It's my life and I'll do what I want

nursejoed · Jan 13, 2011

"How many times am I expected to pick up the tab for someone else's blatant disregard for himself and others?"

...as many times as he shows up to the ER. Unfortunately.

nerdtonurse?, BSN, RN · Jan 13, 2011

This is one of the things that "killed" St. Vincent's in NY. It was a great hospital (my aunt worked there and loved the place) but the city treated it like a homeless shelter without compensating the hospital for those "3 hots and a cot" people it kept dumping on them (there was a fair amount of greed involved after the new management took over, but the folks who treated the hospital like a shelter bear a lot of the blame). EMTALA needs reform, or we're going to lose even more hospitals. The hospital I was at came so close to going under they were told not to admit the "3 hots" folks unless they were in critical condition; treat and street.

thinkertdm · Jan 13, 2011

Hey, I agree with you 100%. However, the alternative of having people make their own decisions is to make it for them, and that never turns out well.

We do need to start holding people more accountable for their actions, and find a suitable way to do it.

Incidentally, "insane" is not a clinical diagnosis.

Freedom42 · Jan 13, 2011

Had a pt. today that presented to ER with SOB. Been in hospital for 5 days, is due to be D/C'd in am. Homeless, refused family care because he refused to quit drinking, and does not want to go to shelter upon release because "they are not great'. This, in the middle of winter.
How much do I care? I KNOW this guy will be back in the ER in 4 days with another complaint, due to HIS failure to see reason and seek treatment, and the fact that he knows that hospitalization is pretty comfy, with 3 hots and a cot.. How many times am I expected to pick up the tab for someone else's blatant disregard for himself and others?
And BTW, he's NOT clinically insane. he would probably be diagnosed as a "personality disorder".

I know this guy, or at least my local version of him. Typically he calls an ambulance, heavily intoxicated and claiming to have fallen, then demands a hot meal that he can enjoy in his stretcher while watching his personal flat screen all night long. Once he's eaten, he enjoys verbally abusing the staff at top volume and periodically staggering around shirtless. Truly charming.

He refuses detox treatment, of course. So, after numerous rounds of this, management came up with a very simple plan: You're more than welcome to come in, sir, but once you come in, you must A) agree to undergo detox or B) stay until your blood alcohol level registers zero. While you are here, you will be served food only during regularly scheduled service for breakfast, lunch and dinner. You are free to move about your room, but you may not leave it. You must agree to these conditions before you enter the ER or you will not be admitted. You cannot come in, refuse treatment, and expect to stay.

Problem solved. We don't see him any more. He now requests transport to the hospital across town. They'll figure it out sooner or later.

Yup, it probably sounds heartless. But he's no longer using the ER like his personal hotel, and he's not occupying a bed that would otherwise be made available to someone who's come in for treatment.

Medic2RN, BSN, RN, EMT-P · Jan 13, 2011

I think he moved to my ER! Every time he came in, I was his nurse. He would see me and say, "Not you again *****!" I told him I would be his nurse whenever he came in. I haven't seen him in a long time, I guess he moved on. I was always nice and respectful to him, but didn't tolerate his verbal abuse and would be bedside anytime a consult was in the room to keep him in check. I guess that's why he didn't like me.

I know this guy, or at least my local version of him. Typically he calls an ambulance, heavily intoxicated and claiming to have fallen, then demands a hot meal that he can enjoy in his stretcher while watching his personal flat screen all night long. Once he's eaten, he enjoys verbally abusing the staff at top volume and periodically staggering around shirtless. Truly charming.
He refuses detox treatment, of course. So, after numerous rounds of this, management came up with a very simple plan: You're more than welcome to come in, sir, but once you come in, you must A) agree to undergo detox or B) stay until your blood alcohol level registers zero. While you are here, you will be served food only during regularly scheduled service for breakfast, lunch and dinner. You are free to move about your room, but you may not leave it. You must agree to these conditions before you enter the ER or you will not be admitted. You cannot come in, refuse treatment, and expect to stay.
Problem solved. We don't see him any more. He now requests transport to the hospital across town. They'll figure it out sooner or later.
Yup, it probably sounds heartless. But he's no longer using the ER like his personal hotel, and he's not occupying a bed that would otherwise be made available to someone who's come in for treatment.

nurse2033, MSN, RN · Jan 13, 2011

The system definitely has a weak spot for these people. It's not just the homeless, I see patients every day in the ICU that haven't been to a doctor for years until it is too late. I recently had a guy with end stage AIDS, yes AIDS. He had a 50 pound weight loss over months. What does it take!? Or those who won't quit smoking or drinking, or eating. It is huge percentage of our health care dollars. It is somewhat poignant but gratifying to see their diagnosis of medical noncompliance. But nursing means we don't get to choose our patients. It does try your patience sometimes, but what doesn't kill you...

EmergencyNrse · Jan 13, 2011

Welcome to the ER and the concept of "frequent fliers".

I'm surprised you only have this one.

It is a source of MUCH stress for all of us working in the ER and there is sadly

NOTHING that can be done about it...

CrunchRN, ADN, RN · Jan 13, 2011

I think people should be allowed to make their own decisions.

However, I do not think that we should then offer any but care needed in emergencies. At some point you cannot give everyone who chooses to live a destructive life style full benefits. There ought to be laws that make it so someone like this is not kept in the ER because of fear of malpractice.

We should provide benefits for people willing to make an effort. Things like care and training. If they choose to partake then we should support that effort. If they screw around then drop them.

I do believe that we do need to provide some basic level of care to all despite poor decisions though. Just as humans. However, not the level we provide currently that is so frequently abused.

ImThatGuy, BSN, RN · Jan 13, 2011

You're getting paid aren't you? Keep treating and streeting him.

Freedom42 · Jan 13, 2011

You're getting paid aren't you? Keep treating and streeting him.

Is that supposed to be a joke?

noahsmama · Jan 13, 2011

after numerous rounds of this, management came up with a very simple plan: You're more than welcome to come in, sir, but once you come in, you must A) agree to undergo detox or B) stay until your blood alcohol level registers zero. While you are here, you will be served food only during regularly scheduled service for breakfast, lunch and dinner. You are free to move about your room, but you may not leave it. You must agree to these conditions before you enter the ER or you will not be admitted. You cannot come in, refuse treatment, and expect to stay.
Problem solved. We don't see him any more. He now requests transport to the hospital across town. They'll figure it out sooner or later.
Yup, it probably sounds heartless. But he's no longer using the ER like his personal hotel, and he's not occupying a bed that would otherwise be made available to someone who's come in for treatment.

Doesn't sound heartless to me! Totally reasonable, and more hospitals should be doing this!