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

[abundantjoy07]

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 XRay. 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.

[VICEDRN, BSN, RN]

I listen and explain the reasons for discharge again. You have no abnormal labs, concerning scans, and that no nursing resources are need (ie IV antibiotics or telemetry monitoring).

I tell them that they will have to leave and that I am very sorry. The ER is busy and there are patients waiting and that the patient can come back if things are worse for them. Then I repeat that I understand where they are coming from (even if it I think there reason is ignorant or narrowminded)

As a last resort, I will call security after conferring with MD and Charge Nurse to make sure they have no input.

[AngelfireRN, MSN, RN, APRN]

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.

Hey, if it works....

[Amnesiac70]

For my regulars who are difficult to discharge, I make them feel very comfortable. Warm blankets, quiet tranquil environment, dim the lights. Basically roll out the red carpet. When it's time for discharge, reverse everything in about 2.5 seconds. Lights come on, blankets come off. Loud booming voice explaining discharge instructions. Position the bed in high fowlers position, IV out, vitals done. Basically make it so that going home is a really good idea right now.

I want to emphasize that I do this only when necessary.