Glad to witness an AMA

[Kharma711]

Oh boy it's been a shift...

First off, I was the code nurse which means I'm responsible for being present if a patient is going downhill or coding and facilitating the process. Which is something I don't mind...

However, this shift I started out with an ICU patient waiting on a bed who got moved 1.5 hours into the shift. No biggie. Also, had a DNR patient expire despite all allowed efforts. Again, dealt with it, did as expected. Also had a patient on the unit go into SVT and very nearly code. Once again, I did my job and helped in every way possible.

None of this was an issue, just giving you an idea of the kind of hectic shift it was...

Now, this one patient out of my four was an absolute nightmare. I've been told I have much more patience than some. I'm rarely phased at all by difficult patients. However this one took the proverbial cake. Except during each of the previous episodes mentioned, I was literally in this patient's room every 15 minutes.

Some of these were because I was called by the patient. A few were other nurses or the PCT calling me to the bedside. Literally over a dozen were because she set off the bed alarm and simply would not call for assistance. Though, they would call for everything else under the sun.

I tried in good faith to get this patient anything they wanted/needed within my scope. I was "rewarded" by the patient urinating in the bed multiple times, on the floor multiple times as well. I was "rewarded" with a million complaints and blatant lies and even fake seizures trying to seek more drugs...

I tried every single method available to explain everything. I gave 8 mg of ativan to them. I gave pain medication several times though they only allowed one dose of narcotic.

I literally did everything in my power and called up more patience than one nurse should ever have at her disposal. Yet, nothing I could do ever satisfied this person for more than 15 minutes at a time.

After 12 torturous hours, they requested to leave AMA and I called the MD to the bedside. I was practically giddy to sign the AMA form. I even gladly unhooked them and removed the IV infusing diltiazem with great joy.

After signing out, the patient tried to get the doctors or myself to arrange transportation. Which, as most of you know doesn't happen with an AMA. The patient even went so far as to ask for a bus pass. I desperately hid my relief as I explained the process to the patient.

Said patient continued to complain, come to the desk, and trash their room for the next 30 minutes. I happily went in, helped gather belongings and sent them on their way. I'd have even been glad to call security had they not vacated.

I didn't care one bit at the accusations of being "horrible" nurse or accused of stealing. I had never been more relieved in my life that I didn't have to pass this patient on to the next shift.

Anyone have similar experiences? Should I feel bad for feeling happy/relieved that they signed out AMA after torturing me for 12 hours?

[elkpark]

Should I feel bad for feeling happy/relieved that they signed out AMA after torturing me for 12 hours?

Not at all!

[Here.I.Stand, BSN, RN]

A while back, one of the most vile human beings I have ever met left AMA. I restrained the urge to sing "So long, farewell, auf wiedersehen, goodbye!" as she left. If you want I can PM you the details, but I don't want to post them here. 1) if anyone I work with is in here, they will likely recognize the details, and 2) she was extremely offensive.

Also, she had offered conditions under which she would be willing to stay. I flat out told the MD and my charge RN "I am not able to agree to that." I was completely unwilling to take that liability upon myself. My charge and the house supervisor agreed, and pointed out that agreement with her demands would jeopardize our credential specific to this woman's diagnosis.

I was never so relieved to see someone go.

[Nurse SMS, MSN, RN]

I think it is pretty natural to feel relief to see a patient who is not going to comply with medical treatment along with being abusive and manipulative decide to leave when we don't give in to their demands. You have nothing to feel guilty for. Most of us who have worked floor nursing have had a few of those. My favorite is when they use it as a threat...as in "If you don't XYZ, I am going to sign out AMA!" Okie-dokey then. Buh-bye.

[elkpark]

My favorite is when they use it as a threat...as in "If you don't XYZ, I am going to sign out AMA!" Okie-dokey then. Buh-bye.

My favorite is the yahoos who complain bitterly that they're being "held against their will." I always smile pleasantly, explain that nothing of the sort is happening, they are entirely free to leave whenever they want, and would they like me to get them an AMA form? (Somehow, they never actually want to leave, they just want to complain nonstop about being there.)

[Kharma711]

Thank you so much for this and all previous replies... like I said, long shift and I had to restrain myself from skipping along happily once she said she wanted to leave. At leasthe I know I'm not alone! Haha

[EaglesWings21, ASN, RN]

Bye, Felicia

[NuGuyNurse2b]

You're not alone, I work in psych and I can only wish some of my patients could sign out AMA...

[Kharma711]

If the patient had been a psych patient then I would have just refused to have them again. My unit is good about making sure not to burn one nurse out on a difficult patient and will rotate our nurses. Thank goodness it ended the way it did, is all I can say. I just wish they had said those magic words earlier in the shift. I was fried crispy after that mess.

[Sour Lemon]

I once walked into a difficult patient's room only to feel a cool breeze from his open window ...best breeze I've ever felt, but he could have been less dramatic and just walked out the door, instead.

[nutella, MSN, RN]

Nope - I can't blame you !

There must have been something going on - full moon or such - I also had a shift that would qualify for "nightmares on elm street" so to speak.....

[nutella, MSN, RN]

If the patient had been a psych patient then I would have just refused to have them again. My unit is good about making sure not to burn one nurse out on a difficult patient and will rotate our nurses. Thank goodness it ended the way it did, is all I can say. I just wish they had said those magic words earlier in the shift. I was fried crispy after that mess.

Years ago I worked on a floor with a high amount of "difficult" patients as a lot of them had overlapping psych problems including manipulative behavior, borderline personality disorders, addiction, and "craziness not otherwise specified". Oh boy .... and a lot of times those patients were under evaluation for "competencies" when wanting to sign our AMA, which created even more drama...

One time, a patient who had many issues related to personality, managed to dart off the floor - bag in hands - out of the building without signing AMA papers or informing us about the intention to leave. Unclear if competent to leave patient was running on street, followed by supervisor, followed by security... police chased the patient down. Luckily, the attending physicians decided that the patient was competent and did not have to be brought back to the hospital - I was doing a dance.