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

[AngelfireRN]

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?

[tcvnurse, BSN, RN]

Oh, yeah. Thing is, we're not there to be friends with patients. We're there to help them become able to manage their conditions and stay out of the hospital! Sometimes, you have to be very firm with people so they understand exactly how serious things are.

Especially, to the OP, what if that lady took that metformin and then her kidneys went boom! I dont think you did anything wrong, I am glad your doc had your back, and it sounds like you are a damn good nurse.

[traumaRUs, MSN, APRN]

Adults are just that; adults. I work with an indigent, at-risk, medically complex group of pts. Its all in how you approach people. You have to get them to buy in to the idea of health. Sometimes you can, sometimes you can't.

I've been an APN for over 5 years now and many, many of my pts are noncompliant. You fix the ones you can.

There is no reason to get upset - the pts are the ones that are sick. The providers must be able to separate themselves from the pts. Documentation!

[traumaRUs, MSN, APRN]

Moving to the NP forum.

[nerdtonurse?, BSN, RN]

*pushing a chocolate bar slowly toward the OP*

You did the right thing. I see this kind of non-compliance all the time in ICU. With us, it's "well, it's getting to be the end of the month, and John's going to have run out of his check by now..." and sure enough, toward the end of the 3rd week of the month, we get our DTs. You talk to them, you tell them what they are doing to themselves, if they don't stop they are going to die and they come back in another month, same thing. Rinse, wash, and repeat. Thousands and thousands of dollars spent on rehabs that they check themselves out of, not to mention that they take the bed of someone who actually has decided they want help, want to stop. My cousin was like that, was in 16 different rehabs over the course of his life. Died from acute ETOH intoxication and aspiration. He always said he'd rather die than stop drinking. Well, he got his wish.

We get the folks wth GI bleeds all the freakin' time. Why? They have diverticulosis (not new onset by any means), and they decide to eat the "fruit and nut" diet they saw on TV/news/from a friend. The seeds get into the diverticuli, and kaboom. Or we have idiot docs who prescribe coumadin for alcoholics who are actively abusing ETOH. Nothing like the smell of a GI bleed mixed with beer.

Then we get the CHF/renal failure/dialysis folks, who absolutely refuse their diets and treatment regime. We had one guy that would go to dialysis, walk out to his car, and pull out a 2 liter soda and drink it before he left the parking lot, in full sight of the other patients/nurses. And then he'd end up with us, emergency dialysis because he'd go into pulmonary edema from fluid overload, and the same dialysis nurse he'd told "you can't make me do anything, B" is staying up until 0400 after working all day trying to get the idiot dried out enough to breathe. There goes more of the social security/medicare money I'll never get to use...

You can't fix stupid, and unfortunately, it seems to be a growth business. *hugs* to you and your little passenger.