Tired of being labeled when I'm trying to save a life.

[AngelfireRN, MSN, RN, APRN]

Ever have a week where you swear it's been a full moon for a solid MONTH? Welcome to my world.

Maybe it's the hormones, maybe it's just an outbreak of people being eat up with the dumb***, I don't know. What I DO know is that the next person to refer to me in the context of "that mean pregnant woman" is going to be very fortunate if I don't come unglued. Not because of them accusing me of being mean, it's just that my condition has less than nothing to do with it. And if they think I'm mean because I scolded them for doing something dangerous, well, I can deal with that.

Cases in point, and this is only this week, mind...

* Youngish 30-something comes in with a B/P of 170s/110s, and a check of her chart shows that this has been happening for six months. I initially started her on lisinopril, she complained that it made her sleepy, so rather than calling the clinic, she just stopped taking it. Next visit, when I discovered this, we discussed proper medication use, protocol for calling the clinic, and the importance of follow-up care ( she did not come back in one week for a B/P check, as instructed). At that time, I gave her samples of a beta-blocker and added clonidine, per my clinic protocol, and with Doc approval. Again, no show for a one-week check. She comes in this week with the aforementioned B/P reading, and says that, no, she has not been taking her meds, because 'I didn't think you had to take them every day. I take them when I think it's high." This was a full 2 months after the swap to beta-blocker tx and she still had pills left in the 2-week sample pack I gave her (she was to report back for a check, at which time I would have done a script for the med, if it were effective).

I rarely get mad, truly mad, at a patient, but I did with her. Especially as she whimpered and whined that this is "all new to her". No, sister, not after six months, it isn't. And I'm sorry, "I can't remember crap" is no excuse to just take the meds you want to take and forget the rest, as well as not to show up for rechecks. We had a serious little powwow about stroke risk, kidney damage, etc. What really got results (sad case) was the fact that she won't get her pain and nerve pills anymore if she's noncompliant, per Doc. He was MAD.

So, yes, I'm trying to save her dang life, and I'm mean. And it's 'all because she's pregnant'. I guess if I weren't, I'd just be a B.

* Second lady came in, with a complaint of "sugar being too high". I inquired about the readings, as we didn't have her listed as a diabetic. She related that she 'got real sleepy' after a meal about a month previous, and checked her sugar, which read in the 300s. I did tell her that, based on the meal, that was likely a normal variant. She them proceeded to tell me that she had had a couple of fasting readings of 160 or so. That was a bit more worrisome, but, knowing that home meters can be incorrect, I opened my mouth to say that we would do a check in office and see what the reading said.

Before I could say that, she holds up a hand and with a very proud, satisfied expression says, "You don't have to worry. My husband's on Glucophage."

I laid down my pen at that point, looked her dead in the face and said, "Tell me you didn't."

She did. Diagnosed herself, prescribed her own tx, and started it. No phone call, no run by the office to ask, just did it. I almost had a fit.

"Mrs. X, you realize Doc will dismiss folks for that. You can't just start taking other people's meds! You could have hurt yourself!"

"Oh, he won't dismiss me. He'll say it's all right. I used to work for him. Just give me my pills, it's not like I took his heart medication."

"Mrs. X, don't try to blur the line here. Meds are meds, heart, diabetes, pain, whatever, and you DO NOT take other people's meds, especially when you don't have a condition that requires them, and you don't know that that's what you'd need if you DID have the condition! You could have had a reaction, and seriously damaged or killed yourself!"

She got quiet. I did an A1C on her, which was normal. By the time I got back with her results, she was crying. Seems her father is quite ill and on hospice, none of which I was aware of, but also nothing that changed the fact that what she did was wrong and dangerous. She got her scripts written, walked out, and proceeds to tell our receptionist that she only wants to see doc ever again, because I'm hateful.

Then she looks at me (I had followed behind with her chart) and snipes, "I'm going to tell him what you did."

What are we, in Kindergarten?

I very calmly set the chart in the rack to have meds called to the pharmacy, and responded, "You're not going to have to, because I intend to tell him myself."

I did tell him, and he said that, not only is she NOT going to see him every time (because he agreed with what I did and said), but that he fully intends to tell her at her next visit that the fact that she did work for him does not excuse her from doing things that are wrong. Thank the Lord, I have backup.

Anyone else ever run into this when you're only trying to help?

[nola1202]

yes but I'm the mean old battleax. u won't be pregnant forever but old is only going to get worse. As the ER pople say...you can't fix stupid."

[AngelfireRN, MSN, RN, APRN]

Nola, I related that very same sentiment yesterday, "You can't fix stupid, but you can flat drive yourself crazy trying."

[carolmaccas66, BSN, RN]

Wow what a bad run you've had! And ur pg to boot!

What sort of clinic do u work in Angel?

Yes I do psych & I couldn't tell u the amount of absolutely bl**dy idiotic & insane things that people do or have done. I honestly believe some of them are in the Ted Bundy corner, no honestly, they are so effed up.

Listen mate, you wouldn't be human if u weren't getting mad. I just tell myself I did the best I can, there is no obligation for them to take my advice. Then I have a nice dinner and a glass of wine! Course u can't have the wine, but you can have a nice hot milo or hot chocolate maybe.

I hate the ones that constantly come back for the same thing, again & again & again. I get soooo tired of seeing & dealing with them. But I just plod on, and keep smiling and nodding. Sometimes I'm so drained and pee'd off, that's ALL I'm capable of doing.

I used to work in plastics & I remember one guy came in. He had a massive, fungating SCC I think & when the doctor asked why he didn't have it seen to when it was smaller, he replied: I just couldn't be bothered doc (the doc told me after). I remember seeing this bloke after his op - the whole surgery took like 16 hours, whereas initially it could have been 15-20 minutes, if he'd needed a flap.

Stupid, stupid, morons. But like they say, there's no pill to cure stupidity.

[imintrouble, BSN, RN]

The nurses I admire the most are the ones who do what they have to do to ensure the health and safety of the pt.

The DM pt who requests a PBJ sandwich with a blood sugar of 400. I'd rather be the nurse who refused, than the one who said yes.

I hope you never get to where you don't care if your pt is compliant or not. Keep fighting the good fight. In this case being "mean" may just save a life.

[AngelfireRN, MSN, RN, APRN]

Carol, it's a general practice, with emphasis on pain management. And, much as I hate to, I have to use those means at my disposal to get people to at least TRY to take care of themselves. In this place, that usually means cutting off their candy (pain and nerve pills), or threatening to.

And no worries, I can't have wine, but I did allow myself a very large Maountain Dew (my drug of choice, lol) and I'm having pizza tomorrow. It'll all be good. I just have this crazy compulsion to want people to be healthy, I guess.

[AngelfireRN, MSN, RN, APRN]

The nurses I admire the most are the ones who do what they have to do to ensure the health and safety of the pt.

The DM pt who requests a PBJ sandwich with a blood sugar of 400. I'd rather be the nurse who refused, than the one who said yes.

I hope you never get to where you don't care if your pt is compliant or not. Keep fighting the good fight. In this case being "mean" may just save a life.

Thank you.

[carolmaccas66, BSN, RN]

Carol, it's a general practice, with emphasis on pain management. And, much as I hate to, I have to use those means at my disposal to get people to at least TRY to take care of themselves. In this place, that usually means cutting off their candy (pain and nerve pills), or threatening to.

And no worries, I can't have wine, but I did allow myself a very large Maountain Dew (my drug of choice, lol) and I'm having pizza tomorrow. It'll all be good. I just have this crazy compulsion to want people to be healthy, I guess.

Hope u enjoyed the mountain dew!

I used to work in a substance abuse clinic (not as a RN then), and there were some terrible scenes & fights with clients who turned up late for medications, or who had had bloods done showing illegal substances, etc. One of the receptionists used to scream at them over the counter, mind you, she wasn't a nurse of any kind & had no substance abuse/pscyh/med training. At the clinic, clients signed a contract saying they had to be responsible for their own health. Sometimes the doctor would give in to them, & then this receptionist would throw up her hands & complain loudly all day long. One young guy (who got addicted to pain pills after a terrible bike accident I think it was), was trying to start up his own business & was busting his butt. He was a nice, easygoing young man, very pleasant. Well he missed the bus one day, or it was late - can't remember - and the doc absolutely refused to give him his meds, I think naloxone?? Well did we hear a tirade of abuse that day. But I felt sorry for this young guy, he wasn't swearing, he was just so angry. And he was trying to do the right thing but felt like he wasn't getting any support.

From my studies of substance abuse, these kinds of strict programs actually disillusion people to go back to taking drugs & drinking.

But u have to fight the good fight. Some people see us as the enemy, full stop. I try hard not to 'tell off' my psych patients, & have learned to say things like: 'Perhaps it would be better if...'., you know. But it doesn't always work.

I hate to say it, but some people you see with either end up in the ER/ED, or in a body bag one day, and it won't be ur problem then. And people will never, ever, ever change ANY behavior, unless they really want to, no matter how much support they have.

But u know all this don't you?

It's probably a bit of hormones, stress & thinking about the baby all combined. Just smile & try to be happy, you can only do so much. Sending you some smiles to brighten ur day from Down Under! :) :) (it's hot and icky and humid here in Southern Aust right now, yukky!)

[AngelfireRN, MSN, RN, APRN]

Carol, I hope I didn't give you the impression that I use the threat of withholding meds on a consistent basis. That's our last resort, after counseling and explanation have failed. Ultimately, if a patient is repeatedly noncomplaint, we dismiss them from the practice, as we treat it all, and if a patient just takes teh candy (I prefer that to 'dope'), well, then Doc says he's just a pill mill, and that's not what we are.

We have an understanding with all pharmacies we utilize that our patients are held to an 'all or nothing' rule, you get all meds filled, maintenance and controls, or you don't get any. They are not allowed to only fill their controls.

I try hard not to tell off anyone either, but with the population I deal with, most of whom are ill-educated, illiterate, and somewhat 'backward' to a degree, a disciplinarian approach is all that's understood. They have a real tendency to only hear what they want to hear, and the Devil take the rest. Of course, being raised around that environment, I can kinda understand it. I mean, if you can't read the pill bottle, you don't know how to take it.

Such was not the case with the two I mentioned in my OP. They can read, and they're both reasonably intelligent. So, no excuses there, except idiocy and laziness. Idiocy to think that you can diagnose and treat yourself, with not a whit of medical training, and laziness to just not show up for a B/P check and not even bother to ask if you're unsure about directions.

[xtxrn, ASN, RN]

:hug:

On days like that, there's nowhere to go but up:up:

[assidere]

Looks like you've got some good replies, but as to the subject of being labeled-

"Oh, you're a male nurse!?! They didn't tell me that! I don't want one of those. I need a "regular" nurse who knows what she is doing"

That one really stung. Even after assuring her that I was a healthcare professional and took the same classes the female nurses did, she (and four others that I can recall) maintained that she wanted a female nurse. I understand from a cultural/ehtnic point of view where a male taking care fo a female could be frowned upon and I respect that, but these were all American Caucasians...

[carolmaccas66, BSN, RN]

Hey Angel

I understand what you were trying to say. Some of the psych clinics I've worked at, if patients are not accountable for their own care, ie: not turning up for medications, the doctors can warn them once (or not at all, their choice) and the patients are d/c.

Some patients need a firmer hand than others, otherwise they just play you like a guitar.

It takes a lot to get me annoyed! I'm too old and crusty now to let the small stuff bother me :)