can a nurse refuse to give vaginal cream to a patient?

[Ms.RN]

I have a patient whose been complaining of itching and burning in lady parts area. So doctor prescribed a lady partsl cream for her but the problem is a nurse that has her is refusing to administer it to her. She says "This patient is competent to be able to insert lady partsl cream by herself" Yes, this patient is able to do it herself but she asked a nurse to do it for her, but this nurse is still refusing. Can a nurse refuse to do it or is she being very unprofessional?

[NurseyBaby'05, BSN, RN]

On the other hand, if there's any physical infirmity that is impairing the patient, obviously the RN should just suck it up and do it himself/herself.

Obviously, that's a different story. I have no problem doing that whatsoever. The OP stated that the pt is able to do this for herself.

At least you would come talk to the pt. Our docs would just laugh at the phone call and pretty much say "Okay. Whatever. Bye" Or depending on the doc a few might say "I think you should do it.:devil:" (As they try to hide their horns from popping out. )

[southernbeegirl, BSN, RN]

no wait. i've got the perfect solution!!!

diflucan.

that way, she gets treated and nobody has to bother the hooha.

[ChristineN, BSN, RN]

I would talk to the Doc and get an order to "teach patient how to apply lady partsl cream" ..if there is a problem with the patient applying, get a different cream with an applicator if need to. I would talk to the patient and ask her how she would do it when she got home, getting her to show me..as a teaching role and also discuss why it is ordered. Push comes to shove however it IS our responsibility to make sure patients get their medicines as long as they are our patients and in the hospital.

I don't see why you see a need to get an order for pt education. I don't get an order every time I need to "teach pt how to administer insulin" or "teach pt how to administer Nicotine patch." Since it is part of our role as nurse's to instruct pt's on how to use and administer their medications, I don't see why we need a doctor's order.

Oh, and I would make sure you documented all pt education as well as the pt's response to it.

[ChristineN, BSN, RN]

IMO, it wouldnt be forcing her to do it. It would be requiring her to perform her job duties. Regardless of whether the pt can do it or not, unless there is something careplanned concerning some adverse behavior (and we've all seen it), then, IMO, the nurse has no choice but to do it. otherwise, it will leave an untreated infection.

first though, i would have a talk with the pt and find out the why of why she wont do it herself. then i would talk with the nurse about the why of why she is adamantly refusing to do so.

heck, if nothing else, i'd just do it myself.

I agree, first and foremost find out why the pt will not administer. Is the pt just being lazy? Is it a lack of knowledge on how to administer? Does the pt maybe need a mirror or something to help her administer?

[FireStarterRN, BSN, RN]

Nothing like the word 'lady parts' to get a thread going...

If this were a man insisting on having the nurse put some creme on his personal equipment, when he was perfectly capable of doing the job himself, then I would question his motives.

No double standards here.

[birdgardner]

Some women are reluctant to touch themselves there - it's not "nice." If that's the problem, and the patient might not discuss it if it is, offering her gloves just might get her over that hurdle.

FWIW, a pair of gloves was just the trick to get one pt. to start doing her colostomy bag care - I figured if I wouldn't touch it without gloves, why should the patient have to? And who wants to touch what the patient has touched if she wasn't wearing gloves?

[FireStarterRN, BSN, RN]

Just chart "Pt A&O, performing all perineal care independently. Instructed pt in use of lady partsl applicator. Pt affirmed she has used tampons before, explained to pt similarity to that procedure. Pt refused to apply creme. Reinforced importance of using medication properly in order to alleviate symptoms."

[NurseyBaby'05, BSN, RN]

IMO, it wouldnt be forcing her to do it. It would be requiring her to perform her job duties.

I am a nurse, not a baby-sitter, mommy, what have you. It is not my duty to coddle and cajole a competent, able bodied, non-compliant adult to take care herself. I would make sure she knew how to administer the med, provide the teaching she needs, provide her the med. And then document. Like Tired MD said, lady partsl itching is not a medical emergency.

As for Diflucan, if the infection is extensive, a topical med is often needed in conjunction with it. Oh, say I offer her the Diflucan and she refuses b/c she wants the cream, what then? Would you write me up again? Or if she wants me to stick the pills so far down her throat that she gags, can I refuse then? After all, it's a duty of my job to make sure she gets the proper medication/treatment during her stay.

[Spidey's mom, ADN, BSN, RN]

Part of a nurse's job is to encourage the pt to do as much for himself as possible. We're not there to wait on them hand and foot. There is no reason for this patient to not be administering something in her lady parts herself if she is able. Also, there are a lot of freaks, weirdos, choose your favorite descriptive word here who get off on that kind of thing.

Write me up. I wouldn't do it either.

These were my thoughts as well - we do encourage patients to do as much of their own care as possible in anticipation for discharge.

I don't think this is something that should be written up - I really hate that term anyway . . . why do we "write up" our colleagues?

Unless they are abusing a patient or stealing narcs . . .

steph

[Batman24]

Is this an elderly patient?! If it is I wonder if she's just not comfortable touching herself down below. I have seen that happen before with elderly patients. It might not be that she's lazy or looking to get her jollies in this case but more fear of touching her own nether regions. Some elderly find that dirty and wrong. Sad but true. If this is the case I would stay with her and show her how to put it on. Maybe do a bit yourself and have her do the rest explaining she will need to do this at home on her own. It might work.

[Pepperlady]

I agree, first and foremost find out why the pt will not administer. Is the pt just being lazy? Is it a lack of knowledge on how to administer? Does the pt maybe need a mirror or something to help her administer?

Dear God that would be the epitome of the word lazy !!!!

[NurseyBaby'05, BSN, RN]

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