Being a patient advocate.

[tookalongtime]

You know how we are supposed to be the patient's advocate??? You know, looking out for their best interests and making sure they get the best of care and all that.

Have you ever not wanted to be their advocate? I am talking about the frequent flyers that take up your time, are on the call light constantly, never happy with the doctor or with you, want cheeseburgers in the middle of the night, complain about the hospital, and when it is time for discharge they try to make up all kinds of reasons they should stay. I just had one this past week. They are non-compliant, and you can't say anything to them to that effect. All they want is their pain meds given to them. I was happy when the doctor decided to discharge them because there wasn't anything we could do more for them. They would not do what they were supposed to try an take care of themselves. When I told the patient they were being discharged, they got mad at me. The patient said we were kicking them out of the hospital and they were still in pain and asked what was I going to do about it. I told them I had a script for them, they asked if it was for pain meds and I said no, it was to help them quit smoking. They got mad about that, and asked what they were going to do for their pain. I said you had pain meds before coming to the hospital, you will have to go back to that source for pain meds. Well needless to say they left mad and said they would probably be back in the ER because of the pain.

I could have or maybe should have paged the doctor to see if they could have a script for pain meds. I didn't want to. I guess I wasn't a very good patient advocate. I was not looking out for my patient.

Has anyone else had this same feeling for not wanting to be the patient's advocate??

[IHeartPeds87]

Well I'm not a nurse yet, but this is imho:

Being a patient advocate, to me, is doing what is in the best interest of the patient. Sometimes, you have to use "tough love"- and that means not always making the patient happy....even if you are doing what is best for them.

I would urge you to try and not group "them" together, as you seem to have done in your post. Remember to treat each patient as a new patient, and not group them in with patients with similar stats!

Also, try and see it from their point of view. Perhaps they are addicted to pain meds. In which case...maybe you could have called a psych consult?

I'm not trying to berate you....we all know that there are frequent fliers and others that abuse the system. My fear, however, is that once you have seen a few of those people you (or anyone) will assume that someone who CAN be treated.....is assumed to be one of "them."

I know its hard...but its part of the job. You are a patient advocate. Whether you like the patient or not!

Think about nurses who work in corrections....many of them, I'm sure, do not particularly like their patients. That doesn't (or atleast shouldn't, in a perfect world) prevent them from getting the best care possible from the nurse.

I know it's hard...and you aren't alone. It's why so many nurses, particularily ER nurses, get burned out.

[PostOpPrincess, BSN, RN]

You are human.

And the patient was an ***.

I don't blame you at all.

Hopefully, next time, they won't wear you out to the point of compassion fatigue.

J,

An experienced NURSE, not a student.

[tookalongtime]

J. Thanks for understanding my post. This discharge was happening at the same time as another discharge for a patient that was terminal and all they wanted was a slip saying they could go back to work the next day.

[mcnursiegirl]

wow- it makes you look at things in perspective huh? I work on a unit where we have the same ones over and over who are on the clal lights frequently, wanting nothing but pain meds and then when you can't get them what they want, they threaten to leave AMA. and then you have the pt's who are dying and the families are so very patient. Its a complete 180.

So sorry that the pt made you feel that way- they wear you down when they are like that.

:hug:

J. Thanks for understanding my post. This discharge was happening at the same time as another discharge for a patient that was terminal and all they wanted was a slip saying they could go back to work the next day.

[LouisVRN, RN]

Honestly, I find it easier to just try my hardest to be an advocate for them, I sleep better at night and I can truthfully tell them I tried. Just my

[LouisVRN, RN]

Honestly, I find it easier to just try my hardest to be an advocate for them, I sleep better at night and I can truthfully tell them I tried. Just my

ETA: On my floor I am known for making food runs to the cafeteria for my patients on an almost daily basis. I had a young patient once request a peanut butter and jelly sandwich at 0300am, of course I had to make it myself, but after that the patient I think understood that if I was a few minutes late for something it wasn't because I didnt care about him and his needs/wants.

[fungez]

Giving a druggie a narc script when the doc already told him no is not advocating, it's enabling. The guy already had his pills at home but he wants what all druggies want - more, more, more.

I mean this in the kindest way possible - quit worrying about these kinds of people. You are not helping them. They will suck you dry with their incessent, unreasonable demands and they'll straigten up and fly right when it gets too uncomfortable for them to do otherwise, not before. Worrying about them leads you down the path of codependency. Yeah, I know it's all about customer service nowadays but these so called customers can get the heck out of my way. I'm here to take care of patients.

Me, I worry about people with cancer, not entitled little twits who complain to patient relations that their middle of the night cheeseburger was cold.

[PostOpPrincess, BSN, RN]

Giving a druggie a narc script when the doc already told him no is not advocating, it's enabling. The guy already had his pills at home but he wants what all druggies want - more, more, more.

I mean this in the kindest way possible - quit worrying about these kinds of people. You are not helping them. They will suck you dry with their incessent, unreasonable demands and they'll straigten up and fly right when it gets too uncomfortable for them to do otherwise, not before. Worrying about them leads you down the path of codependency. Yeah, I know it's all about customer service nowadays but these so called customers can get the heck out of my way. I'm here to take care of patients.

Me, I worry about people with cancer, not entitled little twits who complain to patient relations that their middle of the night cheeseburger was cold.

This is about right. I sleep well at night, trust me. And I don't mind making a PB & J for a little boy. I do, however, manage my time effectively and do not run all over the place for food...unless I want the exercise...there are limits...

[Zookeeper3]

worked the ER, they got motrin, the pure drug seekers, work an ICU... we lay it on heavy. I don't discharge from the ICU, and this is never a lecture, but just please look, if your possible whinny can't make happy patient had been receiving narcs through the hospital stay, it is inhumane to simply cut them off. Narcotic withdraw can be life threatening due to rigors and tremors which throws them into rhabdo and it's ugly.

I get these admits to the ICU... and it's ugly... a fentanyl patch times three doses until they can follow up with their doc... or percocet for seven days to follow up.

YOU can't fix a dependancy on discharge, but you can prevent an acute withdrawl syndrome that gives piece of mind and then lays it on others hands. Plus there is narcotic dependence that we've created through no fault of your own, that needs to be addressed.

Aside from what is "right to do' I always want to kick these suckers out, but know it isn't safe, will result in frequeent ER visits, increase costs and maybe cause harm. The extra call to get them through the week to give them fair chance of a primary care provider is a nursing necessity. that way you never have to second guess yourself.

We don't enable at discharge, we either own an addict or have provided proper placement. Discharge is not the place to determine enabeling, either we've addressed it or we have to continue the weaning though discharge care. we simply don't cut them off because we can.

[cherrybreeze, ADN, RN]

I think you did fine, and agree that trying to obtain a narc script would not have been "advocating," it would have been "enabling" (kudos to the above poster who put that so simply and truthfully!). Being an advocate does not mean getting everyone everything they want, whenever they want it; it means doing what you can that is in their best interest, and those two things, too often, are NOT the same!

On a side note, it also probably would have been a colossal waste of time, since chances are the doc wasn't going to give the patient that script later, either. Chances also are, if the doc HAD given you a script for something, the situation would have snowballed....whatever med probably wouldn't have been good enough, resulting in a request to call the doctor back, ask for something more/stronger, possibly ask to delay the discharge....it was an unwinnable situation (not to mention, not an issue of advocacy).

I disagree with the above poster, I didn't get the impression that you're lumping all of "these" patients together. You are talking about this specific situation. Obviously there are and will be others like them, but I get the feeling you'll also deal with each of those cases individually, as the situations warrant.

That post said, that sometimes being an advocate is doing what's in their best interest, not what they want, and later it said, "you have to be an advocate, whether you like it or not." So, which is it? You're not saying you don't want to be (well, you did, but I don't believe that's how you meant it, you meant "advocating" when the person's requests are either unreasonable, or not in their best interest, etc).

We have a FF that is like the one you describe (I'm afraid to talk about her, next time I work, she'll be back...yep, I believe in superstition!). The pain meds are never enough, it's always a HUGE production when she is discharged because she's "still in so much pain," etc. After DAYS of being on our floor, and numerous tests being negative. The last time was after a lap chole, she developed abdominal pain. Test after test is negative. Huge deal to get her out of there. Back on another floor a few days later with a wound infection needing an I&D (not sure why she wasn't on our floor again, but hey, not looking a gift horse in the mouth). Over the years she's been suspected of Munchausen's (every single surgical wound she's ever had has gotten infected post op, among many other things), but if someone isn't cooperative with a psych consult, nothing you can do.

Oh, that was the last thing I wanted to address. Same response above suggested a psych consult. Really? That wasn't going to work. Patient would never have admitted to drug seeking, if that's what they were doing, or to having a problem with medication. They claimed to be in pain, and wanted meds, period. They didn't want help for it, or a psych evaluation. That would have been a waste of time and resources, to be perfectly honest. In a dreamworld, sure, but....

[cherrybreeze, ADN, RN]

worked the ER, they got motrin, the pure drug seekers, work an ICU... we lay it on heavy. I don't discharge from the ICU, and this is never a lecture, but just please look, if your possible whinny can't make happy patient had been receiving narcs through the hospital stay, it is inhumane to simply cut them off. Narcotic withdraw can be life threatening due to rigors and tremors which throws them into rhabdo and it's ugly.

I get these admits to the ICU... and it's ugly... a fentanyl patch times three doses until they can follow up with their doc... or percocet for seven days to follow up.

YOU can't fix a dependancy on discharge, but you can prevent an acute withdrawl syndrome that gives piece of mind and then lays it on others hands. Plus there is narcotic dependence that we've created through no fault of your own, that needs to be addressed.

Aside from what is "right to do' I always want to kick these suckers out, but know it isn't safe, will result in frequeent ER visits, increase costs and maybe cause harm. The extra call to get them through the week to give them fair chance of a primary care provider is a nursing necessity. that way you never have to second guess yourself.

We don't enable at discharge, we either own an addict or have provided proper placement. Discharge is not the place to determine enabeling, either we've addressed it or we have to continue the weaning though discharge care. we simply don't cut them off because we can.

You don't know, however, what they were taking before they came in. They may not have been on narcs regularly, making withdrawals a non-issue (they aren't going to have that severe of withdrawals after only the meds they were on when hospitalized). In that case, IMO, you go by their home med list....if they weren't on narcs that were prescribed, and the doc didn't feel they needed a script to go home on, that's the end of it. It's also not our job to legally substitute what they were taking illicitly prior to coming in, either (and chances are, they aren't going to admit to illicit use, so you can't assume it and give meds just to stave off w/d's). They're adults. They may have withdrawals, or they may go back to their illegal source and use, but that's on THEM, that's also not our job to address and fix. If they want help with an addiction, they need to admit addiction and seek it on their own (and I am differentiating between addiction, and dependence from long-term prescribed use, that's a whole other ball game).