A little insight....... (long sorry)

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Specializes in critical care.

HI guys! I have been a nurse for almost a year (passed last Feb), and on the unit since December. I got in my first BIG fight with a doc this morning, wondering what you think....

pt was s/p c-section where her bowel was nicked, and long term untx htn, so she came to IICU. Her baby is still in NICU on vent, cocaine, ETOH t/o pregnancy/life. However, pt a+ox3 NOT acting like d/t (see it a lot). Pt states I AM LEAVING! I don't like x,y,z and I am going home! Tried to reason, pt started putting on clothes, saying she was out. Asked charge nurse about IV/foley, she said if you think she is going to leave with it in or pull it out, d/c it, so I did. Told her doc had to see her (per policy ICU resident) and nursing supervisor. pt states "he better hurry, I am not waiting." Ok......

It is 0700 called resident stated "call the intern I don't have time for this crap.."called the intern "I am not on call anymore." I asked well who is? "I don't know" Well what is their pager? "I don't know." "Call the operator." I did she said you are on call.....recalled resident who stated "I am not on call anymore." All this why trying to keep the pt in the room:angryfire

Called the supervisor, who in turn makes them come (which neither is happy about) pt already off monitor, with clothes on, already called ride, etc. Resident makes comment about stupidity and wasting his time in front of pt, then orders ativan 3mg IV which pt states she does not want, blows up when I tell him IV pulled. Then tells pt she can't see her baby if she leaves (hi you can't say that) and orders it IM. I do not think this is appropriate (chemical restraint) for someone clearly wanting to leave. "I am sorry, I am not comfortable with this order, if you want you can give it yourself." Dr. states he thinks she is in DT's. "Well you could petition her..." Pt states she is done and is going home. Put AMA paper in front of her (which she signed) and started heading for elevator.

Then turns to me and says "I hope you are happy, it is your fault she left." "You should have given her the damn ativan." As he pages OB supervisor. I tell nursing supervisor what's up, as I am on the phone he is still hissing at me (I finally said I will be with you in one moment.) He smiles when he hands me the phone for the OB supervisor, who just states let the attending know (he looked disappointed). grrr........ My manager showed up for the last part and said don't worry but, I am still nervous. Did I do the right thing? Now it is in risk management, and god knows where else. Is there something I could have done differently? Would any of you given the ativan? I don't know, keep rep-playing it don't know what else to do......CAT

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He's a power-hungry idiot. I'm glad your manager backed you up.

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Specializes in ER/EHR Trainer.

You did the right thing, hope you documented patient refusal of IM and your response to physician re: administering meds against a patient's will and to do it himself. I would also write that the patient was counseled with all possible problems up to and including death! CYA!

I would.

Maisy;)

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

You did the right thing.

If the resident had come promptly when you first called and sat down calmly with the patient, he may have been able to have talked her into staying. Maybe not.

Document, document, document. Be objective, but document what was said.

You did everything you could. Giving the Ativan would not have been the right thing to do!

The resident was in the wrong and handled the whole thing very poorly.

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Specializes in Rodeo Nursing (Neuro).

False Arrest is not an appropriate nursing intervention. You did all you could.

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Wow... trying to force Ativan IM on a coherent pt. who didn't want/need it? Illegal much? And to say that pt. could not see child? Yikes... You did the right thing in my opinion. If anything comes from this it will be on that doctor, and deservedly so.

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Specializes in Emergency.

All I can say is Document the heck out of that situation. If you have witnesses, have them document it also. The attending or whoever cannot make the determination as to a parents right to visit her child, only social services can make that determination. If the patients caseworker is on it, she should already have notified SS about the mothers and childs positive drug screens. Even if the pt is a drug addict, that does not make them incompetent to choose to receive medical care or not. The doctor who told you to give the IM ativan regardless of the pts wishes was wrong, and needs a refresher course on pts rights. You did the right thing by refusing to give it, and they cannot blame you for the pt signing out AMA. Just be sure to document everything that happened. I am glad your supervisor is backing you on this. You are in the right, and don't let anyone tell you differently.

Amy

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Also... even if they both tested positive for drugs (which im sure is no fault of the baby's) I still don't think they should have the right to deny the mother the right to see her child. If anything, I'm a die hard believer in trying to save addicts from themselves. I've seen a lot of people go down that road and I've been able to help a couple of my friends who went through some rough patches get over the obsessions and staged interventions and got them into rehab and all the like. Unlike gun use, where people kill people, not guns... drugs help people kill themselves and their lives and everyone the love around them. Addiction is a disease that effects otherwise normal, decent human beings. Some people don't want to be help, which is true, but a lot of others... the majority IMHO want to be helped and are crying out for it, but most of us in this society just thumb our noses up at them and consider them weak, depraved individuals who would do anything for their fix.

I think it's sad that the majority of these addictions all stem from drug that were once used in the medical setting.

The so called war on drugs is a failure. Instead of punishing those who have fallen into this dark path we should be doing everything in our power to get them into treatment, to help them understand they don't need this crap to be happy. But... we don't have the money... the same money that is spent on new medications that will probably some day be abused just as much as the old street drugs of the 60's 70's and 80's. Look at adderall, look at Ecstasy look at Oxycotin (which in my opinion is just prescribed heroin) look at any other drug that has potential for abuse. Something has to be done about addiction not those who profit from and exploit that addiction. That's my piece, and I'm sticking to it.

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Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

I think you did the right thing. You can not force medication on someone who is in control of their faculties and does not want it. You can not hold someone who is in control of their faculties and not in imminent danger by leaving.

Do document everything clearly. I recently had a similar situation with a patient leaving and wrote a typed two page documentation explaining my reasoning in letting him go. About the only thing I might have done differently is keep the IV until the doctor arrives if you feel the patient was going to stick around until they showed (although with any history of IV drug use I would be watching closely for signs of bolting).

The doctor can order involuntary treatment if they believe the patient is imminent danger to themselves or another - but from you description I did not get that impression (high danger as probably going to go use more drugs, but not imminent). We can not hold people because they make stupid choices and based on your description I would probably have refused that order also.

It is quite probable the patient was in DT's based on history, but that still does not allow for us to force medication on them.

So, you did the right thing (based on your description). No doctor should ever tell you it is your fault - even if it is. They should give their concerns to your manager who can then constructively help educate if you did make a mistake.

Hope it turns out all right. I'm still waiting for the meeting regarding my guy leaving (which they scheduled in the middle of the day - I work nights) so I won't attend. But hopefully they will come up with clearer guidelines and the doctors will start writing clearer orders on patients they feel should stay in the hospital.

Hope this helps,

Pat

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Specializes in Staff nurse.

You "fought" the doc and the doc didn't "win". It doesn't feel like a victory now, but you advocated for a pt. (a stupid pt. imo, but nevertheless, a pt.) in not giving an A&O a chemical restraint. You are blessed that you were supported, too. Great job!

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Specializes in critical care.

;)Just an update!

1. I think the doc got more mad, because it is November and she didn't have socks and gave her some. Of course, this also encouraged her to leave. Also I checked he CAN NOT say she can't see her baby.

Everything is going to be "taken care of" My manager called me in the office, and I thought "oh crap." but, the resident is getting called out by 1. the nursing supervisors 2. The head of medical education 3. The intensivist group 4. My nurse manager! I could not believe it! She gave me a hug and showed me the letter she wrote about what happend to everybody. Whew! What a horrible day. Thanks to everybody for the support/opinions CAT

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Specializes in ICU.

It sounds like you did the right thing. I'd personally be hauling the intern and the resident to their attending as their actions sounded 100% inappropriate!

Always just document, document, document to CYA.

I'm sorry that they made you question yourself. You can't stop a patient from leaving AMA and you can't force drugs on a patient. Patients have the right to refuse.

Sounds like you did a good job! Just hang in there!

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