SO mad...and not sure I should be.

Specialties NP

Published

Please forgive the length...it's been a bad day.

I work in a clinic that dispenses controlled substances. As such, we have various and sundry very stringent rules in place so as to prescribe as safely and therapeutically as we possibly can.

One of those rules is: "If you know you are pregnant or think you may be pregnant, it is your responsibility to inform the clinic. Failure to do so will result in termination as a patient."

Back the first part of last month, we got a fax that a patient, in addition to being a 'guest' of another state, had had a positive hCg at the facility. In cases such as that, we turn care over to the OB/Gyn.

Said patient showed up today, acting as though nothing was amiss, and did not disclose her pregnant state until confronted with it. The conversation ran the gamut of her legal troubles, her 'stress' and her need for her pills. I politely informed her of our policy (did not terminate her on the spot as I probably should have) and asked for the name of her OB/Gyn so that we could contact them to send records of her meds, etc.

That's when I'm pretty sure my blood pressure hit higher than it ever registered before, even counting my toxemia-plagued pregnancy.

"Oh, I don't have one. We're not going to continue with this. It's just not a good time. So, what do I do? I need my pills. Do I just have to bring you proof that it's done and I can have them?"

In a nutshell ( and yes, I'm being judgemental here), she didn't keep her legs together, and now she's just blithely going to terminate a pregnancy so she can get her candy. It's an inconvenience for her. Before you flame me, I consider myself pro-choice. In cases of rape, incest, extreme youth, maternal danger, or a known fetal condition that will result in little to no quality of life, I support the termination of a pregnancy. Not because one had no foresight to take precautions. And yes, we did ascertain that none of the above were a factor. She didn't care to announce it to the entire lobby, triage, and clinic in general.

I was so mad I was shaking. Maybe it's the miscarriage of my first pregnancy followed by a difficult and premature delivery of my son making my hormones run cattywompus, but I could have absolutely ripped her head off. I can't remember the last time I was that mad.

She then had the nerve to hang out in the lobby 'just to see if the doc comes in, so she can go ahead and see if I can have my pills'. The secretary finally had her leave.

My question...am I wrong (or hormonal)? I know ultimately it's her choice and her body, but it just cheeses me off to no end. All she was worried about was the pills! That's all!

Sorry for the rant. Full moon and a bad day. Thank you for reading, and I look forward to hearing your take.

Specializes in Nephrology, Cardiology, ER, ICU.

As a provider, you need to not personalize pts. If you do, you are always going to find drama and ways to be upset.

I only support abortions when they're absolutely necessary...like when a woman is pregnant and doesn't want to be

...sorry I can't really be on your side on this one.

Ok, you say you are mad and not sure you should be? well I believe anyone can feel anyway they want to....they are feelings! But how you choose to react to those feelings are an entirely different subject and you chose to deal with your feelings by venting here, which is helpful. No matter how any of us feels about drug addicts or abortion, like some wise nurse said in a post here,"do not personalize pts, you are always going to find drama and be upset". Even if we think we know what someone is going through, we may not have the full story of their lives, their hardships and it is not fair to them or ourselves to rack our brain judging them. Judging is so exhausting! Compassion(even though it may be hard to give at times)is so much easier...accept the situation, handle it the way it must be handled(your clinic has policies) and give the best care we can as nurses.

just my:twocents:

and sorry i forgot to :hug: for your bad day.

Specializes in Emergency Nursing.

I can understand why the OP would be frustrated and angry. I understand and completely agree with her on this issue. I also think she did a great job by not sharing that with the patient and maintaining her professional boundaries. I will say this though, if she broke this rule that your clinic has clearly spelled out and the consequence of breaking said rule is termination as a patient then I wouldn't hesitate to terminate her from the service.

I should add that this decision would not be as a punishment for the patient because I disagreed with her choice to terminate her pregnancy so she can continue to get controlled substances. This decisions is a matter of setting expectations with these patients (i.e. reporting a known pregnancy to the clinic immediately) and following through with the consequence (terminating the patient from the service for failing to report). Failure to do so with this patient could create a ripple effect in which other patients begin breaking the rules and expecting no consequences. That's my opinion as a psych. nurse and I'm sure on the flip side you could find another psych. nurse who would say that you have to remain flexible and not terminate the patient from the program because that would force her to seek her medications from other potentially dangerous sources. I think in this situation it is very difficult to think with an objective mind and there might be no "right answer". Best of luck and let us know what you decide to do about this situation.

!Chris :specs:

I'm of the opinion that "she's pregnant and doesn't want to be" is 100% a valid enough justification for an abortion in and of itself.

Specializes in med-surg, psych, ER, school nurse-CRNP.

It was not my decision to have that conversation amongst all and sundry present. The initial interview took place with myself and another staff member present as witness. Then the patient went back to the lobby and after sitting awhile came up to the window and hollered the question through.

Not the way I would have preferred, to be sure.

Specializes in CTICU.

These are the precise type of people who need to be allowed access to terminations. Do we really need more children with parents like this? At the very least, she recognizes her limitations.

What happened to the "do no harm". This post has become about abortion, and shame on you nurses for deciding it is your right to feel that termination would be best. Who elevated you to that position?

The comments giving unequivocal support for abortion on demand make me uncomfortable, especially the commentor who had to keep reminding herself to ignore the ethical side of the debate. It's so complicated! That's why I don't work in women's health :D.

I have to agree that the patient should have been immediately released from the practice because if you give her an inch, she will take a mile. Readmit her to the practice after the abortion? Fine. Perhaps it would be a wake-up call that getting pregnant again would be a major inconvenience, if only that it interrupts her narcotic access.

Sad situation all-around.

Your not wrong for feeling the way you feel but I would rather her abort this baby then to be doing insane amounts of drugs and really messing this baby up for the rest of his life. She may not have the same moral principle as you, but she knows that her drugs are more important than the baby inside her and for that I applaud her for not ruining anothers life because she has an addiction.

What happened to the "do no harm". This post has become about abortion, and shame on you nurses for deciding it is your right to feel that termination would be best. Who elevated you to that position?

How dare we decide it is our right to feel? Last I checked, everyone has the right to feel whatever they want. Just because you disagree, does not mean that our "feelings" are any less valid than yours. We disagree. That's fine. However, shaming everyone that disagrees with you will get you nowhere.

What happened to the "do no harm". This post has become about abortion, and shame on you nurses for deciding it is your right to feel that termination would be best. Who elevated you to that position?

In the end it doesn't matter what ANY of us think is the best...it matters what the patient thought was best for HER. And she made that choice. I'm also guessing she didn't mention any pregnancy because she knew she was terminating.

(For the record, I'm also in the "it's for the best" group).

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