(VENT!!!)Tonight I wonder..Why did i choose nursing?

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Specializes in Critical Care.

So last night I had a patient who was a serious pain in my ass, and would eventually sign out AMA. Well here's the story....Come on shift and get report. PT is a xx YO with Right LL PN. Ok so I get there and i go in to assess him and do my thing and he's tripoding, turning red and sucking wind hard. AND to top it off he's on a vent via trach but on PSV/CPAP of 10. So i call the RRT to come and do a treatment and change out the HME, I believe it's called. It's the sponge like thing on the vent circuit that traps the PTs on moisture so that they breath in humidified air (CCRNs will know what I'm speaking of) Anyways...Thats gets changed and symptoms resolved...WAHOOO! Great.....I call the MD for an order for something to calm this PT down with because he's super anxious and was just F-ing D/C off his versed drip! (DUMB MOVE) So I finally get ahold of the MD and he gives me a PO Ativan order for 1mg (gee thanks a bunch) and has me change his vent to AC and such and such settings. Well the patient ends up fighting the vent the whole time. Refuses to take the ativan and the xanax I have for him. The son of the patient says well he's never on the vent at home and he only uses nasal cannula oxygen and he is fine, he said "Can't you just take him off the vent and put him on oxygen?" I wanted to say Excuse me sir but when did you get a medical degree and second of all I WILL NOT, and CANNOT DO SUCH A THING. I told him We do not wean people at night and I legally cannot do that, because this is my licsense at stake here. I will call the MD again and see what he would like to do. I called the MD, and no response. All the meanwhile the patient grows increasing more agitated, and now im running out of options..I call my clinical administrator and tell her the deal. Before she gets to the unit the patient wants to go home AMA. I said please give me a minute to try and contact the doctor and then you can make a decision. I call the MD again and no response back. Finally the son of the patient says "I'm taking him home." My clinical admin was there and saw and heard the whole thing and she even said herself if he wants to go then let him go. I go into the room with the AMA papers and I said "Sir you must understand something, I think it is not a good idea that you leave, you have bi-lateral PN and your lungs need to rest. This is why you are on the vent. If you want to leave which i understand you do, you have to understand that you could potentially step only 2 feet outside the hospital and die. You NEED to understand this." The patient became infuriated at me, threw the paper in my face. I stepped out of the room, took a deep breath. Went back in and the son signed for the patient. The patient ended up leaving and I'm sure he will be back by the time I go in tonight.

Well thanks for reading I just needed to get that out. Ya know being new as a nurse is a bit scary. I worry about my license all the time. I feel like if i breath the wrong way that I could potentially lose my license. I know how 'sue'- happy people are because I have been sue (well attempted to be sued) for 2 million dollars for an MVA when i was 18 and it's the most awful thing I ever experienced and I never want that to happen again. Idk i guess I'm just a little scared because I know n understand the ramifications of allowing Pneumonia un-checked. I'm scared for my license and I'm frustrated that this patient would just relax take the meds i had for him and let that be that. I know people have the right to make their own medical decision but ***! UGGggggggh whatever.....Has anyone ever had a similar situation?! I know I cannot be the only one, I just need to hear it from someone who's been there and I know someone has been. Well thanks for reading. I'm going to bed cuz I'm back at it tonight. UGH FML. :eek:

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Specializes in Acute Care Cardiac, Education, Prof Practice.

I am sorry for the stress you had to undergo. Do you carry ? It is about $100 a year and is worth every penny. It gives me peace of mind and helps me feel I am doing my part to safeguard my home, family and future children.

You can't change the lousy habits of society, but you can CYA. ;)

:icon-hug:

Tait

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Specializes in Critical Care.

Yea I got it thru NSO THANK God

-Thanks for the hug, totally needed that and 50 of benadryl so i can sleep lol

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Specializes in Oncology/BMT.

Take a nice deep breath... Maybe have a glass of wine before bed (LOL)... I had a rough time the past two nights as well...

It sounds like you did everything that you could have and needed to do. You thoroughly informed the patient about leaving AMA in his condition and got the son to sign it. Just make sure that you document everything that took place.

And, I think personal is a good idea, too.

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Specializes in Med/Surg, ICU, educator.

You'll never run out of jerks that do things like this, but hopefully they are far and few in between.....I know some locations have more AMA type stuff. Just always CYA and know that it's nothing personal against you.....Get that sleep! And if he is back there tonight, kill him with kindness

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Specializes in Acute Care Cardiac, Education, Prof Practice.

If he is back tonight I would demand a new assignment!

I have a thread out, I will find and edit into this post, about my creep from last week. He came back the next day after he left the day nurse AMA after "reconsidering his actions" and probably having a good smoke and drink. My manager/charge nurse wouldn't even let him back on our floor!

https://allnurses.com/general-nursing-discussion/did-i-keep-441673.html

Tait

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Specializes in Oncology/BMT.

...and tell him about the good time on the unit he missed after he left...

YOU HAVE TO HAVE A SENSE OF HUMOR!!!

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Document document document! While I'm only a student, it sounds to me that you handled the situation the best you could. To give you peace of mind, make sure you document what you told the patient about leaving.. That CYA!

As to why did you choose nursing... How many great patients did you have until you ran into this one? And even though this one was difficult, you did the best you could to help someone. You can only do so much for someone who is not receptive.

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Specializes in Critical Care.

HAHA i do have a good sense of humor when I'm not getting my buttons pushed. Trust me I worked EMS as a career for 4 years and I worked in a place called Newburgh, some called it the '6th Borough' because it was so bad. Shot at, nearly stabbed, you name it it happend. So i'm used to jerks. Idk i just feel like i have alot more to lose here ya know. I worked so hard and for too long to god forbid lose my license. Idk im just a worry wart sometimes. But I have a good sense of humor, come get a drink with me and I'll prove it ! lololol. Thank you guys for the support, It's nice to hear it, really.

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Specializes in Critical Care.

As to why did you choose nursing... How many great patients did you have until you ran into this one? And even though this one was difficult, you did the best you could to help someone. You can only do so much for someone who is not receptive.

I had 4 total, 1 my LPN had but I just watch over them. Thanks god it was a 'slow-er' night. But I felt like the care of my other patients suffered ya know. Sometimes i want to be everything to everyone and I know that in reality it's just not possible. Idk I'm a perfectionist like most RNs and I just like people to get the best care as if it was my own family member ya know?

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

You really tried to help him, and he didn't want to be helped. You did right. It's a tough world...

Next on the list..is to learn how to not let these types of people affect your health. .....there will always be people who will push the buttons.

The trick is learning to move the buttons so these types can't find them.

Good job....

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Specializes in Cardiac/ED.

I had a patient that wanted to go AMA, I pushed the elevator button for him and asked him while he was waiting if he would sign this little form I had entitled "AMA". When the elevator came I said see ya later.. and we was back before I came back on shift.

I agree with everyone in regards to having a sense of humor with your patients so as to not let them get to you. Once they get to you then they have won, plain and simple and thus have power over you.

The one thing that I always suggest is that they don't have to leave...they are allowed to refuse parts of the treatment regimen...I think in your situation I would have asked if he wanted t refuse the vent...got the AMA form signed with at least 2 witnesses to the AMA advisement and signature. Called the MD left a message that the patient was refusing the vent as he wouldn't call back and call RT to remove it. At least your clear as being able to monitor him and if he got bad again you can say "told you so". I think nurses often forget that patients are allowed to refuse a medication but accept other meds or they can refuse certain treatments and I will even remind the patient thay they have the right to refusal. I had a patient refuse a med then continued to apologize for refusing it...I reminded her that it was her body and thus she was still the boss of it. No skin off my nose!

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