How far can a patient go?

morte, LPN, LVN · Apr 30, 2009

I hope the sentence I bolded is a joke (I can't tell by reading the post, and I know that since inflection doesn't come across in the typed word, things can be misinterpreted). I also haven't been here long enough to know other members' senses of humor yet.
Obviously, you wouldn't be giving this lady (or anyone else) a "fast push." Desirable as it may be, I know where I work I couldn't take that prn and put it in a mini bag; we don't mix meds on our floor and there's no written policy for doing so, so I would actually get in trouble for it. My only choice is to give the med push, and over the time recommended (also, and this is a serious question: if a PRN order states "IV push," can you truly give it in a minibag? Doesn't that change the route from IVP to IVPB?...I know it's still IV, and that's why I'm not clear on it).
Let me restate, I am taking the quoted post's first sentence as a joke, but I DO honestly hope that someone wouldn't use their power and withhold a PRN med that the person could otherwise get, due to their behavior. It certainly would be tempting, and something that you would mutter to yourself as you drew it up, but you wouldn't actually abuse your role and not give it.....right?

i took it seriously, why would you subject yourself to being spit at?....either she stops, or i dont get that close

RN1982 · Apr 30, 2009

I agree with Morte. If I was the nurse taking care of the patient and they were spitting at me to try and infect me with HIV, I would walk right out of the room and wait til the patient straightened up. I don't have to let them abuse me.

Plucker · Apr 30, 2009

I 'caught' a pt doing something bad with their meds and told on them because it had made them very sick--spiked a temp, lethargic.( pt had been at this hospital for over a year) The next day the MD came in and stopped all the pain meds...and the pt found that I told on them. Pt threatened to kill me, (pt had been in prision for 30 yrs for shooting a security guard), told me they'd have my children raped and murdered among other things. Was very specific about what would happen to me and my family. And pt didn't say this to me, said it to other nurses who told the NM and the NM told them to keep it quiet because she didn't want me to be upset. Thank goodness one of those nurses told me about it! I went to the police and they couldn't do anything about it. Obviously, I was extremely upset about it, I had just gotten off orientation at my first job right out of nursing school. I begged for the pt to be moved to another unit....their response was that I could be moved to another unit. I refused to be moved...I loved the floor and had just gotten through orientation and all. My charge nurse had cops come in and talk to the pt who was still making threats on my life a week later. Didn't help. He made threats to the cops face about me and they couldn't do anything because pt had to be in the hospital. MAnagement still wouldn't do anything. After another week, pt got sick went to the OR and then ICU. Once off the floor, NM told be they would not take pt back which made me really happy, I felt like it was all over. A few days later, they tried to send pt back to us and the charge nurse that day refused. My NM was ticked and said she should have taken them back and took that nurses charge privileges away.

Finally, pt went to another facility....but what a nightmare. I no longer work there to say the least.

mama_d, BSN, RN · Apr 30, 2009

We had customer service classes a couple of years ago that were taught by the medical librarian and a chaplain. The chaplain was a OT assistant twenty years ago, so she said "I know how difficult patients can be, I have been there." Many of us respectfully disagreed. When we asked how to handle a patient who was threatening physical harm and screaming things like "F*** you, b****" at the staff, her reply was a blank look and "Surely that doesn't happen". Great...we're supposed to be learning how to handle difficult patients from her?

We've actually had patients who were transferred off of our floor before due to just awful behavior, but that just sticks another floor with the problem, so I don't really consider that to be a solution.

We do have a patient who no longer comes to our floor b/c of the way he treated the staff the last time he was there, about two years ago. He also refuses to come to our floor. He's a noncompliant CHF/HD patient, with horrible veins, and usually comes to the floor from ED with a EJ in. Which he will then pull out to, as he put it, "waste you worthless ****'s time." Last time he was on our floor and pulled that crap, we told him sorry, no more IV dilaudid or benadryl for you, since you don't have an access. The charge nurse went in and nicely explained to him that well golly, he's such a hard stick, and the nurses who MIGHT be able to get his veins were all tied up with critical patients and there was no let up in sight. He left AMA shortly thereafter. Good riddance too.

My favorite story though that shows that setting limits early on might just help avoid issues is when we had a demanding, obnoxious old lady on our floor for an infected TKA and resulting sepsis. We caught the daughter digging her ungloved finger in the incision "to see how it's healing" and when the nurse told her to stop she threatened to meet him in the parking lot with a gun. She got to stay.

Eventually, the patient wound up on step-down, where the daughter got into a verbal altercation with another patient's daughter that escalated into a fist-fight on the unit between the two families. Thankfully neither family had any weapons on them. Cops were called, all of us who had participated in her care and been threatened or verbally abused had to fill out paperwork with the cops, and it was just a nightmare.

If risk management and nursing management had gotten on the ball from the get go, and she had been banned, it would never have happened. Which I was sure to point out as a possible root cause to the police.

junebride · Apr 30, 2009

I have to say how much I adore you all for these often hilarious replies. What has actually become more clear to me is how unsupported we are by management and administration. We're a means to an end. Without us, the hospital does not exist. It really is that simple.

**canoehead, BSN, RN** · May 1, 2009

I hope the sentence I bolded is a joke (I can't tell by reading the post, and I know that since inflection doesn't come across in the typed word, things can be misinterpreted). I also haven't been here long enough to know other members' senses of humor yet.
Obviously, you wouldn't be giving this lady (or anyone else) a "fast push." Desirable as it may be, I know where I work I couldn't take that prn and put it in a mini bag; we don't mix meds on our floor and there's no written policy for doing so, so I would actually get in trouble for it. My only choice is to give the med push, and over the time recommended (also, and this is a serious question: if a PRN order states "IV push," can you truly give it in a minibag? Doesn't that change the route from IVP to IVPB?...I know it's still IV, and that's why I'm not clear on it).
Let me restate, I am taking the quoted post's first sentence as a joke, but I DO honestly hope that someone wouldn't use their power and withhold a PRN med that the person could otherwise get, due to their behavior. It certainly would be tempting, and something that you would mutter to yourself as you drew it up, but you wouldn't actually abuse your role and not give it.....right?

Thanks for asking,

Yep, I meant it exactly as it sounded. If someone is spitting or hitting, and they are in their right mind, I would not get close enough to be hurt unless they were restrained. I would also say to the patient that they need to cut out the abusive behavior before I could care for them (except life or death issues). I'm not saying I would withhold meds because they cussed me out...I'm saying I would not approach them because they were attempting to physically harm me. I'd also ask a second nurse to come in with me, sometimes another point of view can help the situation, or can give the patient a graceful way to back down.

Yes, I would use a piggyback. We are able to dilute a prescribed medication in as much fluid as we feel appropriate in my hospital. I wouldn't go against hospital policy, and don't blame you for choosing the push method if that's what your hospital demands. If pressed on the issue I would argue that the highs and lows of the narcotic effects may be causing a change in mental status, and perhaps a 30 minute hang time would provide pain relief without throwing off the patient's mental status. I'm NOT advocating a decrease in meds when you have a patient in pain, just trying to get them off the emotional rollercoaster. Seriously, if you have someone with rotten coping skills it makes sense to try for a steady level of any meds in their system .