Soooo frustrated...what to do?

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Specializes in Psychiatric nursing.

Hi all, I'm a first time poster but an avid reader of the site. This may be a rant: but I am also quite interested in what other nurses have done in this situation...Here goes...

Background info: I work in community adult case management (mental health). There is a drug (we shall call Med A) in Aus that is not PBS listed. The drug companies application for PBS listing was deferred indefinately by the government. It is currently on a trial- all Dr's must be signed up to the trial in order to prescribe it. There are no Dr's where I work who have signed up to this trial.

Frustration: A client's (who is currently an inpatient) mother presented to the community mental health service stating she had been advised by a Dr to collect a script for Med A. This is a Jnr Dr who works at the inpatient facility. She requested information on the drug (as she had been given no information by the Dr- only that her son was to be commenced- the mother is the allied person and guardian- which in Aus means that she is told about everything. Her son also is currently deemed to have no capacity to consent). I advised the mother what this drug is, and that it is on trial and she stated that he was NOT to be commenced on any trial medication.

I contacted the ward where the client is admitted (we work together) and was advised that the Dr who had said this was not yet at work but would be in "hopefully soon". I then DROVE to the ward to discuss this with the Dr and also my client. When I got to the ward the Dr was not there- still- and my client informed me they had not been told about the change in medication. The nursing staff on the ward confirmed this. I waited an hour for the Dr to turn up (she was uncontactable by phone and it was my lunch break- lucky me) and then had to leave as I had other appointments to attend. As I was getting in to my car I saw her pull up to the ward. (4 hours late to work but had time to stop off and get coffee...) I asked if we could talk- she said yes. I asked what was going on with this clients medication and she said she was commencing him on Med A. I advised her that his mother had refused- and that there was no script at the community facility to give to the mother. The Dr then told me that her consultant (He is both our boss) had written the script on Friday and left it for me to give to the client- that I had misplaced the script. I then advised her that the consultant does not prescribe this medication as it is a trial, and that she will need to discuss the options this afternoon with the client and his mother. She mumbled something which I could not make out and walked away from me.

I got in my car to drive away, and all of a sudden she was at the drivers side window banging her keys on it. I wound it down and she stood over me in the window saying "you are wrong. It is not a trial drug"...I said very politely "it is currently not on PBS and clients can only be commenced on this medication until April 18. Dr's have to be signed up to prescribe it and your consultant psychiatrist has not signed up". She then walked away again- got to the door of the ward, turned around and yelled out "you are wrong" again, and then walked inside.

WHAT THE?????

I think I was very professional in my approach- yet she spoke to me like I had no right to advocate for my client? That is my job!!!!!

Should I discuss this with my consultant when he returns to work tomorrow am? What would you do? Thanks for any advice!

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Specializes in CNA: LTC & DD.

Would definitely bring this to your consultant's attention. Her behaviour's not only rude to you, but blatantly ignores her own role in the entire affair - pushing blame onto you for losing the script, etc. etc. The consultant should be made aware that this is how she comports herself when dealing with "difficult" situations.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I'm an Aussie nurse and have done quite a bit of work in different mental health units.

It doesn't matter what you or the Dr think, or whether this drug is ratified yet or not. Though this Dr was undoubtedly rude to you and out of line, it is not up to you or her whether or not this patient gets Med A.

If the mother is the legal guardian, there is nothing you or the Dr can do about giving this drug, irregardless of what the specialist says re the script. Ask the mother to speak to the specialist who wrote the script.

As a nurse advocate, I would be supporting the mother and the patient in the best way I could, and following the law. That means supporting the mother who is the legal guardian.

Remember to always support your client - which you are trying to do to the best of your ability - and fall back on what the law says - always. That's what I would do in this case.

And I would be confronting that doctor in private when I had the chance, and asking her VERY UPFRONT for an apology for banging on your window and screaming at you. Definitely NOT professional!

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Specializes in Psychiatric nursing.

Yeah, that's the thing that really got me- there was no script written because noone I work with prescribes it! So the consultant didn't want it, the client didn't want it, the parent didn't want it, the case manager didn't want it (as we don't enter in to the trial where I work- not for any other reason)...the only person who did was the VERY new Dr who didn't know the medication well enough to know that not just anyone can prescribe it...and also ethically she can't sign someone up to a trial without discussing it with them...the mother was very upset that the Jnr Dr didn't tell her about the medication- what the Dr didn't realise is that they don't have to deal with the family in the community. The case manager is the one who looks after the client every day and gets the earbashing because someone else did something a little off....(I've worked both wards and community over the years so I know that both have their good points and less good points...)

I spoke to the consultant who was not so suprised with the Jnr Dr's behaviour-but gave me kudos for advocating for my client....I guess all's well that ends well. The client/parent got what they wanted in terms of treatment :)

Thanks for the advice!

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

No worries aussienurse1

Meant to say welcome to the site!

Any other problems let us know, we are always here to listen - and I'm studying mental health (grad dip) so I'm used to listening to people's problems! and I don't mind anyway :)

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Specializes in ER.

not sure how things work in Australia, but I'm assuming your "consultant" is either your manager or that prescribing doctor? I would definitely bring this up that someone needs to inform this doctor of what she does not know and let it go. You did your job and informed her and protected the patient. The mom is aware and seems like it'll all be ok.

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Specializes in Med surg, LTC, Administration.

My cynical, suspicious American mind, thinks there is more to the angry doctor, than meets the eye...

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.
not sure how things work in Australia, but I'm assuming your "consultant" is either your manager or that prescribing doctor? I would definitely bring this up that someone needs to inform this doctor of what she does not know and let it go. You did your job and informed her and protected the patient. The mom is aware and seems like it'll all be ok.

A Consultant over here is a specialist doctor, ie: a psychiatrist or a plastic surgeon for example. I think you call them internists over there?

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Specializes in Critical Care.
Hi all, I'm a first time poster but an avid reader of the site. This may be a rant: but I am also quite interested in what other nurses have done in this situation...Here goes...

Background info: I work in community adult case management (mental health). There is a drug (we shall call Med A) in Aus that is not PBS listed. The drug companies application for PBS listing was deferred indefinately by the government. It is currently on a trial- all Dr's must be signed up to the trial in order to prescribe it. There are no Dr's where I work who have signed up to this trial.

Frustration: A client's (who is currently an inpatient) mother presented to the community mental health service stating she had been advised by a Dr to collect a script for Med A. This is a Jnr Dr who works at the inpatient facility. She requested information on the drug (as she had been given no information by the Dr- only that her son was to be commenced- the mother is the allied person and guardian- which in Aus means that she is told about everything. Her son also is currently deemed to have no capacity to consent). I advised the mother what this drug is, and that it is on trial and she stated that he was NOT to be commenced on any trial medication.

I contacted the ward where the client is admitted (we work together) and was advised that the Dr who had said this was not yet at work but would be in "hopefully soon". I then DROVE to the ward to discuss this with the Dr and also my client. When I got to the ward the Dr was not there- still- and my client informed me they had not been told about the change in medication. The nursing staff on the ward confirmed this. I waited an hour for the Dr to turn up (she was uncontactable by phone and it was my lunch break- lucky me) and then had to leave as I had other appointments to attend. As I was getting in to my car I saw her pull up to the ward. (4 hours late to work but had time to stop off and get coffee...) I asked if we could talk- she said yes. I asked what was going on with this clients medication and she said she was commencing him on Med A. I advised her that his mother had refused- and that there was no script at the community facility to give to the mother. The Dr then told me that her consultant (He is both our boss) had written the script on Friday and left it for me to give to the client- that I had misplaced the script. I then advised her that the consultant does not prescribe this medication as it is a trial, and that she will need to discuss the options this afternoon with the client and his mother. She mumbled something which I could not make out and walked away from me.

I got in my car to drive away, and all of a sudden she was at the drivers side window banging her keys on it. I wound it down and she stood over me in the window saying "you are wrong. It is not a trial drug"...I said very politely "it is currently not on PBS and clients can only be commenced on this medication until April 18. Dr's have to be signed up to prescribe it and your consultant psychiatrist has not signed up". She then walked away again- got to the door of the ward, turned around and yelled out "you are wrong" again, and then walked inside.

WHAT THE?????

I think I was very professional in my approach- yet she spoke to me like I had no right to advocate for my client? That is my job!!!!!

Should I discuss this with my consultant when he returns to work tomorrow am? What would you do? Thanks for any advice!

While I don't practice in Australia, I'm in the US, I want to commend you for strongly advocating for your patient. No matter where your practice is, we all realize that it can take a sacrifice to be such a strong advocate. Kudos to you.

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