I have posted this also on another forum....Just looking for advice
I am a working new nurse since May 2011. I did my 3 month orientation on med/surg and now I am on my own!! I am so excited until last night. My patient fired me Ok from the beginning to catch you up to speed....I was doing my initial assessment (i.e. history, allergies, contact information, etc...) As I came to the question about previous suicide attempts the patient stated no. Next question, do you have any suicidal thoughts patient answered yes due to loss of job, living pay check to pay check, no health insurance, multiple hospital bills, etc... I stated due to acknowledgement of suicidal thoughts suicidal precautions would have to be implemented and a sitter would have to sit with them until the physican can come in the morning hours for further evaluation. Patient became irrate stated they wanted to retract their statement, they need their privacy, and refused sitter. Charge nurse, house supervisor, and hospitalist informed. Hospitalist reienforced suicidal precaution implementation. Security was called to control patient ourburst. Patient stated he had no plan of harming themself and it was my word against theirs, we were violating their patient rights, and they wanted to leave. Patient could not leave due to protocol, so patient had to be upgraded to invol. committed until a psych doc could come evaluate. Well, his surgeon came in the early AM and dc'd the sitter and stated the patient was not suicidal and we blew everything out of portion and the patient is very unhappy. I tried to explain that it was protocol, but fell on the drs deaf ears.
Question: 1) Protocol is protocol, right?
2) If patient has no plan should I have implemented suicide precautions?
3) What could I have done differently?
4) Why do I feel so guilty of the whole thing spiraling out of control?
Always error on the side of caution. I think you were right to get the supervisor involved and the hospitalist involved but if you didn't react and he hurt himself, you're liable and responsible.
Food for thought....I had a patient once present to triage. Professional male mid thirties early forties, he had been drinking. He admitted to job loss, family loss, house loss. He stated he has lost everything that meant anything to him. He stated he wished he was dead. When I asked him if he would hurt himself he stated that was what mede him come to the ED........he stopped his vehicle just before driving off a bridge and he was scared.
When he realized what SI watch 1:1 entailed he decided he didn't want to stay, convinced the psych eval person that it was the alcohol talking that he would NEVER hurt himself and would follow up outpatient(he was also prominent in the community and very bright). I was chicken little and over reacting to the situation and adding too much drama.
I was dead set against it.......I was the one who spoke to him when he was SI upon arrival and I said he still was........after much debate....he was discharged.
Later that night............He hung himself in the hospital garage.......
Always be safe not sorry.:hug:
i agree w/your assessment.
specifically because he admitted to wanting to, but got scared.
this scenario to me, is a lot less ambiguous than the op's.
At my facility, admission questions include asking about suicidal thoughts (recent or past), once the pt answers yes to that. A whole slew of "yes" and "no" questions which you have to ask the pt opens up. These questions automatically score 1 for every yes and 0 for no, then depending on how many points they get, the computer designates them as low, medium or high-risk for suicide and the various precautions are put in place. A medium-risk has to be assigned a 1:1 sitter, no call bells or phones, plastic utensils, no privacy and frequent checks and documentation by the nurse.
Now, the last time I admitted a pt that answers made a risk, I got chewed out because we didn't have a someone to sit with them and it was such an inconvenience to pull aides from floor and make them sit. I was also asked to change my assessment and what the pt had answered which I refused to do. I made my notes, called the pt's physician, and eventually left after the shift. What I haven't forgotten was how I was ridiculed for inconveniencing everybody by 'making' the pt a suicide risk.
OP, I think you didn't the right thing. I would always prefer to err on the side of caution.
Thank you all for your comments....I was really being hard on myself about the decision that I made that night, but now feel much better and confident on the choice I made...Being in this profession is very overwhelming when trying to figure out what is right/wrong, how to approach the situations, what policy or procedure is correct in this situation...thank you for the positive comments and the educations statements...This experience I have definitely appreciate all the feedback!!!
! I am so excited until last night. My patient fired me 
Ok from the beginning to catch you up to speed....I was doing my initial assessment (i.e. history, allergies, contact information, etc...) As I came to the question about previous suicide attempts the patient stated no. Next question, do you have any suicidal thoughts patient answered yes due to loss of job, living pay check to pay check, no health insurance, multiple hospital bills, etc... I stated due to acknowledgement of suicidal thoughts suicidal precautions would have to be implemented and a sitter would have to sit with them until the physican can come in the morning hours for further evaluation. Patient became irrate stated they wanted to retract their statement, they need their privacy, and refused sitter. Charge nurse, house supervisor, and hospitalist informed. Hospitalist reienforced suicidal precaution implementation. Security was called to control patient ourburst. Patient stated he had no plan of harming themself and it was my word against theirs, we were violating their patient rights, and they wanted to leave. Patient could not leave due to protocol, so patient had to be upgraded to invol. committed until a psych doc could come evaluate. Well, his surgeon came in the early AM and dc'd the sitter and stated the patient was not suicidal and we blew everything out of portion and the patient is very unhappy. I tried to explain that it was protocol, but fell on the drs deaf ears.
leslie :-D
11,191 Posts
i agree w/your assessment.
specifically because he admitted to wanting to, but got scared.
this scenario to me, is a lot less ambiguous than the op's.
such a tragic ending.
leslie