Running About a Quart Low on Compassion?

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Specializes in LTC, assisted living, med-surg, psych.

I must be getting old, jaded, cranky, or all three...........

Last night, ten minutes before shift change, this patient (one of my all-time favorites, the middle-aged female with abdominal pain that no one ever finds a cause for but requires LOTS of narcotics) suddenly decided she was going out for a smoke. Never mind the fact that her doctor wrote orders that she could NOT do so, never mind the fact that she had Ativan, Dilaudid, Phenergan, and morphine on board, never mind the fact that she's on TPN, lipids, and massive doses of antibiotics for her post-op pneumonia........she'd torn off her nicotine patch, claiming that it didn't work (she'd given it all of 2 hours) and she was GOING.

I intercepted her at the elevator and reminded her--nicely at this point--that her doctor had said she was not to go off the floor, let alone outside to smoke. Whereupon she launched into this screaming fit about her "rights" and how we couldn't keep her against her will, etc. etc. I called for the nursing supervisor as backup and proceeded to tell this overgrown 2-year-old that she would be considered discharged against medical advice if she left the floor; she burst into tears and began to whine "You don't understand, I'm addicted to nicotine, I can't help myself, and Dr. ____ can't fire me as a patient because I smoke".

Anybody ever notice how these folks go on and on about their supposed rights, but never remember they have RESPONSIBILITIES as well? When I was a newer nurse, I'd have stood there all night being diplomatic and compassionate and listening to the rant with all the patience in the world; but last night I was running about a quart low on compassion, and I let her have it! I told her I wasn't her doctor, her jailer, her keeper, or anything else---I was her NURSE, and if she didn't want to comply with her treatment plan it was no skin off my nose. I would be more than happy to bring her the AMA papers, take out her triple lumen, get her valuables out of the safe, and send her "home to die", as she put it, if she insisted on destroying her body against doctors' orders. If, on the other hand, she wanted to get better, she'd have to go back to her room and settle down.......I'd already called her MD, who said "I don't give a ****, send her home if she wants to smoke".

Well, to my surprise, she did go back to her room, although with much grumbling about needing an attorney and calling the police on us for false imprisonment. I spent half an hour after the end of the shift documenting all of this and fielding congratulations from my co-workers, who'd witnessed the exchange and thought my speech about responsibility was a good one, even though it fell on deaf ears. But I realized that part of what made me a good nurse is gone.........I've seen and taken care of SOOOOOOOO many patients like this one, and they just wear me down.

Now, I will undoubtedly continue to do so, and I will treat everyone with equal respect just as I always have; but if you're in the hospital and you want to destroy yourself, you're going to have to do it without my help........I'm not going to stand there all night arguing with you and begging you to cooperate.

Thanks for letting me rant.........I feel better now, and since the police haven't shown up with a warrant for my arrest, I think there's a good chance I may make it through this last shift for the week and get to enjoy my anniversary celebration this weekend! TGIF!! :p

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I hear ya. I get so sick of people coming into the hospital and complaining about how things are not just to their liking. Or, they require so much of your time just for THEM, and then they complain when they don't get it. Yes, they are very much like children. And it is hard to not become jaded towards patients in general when you just get so many FOOLS like that.

Congrats on your 25th! I just celebrated my first!

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Specializes in Medical.

Oh Marla - what a way to end the night!

For all that you think you're running low on compassion, I've got to tell you that I think you're not dry, yet. It sounds like you dealt with a difficult situation in a reasonable way, and I'd be happy for you to be the nurse for any member of my family.

I'm so with you on the lack of awareness there seems to be about rights going hand-in-hand with responsibilities. Maybe we should launch an allnurses education campaign!

Have a great anniversary weekend :)

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I hear ya. I get so sick of people coming into the hospital and complaining about how things are not just to their liking. Or, they require so much of your time just for THEM, and then they complain when they don't get it. Yes, they are very much like children. And it is hard to not become jaded towards patients in general when you just get so many FOOLS like that.

You did what needed to be done. You told her the reality of the situation ( which is something she did not want to hear).

I know I've become more jaded the more time I spent in nursing. At some point, patients need to take responsibiity for their healthcare.

Last night, I had 3 adults have temper tantrums over the phone, because they were going out of town, state, country, etc., and decided at 10 pm at night, that their minor injury/illness just couldn't wait until they returned from their trip. The funny thing is they all had symptoms for weeks to months and none of their symptoms were clinical urgent or emergent.

I had the lovely experience of being called names, sworn at, and demanding that I get them an appointment "tonight". The only facility open was the ER, which I advised them they could go to. Then I got to listen to an earful about how they didn't want to pay the $100 copay the ER charges.

My compassion level by the end of shift was zero.

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Wow, you handled a tough one with remarkable aplomb. You're not short on compassion, just short on some R&R. Happy anniversary!

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Specializes in NICU, Infection Control.

In this case, Marla, I'm thinking compassion was all about waking her up to the reality of her situation! IMO, you did just what she needed: you set limits. Just like you would w/a 2 y/o. Somewhere, I think she wanted you to do just that.

Good job!

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Specializes in Case Mgmt; Mat/Child, Critical Care.

Good job, Marla, I think you did fine. More people need to wake up and take responsibility for their own health and kudos to you for laying it on the line w/this pt! But geez, I just hate it, that we feel badly after doing something that is ultimately for the pt's good!!!

And, btw, Congrats on 25 yrs! Now that's an accomplishment!

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Specializes in ER.

She needed someone to yell at her. Unfortunately the pr minions don't realize that ticking off some patients is therapeutic for them. You did just fine.

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Specializes in Psych, Med/Surg, Home Health, Oncology.

good going, marla

sometimes patients need to be told these things!!

congratulations on your 25th!!:balloons:

mary ann

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

YOu did GREAT Marla.

I have shown them AMA forms myself, when people started acting like this. (it was TOUGH working in a facilty that disallowed smoking ANYwhere on campus, believe me).

It (seeing the AMA form) usually brings 'em the dose of reality they need and those pesky charges of "false imprisonment" evaporate right before your eyes.

YOU rock MARLA!!!

Oh and happy anniversary my dear since I won't be here to wish you so on the exact date.

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Wow, you really did a good job of handling that one.

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Thanks for letting me rant.........I feel better now, and since the police haven't shown up with a warrant for my arrest, I think there's a good chance I may make it through this last shift for the week and get to enjoy my anniversary celebration this weekend! TGIF!! :p

I think you did a great job! I hope you have a terrific weekend. You deserve it! :yelclap:

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