Please go home...you are stable enough to be discharged...don't make me call security

merlee · Oct 18, 2011

The doctor should have already told them that they are discharged, and that the nurse will be in with the paperwork.

They need to argue with the doc.

Esme12, ASN, BSN, RN · Oct 18, 2011

What is the best way to discharge patients easily? It seems like the hardest thing is discharge. People expect to be admitted for every and anything. Most of the time I as the nurse get the grief. I mean is it my fault that we aren't hospitalizing you for back pain or for a laceration to the head? We sent you to CT scan, MRI, and X Ray. We drew labs, we stitched you up and made sure you were okay to go after 5 hours of work on you but yet...it's not enough. I try to explain that we cannot hospitalize for everything. Somethings aren't worthy of a hospitalization. You should get the prescriptions filled and follow up with your PCP in 2-3 days. Or employ conservative treatment such as heat and ice on ailment A, B, C and D.
How do you gracefully explain and discharge a patient without them complaining, threatening, and asking to speak to the boss? How do you get them out the door sans security? I mean I understand fear, but if you weren't stable we would not send you home...
Sigh.
I need pointers.

You tell them that you hear what they are saying and understand that they feel anxious. Don't let them feel they are being pushed out the door for the bed because the ED is busy. Understand that their problem is the biggest (to them) and more serious and they don't care about any one else.

Tell them that you have done all the medical tests indicated (or not indicated) in this scenario and they have revealed that there is not any serious issues to be found. You tell them that the ED is open 24 hours 7 days a week if something changes and you will be sending them home with instructions and things to look for so they don't need to worry or try to remember. Tell them they can always call the ED since they have already been seen by the MD if they have questions or concerns and they can call their PCP anytime as well and to follow up in the morning if they are still concerned and when they get home if something changes to just come back.

When people act out it's because there is something else going on or they are frightened. Acknowledging that fear and recognizing that they are being heard can go a long way in making them feel better and feel that their concerns are being heard. The "invite " to return is really helpful in allying fears. Have the presence with them that they aren't being rushed (even though you are) and that you are listening to them whenever humanly possible.

I hope this helps.

ChuckeRN, BSN, RN · Oct 18, 2011

The one advantage to correctional nursing, "Officer, you can take him back to his house now."

EmergencyNrse · Oct 18, 2011

I tell them that a hospital is no place to get better. It's only there if a patient needs someone to keep a closer eye on them.

I emphasize the comfort of being in their own home as opposed to getting bothered every 2-4 hours for medications, blood draws, vitals, assessments. Then the are the noises. Nurses and families talking, overhead intercom, phones ringing, and the banging of housekeeping making their rounds.

...then there is always security.

ninjago · Oct 18, 2011

If you have already discharged them gracefully after explaining that all the tests are normal and still they wouldn't leave. Then by all means, let the NM know if you need to call security. Here's what I did with them. Offer to call somebody for them to pick them up. Have the wheelchair (if they need one) ready as you go to the room. then I tell them to make sure they have all their personal belongings with them. Then help them to the WC and wheel them to the lobby to wait for their ride. All the while, they will complain and throw a temper tantrum for not letting them stay. I just listen with occasional "well, it's hospital policy we cannot keep you here" but keep it as brief as you can or they will go on and on and on again on how they should be admitted. Good luck!

AJPV · Oct 18, 2011

Give the pt a pamphlet for a local concierge medicine business. Then the pt may pay for an MD to be available 24/7.

nerdtonurse?, BSN, RN · Oct 18, 2011

What I've said, "You cannot live here. We can get a social worker to talk to you about a shelter, but you cannot....live...here."

Had one try to throw himself off the stretcher, admitted he "knew" if he broke something he'd be admitted. I pointed to the fire suppression sprayer in the ceiling, told him it was a camera, and that we'd have called the cops for fraud if we saw him do it. So mister "I can't feel my whole right side, I can't walk" sat up, called me a name, ripped out his IV and stomped out of the ER.

Editorial Team / Moderator · Oct 18, 2011

I have a speech about the purpose of the ER -- that we rule out the life threats. If we've done that, the visit is over. If someone flat-out refuses to leave, I have a couple of choices -- alert the MPs (military police), or have the doc come back in to reiterate the plan of care and try it again. Kind of depends on the patient and the complaint; I use my best judgment.

healthstar, BSN, RN · Oct 19, 2011

On my floor this is not the case, they beg, scream, yell because they want to go home even when they are not stable lol.

Flo., BSN, RN · Oct 19, 2011

First I try to quell any fears and explain that they are ok. For the ones who have told me flat out "but I want to be waited on" they get the below:

I explain to them that they are stable and that insurance will not pay for them to stay. If they want to stay they will have to pay for it up front as there is absolutely no medical reason for them to be here. Went as far as having billing come up and give them a statement.

If they don't have insurance I just call security.

rjflyn, ASN, RN · Oct 20, 2011

Often times there is no easy way and you just have to tell them in no uncertain terms that they have to leave. If i'm calling security i'm not telling them. My nurses have already given the pt there instructions, the pt is refusing to leave and they have already spoken to me. SO now its time for them to just go, with a final stop at the discharge coordinator- which really gets them going because 99 out 100 of them have no money and thats where the get asked to pay this bill and the ones they more than likely still owe.