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

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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?

Specializes in Maternity, Cardiac Care.

A patient isn't expected to remove the extra paper tape around a dressing or after an IV is DC'd. Is it because it involves the genitals? If a patient is incontinent or has soiled a bed, as an RN I am responsible for making sure the patient is clean, including perianal and genital areas. Sometimes a patient seemingly does this purposefully.

In either this hypothetical situation or the actual one involving the lady partsl creme application, some therapeutic communication to find out why the patient refuses to do it themselves. There are nursing interventions listed in NANDA handbooks for self-care deficit, as well as neglect and/or elder abuse, etc.

A useful government website for guidelines to help with further nursing assessment and nursing interventions is:

http://www.guideline.gov/summary/summary.aspx?doc_id=6829

This might help keep the situation professional rather than a battle of wills, whether it be between patient, nurse or supervisor.

I hope the website is useful and helps! I like how it even identifies the healthcare provider's feelings as well as the patient's. NANDA's are helpful tools, I find, especially in potentially frustrating situations. Best wishes!

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first, we dont know that she has an infection, and there is no mention of what the cream is.....

second, if the patient is scratching, i would think this rules out the inhibition of touching the area in question

third, has anyone, doc or nurse, checked out the area for evidence of inflammation/irritation/discharge??

fourth, if she (the patient) can reach it, it is on her to do.....document/document

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Specializes in ER, Medicine.

I don't see this as a battle worth fighting. I'd let her know that she (pt) will have to do it herself upon discharge, provide some type of education, and find out why she is having issues administering the medication. And then I'd just give the medication because...an order is an order. Education is education. If the bottom falls out when the patient is home is that my problem? I've done my part and if she doesn't want to do it at home, oh well. More power to her.

What a waste of energy. I'd rather put in a lady partsl cream than be doing CPR any day of the week.

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Specializes in Management, Emergency, Psych, Med Surg.

What makes this situation any different from placing a foley or inserting a suppository or giving an enema? Is she willing to perform those tasks? Has she suffered some kind of trauma in the past that she associates with this task? I would certainly want to sit down and explore this situation with her. There might be a good reason that she does not want to perform that particular task. Does she know how to do the task? If is continues to be uncomfortable, I would do it for her. Just as I have to start IV's for others at times, I might help her with this task as well.

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Specializes in Operating Room.

An patient who is able-bodied, should do this herself.

Who is to say this patient isn't looking for a reason to sue the hospital and/or RN for sexual abuse?????

I would talk to the prescribing physician. He/she can write it in the order to teach patient correct administration, and have patient self-administer.

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I work as a cna for a staffing agency. the other day I was at a ltc facility and got physically attacked (both forearms scratched) by a pt for refusing to wash inside her orifice while giving her a shower. The really annoying thing about it is that while screaming at me this patient who kept notifying me she was blind (and therefore could do nothing herself) tracked my movements while looking me directly in the eyes and had no problem locating both of my arms to scratch me. I left the room, found another CNA to take over, reported it, and refused to care for that resident again during that shift. A staff cna there said she daily tried to get the cna to insert lanolin cream inside her lady parts.

Another resident in the same facility gets hysterical and insists on "needing" to be cathed every time there is a male nurse on duty in her area, regardless of if she has already gone to the BR 3 times and has an output of 1600 in the previous 6 hours AND being incontinent. They just cath her. In the other facilities I work at they would never cath someone who is clearly in it for the attention, as if a female comes in to do the cath she mysteriously doesn't need it anymore.

Other facilities in the area don't handle those types of things that way, but that one does.

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For the life of me, I don't know why there is so much discussion about this. There is an order for the cream. If pt is given a choice of doing it herself and refuses then nurse does it. End of story. A simple procedure gets way way to complicated.

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Specializes in NICU, Post-partum.

That's basic nursing care...and if the nurse has a problem with inserting it, then she needs to find another profession.

I can't even imagine her thinking.

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Specializes in NICU, Post-partum.
IMO, flat out, No she can't refuse to do it. There is an order from the doc for the cream. It makes no difference if the pt can do it herself or not. if the pt can't/won't do it then she has to do it.

i dont like to write people up and rarely do it. but unless this nurse has a darned good reason for refusing an order by the doc..i think i'd have to write her up over this one.

i've worked with some nurses that sound like this. it's like they are on a power trip over the pts and think they can order the pts around. not saying thats what she's doing, it just made me think of those type nurses.

but yep...i'd have a stern talk with her, with a witness present, and let her know in no uncertain terms that she WILL give the med.

how lazy can you be?

I understand what you are saying with that.

During my OB rotation, I was taking care of a new Mom that was less than 24 hours post c-section. All she asked for was a shower chair to bathe.

I was looking for one and my clinical instructor refused to tell me where one was and told me to go back and tell the patient that there wasn't one available...when there WAS.

I felt so sorry for that patient. I am not lazy, I am not a baby...but I distinctly remember after my own c-section how my legs felt like that they were going to give out on my that first day and MY nurse got me a chair when I asked for one.

The patient wasn't happy....and I felt very sorry for her.

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Specializes in Med/Surg, Geriatrics.
I work as a cna for a staffing agency. the other day I was at a ltc facility and got physically attacked (both forearms scratched) by a pt for refusing to wash inside her orifice while giving her a shower. The really annoying thing about it is that while screaming at me this patient who kept notifying me she was blind (and therefore could do nothing herself)

I'm sorry for laughing but that's kind of funny. Is she claiming that she is unable to find her own butt because she's blind? Bwahahahahaha!!!!!!

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Specializes in Med/Surg, Geriatrics.

My goodness, she must not be itching that terribly. Having suffered through a yeast infection (not in years thankfully) there is no way I would pass up a cure in order to insist that a nurse administer it.

Personally I would try to figure out why the patient will not self-administer the meds. This is a fine line even though most seem to feel it is cut and dried either way. If she won't give it to herself, can we honestly say she refused? How is this different from administering a suppository or an enema?

On the other hand, where does it end? What if she refused to feed herself and insisted that the nurses do it? What if she refused to go to the bathroom, insisting the nurses provide her toileting?

So it's a good question. A good way to cover oneself is to ask the physician if he will write the order for the patient to self-administer it. They used to write "leave at bedside" for these types of situations. That leaves it up to the patient to take it or not and lets the nurse off the hook.

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Well, I'm not a nurse yet, I'm a NA, but I've come across plenty of patients who are able-bodied but expect me and other NA's to wash them. One female patient got upset with me when I gave her a rag to wash her perineal region. She said," I don't know why I have to go through all of this! The other girl did it!" Yet this same patient is using her arms to push herself up into bed, turn, reach for items, and wash her face. Our jobs are to assist people but at the same time patients should maintain their independence if they are able to do so. I agree that an able-bodied patient should be given intructions to apply her own medication in her private region.

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