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!!