access from which all sorts of things could be done.
Not to mention you took it upon yourself to involve yourself in this patient's care. Which perhaps made the nurse that was assigned the patient a little miffed.
There are some policies in hospitals that AMA patients who are obviously in distress need to be seen by social work. Perhaps if this patient shows up again, this could be the case.
JustBeachyNurse, LPN
13,957 Posts
The pieces of information we don't have:
Was the preceptor asked by management or the attending provider to approach the patient? If so, different scenario.
If so, is this a frequent flyer/regular visitor to the ED? If so, again different scenario. This may be a chronic sufferer with a needle phobia that presents to this ED on a regular basis for the same complaint. The OP being new to the department likely would not be aware