NONCOMPLIANCE, why be at the big H? in the first place?

Nurses General Nursing

Published

I was discussing with fellow coworkers the unwillingness of patients at my hospital to get with the program: COPDers with pneumonia receiving a breathing treatment followed by a dose of morphine walking to the elevators to go smoke on the balcony. What's with this tolerance of such beligerant actions on the patient's part? Can a hospital have a policy that would state: If you show no willingness to comply with the treatment recommended by your physician, the hospital has a right, the physician has a right, even the NURSE has a right to terminate your stay; a sort of reverse AMA!!!

So what's your take? Is this too harsh a proposal? Totally out of the box, crazy??? Part of me wishes it were a reality...

Specializes in Education, Acute, Med/Surg, Tele, etc.

My patients are NOT my CLIENTS ever ever ever! Rules be darned..NEVER EVER~! I am not a hooker, I am not in another job field where I help with draperies or picking out flooring or what not. I am their NURSE..and I do much more than any profession that calls a person CLIENT! They aren't my client..they don't go through a contract with me, they don't get a statement of time and date of wellness agreed by both of us..no...this is friggen silly!

My patients are my patients..and some day the powers that be will realize this...flip the total opposite way (notice things trend towards one extreme to the other an never in between!), and they will become something less than patients in some PC way!

In school call them what they want..outside, if it makes you upset..call them what you wish..and fight for it. I call them patients, and never had a probelm outside of school~!

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I understand the frustration, but otoh I'm a big advocate of pt rights. I think that people should be free to pick and choose what treatments they'll accept while there, even if the nurse disagrees. The important thing it to educate them on the possible consequences.

These people aren't our prisoners or our children. They are adults who make choices that we might disagree with. They over eat, smoke, don't exercise, and so they land in the hospital. Think of it as job security!

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You make very good points, and I appreciate them. I, too, advocate for pt's rights, but I suppose I fall more into the category of "my patient WANTS this treatment" or "this pt is in pain and his MD doesn't want to be bothered? CALL AGAIN", like that.

I get frustrated and/or angry when a pt's non-compliance with standard medical care in the hospital prevents me from helping him heal, or actually gives me more work to do (calls to make, extra documentation, and of course the EFFECTS of his refusing to do anything his MD requires).

Every pt should have the right to refuse any treatment, of course. But if they're going to refuse to do the stuff that is the REASON they're in the hospital, then....GO HOME! Don't take up the valuable resources of the hospital (that likely they aren't paying for anyway, and neither is whatever insurance they have, if any). If they want a five-star luxury hotel to stay in while recuperating, sans medical care, then they ought to find one and pay for it, and stop wasting the time and resources of the community hospital.

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Take, for instance, the pt refusing to wear O2 or BiPap. As long as you inform them, inform the doc, and document, then I think that's their choice. There may be other aspects of their treatment that they accept, such as neb treatments and antibiotic therapy.

Yes, they might be an annoying smoker or another type of social outcast with an addiction on top of it. I figure, it's not my problem, it's theirs.

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Specializes in Neuro ICU, Neuro/Trauma stepdown.
Take, for instance, the pt refusing to wear O2 or BiPap.

there is not much treatment the a pt can refuse in my book, certainly not these two. mostly, i can be persuasive and informative enough for a pt to understand why such treatments are important. and when they are getting out of line i get near the line and ask them why they are there, if not to be treated?

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I agree with GardenDove on all points. We are a free country.

However, I understand the frustration of a patient coming back from smoking and callling for a breathing treatment. Or the diabetic patient who eats the meal we provide, plus candy bars, cokes and McDonalds Burgers, and says "I wonder why my blood sugar is 400".

Sometimes you want to say "no I'm not giving you a breathing treatment" "no we are not treating your hyperglycemia". Both of you have to go home now.

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That's nice, but sometimes people just cannot tolerate things. I'm glad you're so persuasive. Some people have severe claustrophobia. They have a right to refuse treatment of any kind. Yes, there are some people who totally don't co-operate with any aspect of their care and there is no reason for them to be in the hospital, but most will accept something.

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Specializes in ICU, PACU, Cath Lab.

sorry...I will stay out of it

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Exactly Tweety. We are not going to change lifelong personality traits or addictions in one hospital stay. We are there to do the best we can with the pt based on their individual needs. We shouldn't impose our value system on our pt, but educate and respect their choices.

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I'm not a smoker, but I think society has gone overboard in villifying them. It's only one of many unhealthy habits that people have. I get tired of the puritanical outlook that people have about this habit. As long as I don't have to breathe it, I think people should not be crucified for this vice.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Exactly Tweety. We are not going to change lifelong personality traits or addictions in one hospital stay. We are there to do the best we can with the pt based on their individual needs. We shouldn't impose our value system on our pt, but educate and respect their choices.

Agreed but with one nitpick. I don't respect their choices, but I allow them and accept them. If that makes sense.

The smoking topic is an entirely different thread, do we really want to go there when we have page after page after page of threads? LOL

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Agreed but with one nitpick. I don't respect their choices, but I allow them and accept them. If that makes sense.

The smoking topic is an entirely different thread, do we really want to go there when we have page after page after page of threads? LOL

Yes, your wording is better. Tolerance is the word, not necessarily respect. We can act respectful without really feeling respect.

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