How would you have handled this pt?

[benette]

Had a 22 y/o female pt in sickle cell crisis w/ lymphoma who gave me problems from the first minute I had her. She was allegedly smoking in the bathroom in the am. Insisted she go off the floor 'to walk around' . The MD came to the unit and was looking for her while she was off the floor. Senior nurse was so embarrassed that I (we) did not know where the pt was exactly. Senior nurse was almost screaming at me for letting the pt go off the floor, saying that everything that happens to that pt is my responsibility. I understand that the pt is my responsibility but if the woman wants to leave the floor with no intentions of leaving the hospital, is it my duty to forbid that person to do so? I asked the pt why she wanted to get off the unit and I had asked her to not leave the hospital and that I wanted her back in the unit at a certain time. I didnt tell her that she cant leave the floor for fear of getting accused of harassment. Senior nurse told me that I should have forbid to pt to leave the floor, if she still insisted to leave then I would call security. Would that be the prudent thing to do in this situation? Seems like its too harsh, treating my pt like a prisoner. What do you think?

[Indy, LPN, LVN]

I probably would have asked the patient to sign an AMA form for the future to CYA in case she does it again. I'd explain the risks of leaving the floor and ask the patient to leave so that I can continue to keep my license.

Very rarely have I had patients refuse to sign such a form. Mine are usually on telemetry and I tell them that if would worry the snot out of me to see arrythmias if they're not where I can get to them to help them. We did have a fella who had v-tach while outside at the front of the hospital, smoking. Without telling me that he was leaving. I called security; patient sauntered back by the nurse's station as I was on the phone with them. Reason for calling was simply to make sure he was not trying to code on the sidewalk! When I explained all of this to him he was apologetic, signed my AMA form, and made sure I knew where he was from then on.

[mentalhealth1]

Not sure how things work in the states, but i reckon that there's not much you can do if your patient wants to leave the ward- she has a right to make decisions for herself, you're not her keeper and have a responsibility to respect her autonomy. However, you could explain to her that you stongly advise against what she was doing, explaining risks etc, and make it very clear that she's responsible for her own actions. As always, record in her notes what had taken place, including advice given, times etc. I would then report the situation to the nurse in charge so that she's up to speed on what's been happening. I personally think that the senior nurse was a bit annoyed at herself for not knowing what had been going on- saying that you should have forbid your patient from leaving and threatening to call security seems like a bit of an over-reaction to me!

[HappyNurse2005, RN]

We have forms the pt's who want to smoke can sign-pretty much says i understand smoking is bad for my health, i understand smoking can make my health condition worse, i understand that this is against medical advice, and that i will not hold the hospital/doctor/nurse liable for anything that happens to me off unit

[CHATSDALE]

we had a alcoholic pt who was very uncooperative about cigs and alcohol

he had a gardener who visited him go into the room and they would both be drunk...came from a highly regarded family but they were very familiar with both of them and there were no complaints there. one time they had a couple of girls in there and the nun went in there and talked to them . girls left quickly other patients who were noncompliant were asked to sign an ama and asked to leave and admitt to another hospital in the future

funny how money affects you where ever you are