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!!
But I have a question because I'm not a nurse yet (just a student). Can you get into big trouble with your job for doing that? (even if the patient deserved it, and she certainly did). Nursing doesn't have all of the whiney two-year-olds in a 40 year-old's body. Public education has A LOT of parents like that. "I let my teenaged kid run wild, I give him expensive presents because he says he'll be good at school if I do, and it's YOUR fault, teacher, that he misbehaves because he doesn't like you." When I knew I was going to nursing school, I got that parent and I let her have it with both barrels. I did not care about being 'pc' and let her know that if she kept up with the 'my kid does nothing wrong' attitude, she'll help him head right to jail. But boy, did I get in trouble. I got reprimanded, and it went into my teaching file. I had the parent file a complaint, and they would have had a hearing if I hadn't told them that they should go ahead and have one, I wouldn't be returning next year anyway. I'm glad to see that maybe it's a different story in nursing.........
I hear you...I got reprimanded this week when my patient less than 24 hrs. post op disappered off the unit for 90 minutes. She and her family told me they were going up to the Special Care Nursery to visit their baby. Needless to say, they took a detour to the cafeteria and out to smoke. The doc read me the riot act.
I calmly looked at him and said "I am a firm believer in patients rights and RESPONSIBILITIES (emphasis on responsibilities)...it is not my job to baby sit her!" And for that, they normally very talkative, confrontational OB became very quiet. If we are suppose to respect the patients rights they need to respect us as well and take responsibility for their actions!
We've all been in your shoes. Ironically, I find that when I do that, the pt and I usually wind up coming to an understanding. Sometimes the best thing you can give someone to get better is a swift kick in the a**. (Figuratively speaking, of course. ) Then they know that you really care about them getting better instead of catering to their every whim. I say three cheers to you! :yelclap: :yelclap: :yelclap:
Specializes in med/surg, telemetry, IV therapy, mgmt.
I would have told the patient exactly the same thing in exactly the same nice way. It sounds like she was acting out. We got a lot of that when the hospitals went to "no smoking" policies some years ago. Going cold turkey on your own is very hard let alone having it forced on you by the circumstances you are in. You may have been a quart low on compassion, but the important thing is that you didn't let the patient see that you were.
Specializes in LTC, assisted living, med-surg, psych.
Thank you, one and all!
I felt better about the situation today when I came in to work and found out from this pt's nurse that she had not only stayed in the hospital, but had been quite subdued since our little run-in last night.......she was on the light wanting her pain meds Q 2 hrs, of course, but other than that she was behaving nicely and hadn't made so much as another squeak about going out to smoke. Hmmmmm.........you don't suppose my reading her the riot act had anything to do with that, do you? :chuckle
I do appreciate everyone's perspective on this incident. And no, I didn't get in trouble with the management---I had the house super and twenty other people as witnesses, and not one of them said anything negative. In fact, the super said exactly the same thing, and backed me all the way.......plus, she and I both documented every word of the exchange, so there's no way this pt. can come back and say "I never said that".
AACCCCCCKKKKKK!! I hate confrontation!! But it needed to be done, and I know I'll be less afraid to do it again the next time a situation like this arises. Sometimes, you've just gotta take a stand.
BTW, thanks to all of you for your good wishes for our anniversary and my mini-vacation........I do need one sorely, I've spent almost all my vacation time this year recuperating from one illness (or surgery) or another, and I need the break.
) Then they know that you really care about them getting better instead of catering to their every whim. I say three cheers to you! :yelclap: :yelclap: :yelclap: 
tencat
1,350 Posts
I think what you did is great!
But I have a question because I'm not a nurse yet (just a student). Can you get into big trouble with your job for doing that? (even if the patient deserved it, and she certainly did). Nursing doesn't have all of the whiney two-year-olds in a 40 year-old's body. Public education has A LOT of parents like that. "I let my teenaged kid run wild, I give him expensive presents because he says he'll be good at school if I do, and it's YOUR fault, teacher, that he misbehaves because he doesn't like you." When I knew I was going to nursing school, I got that parent and I let her have it with both barrels. I did not care about being 'pc' and let her know that if she kept up with the 'my kid does nothing wrong' attitude, she'll help him head right to jail. But boy, did I get in trouble. I got reprimanded, and it went into my teaching file. I had the parent file a complaint, and they would have had a hearing if I hadn't told them that they should go ahead and have one, I wouldn't be returning next year anyway. I'm glad to see that maybe it's a different story in nursing.........