The medication is a blood thinner, the patient is a competent adult not in delirium, A&OX4. There are 2 ways to see this:
Manager’s and a group of doctor’s POV: you are a nurse and it’s your job and duty to do that. Plus, we know better than him what’s good for him. These people have built their identity around working in healthcare and to them this means I have to stay in the room and make sure the patient takes the medication.
My POV: nursing is not a calling but a job. What my manager and these doctors think is stupid:
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the patient is a competent adult not in delirium, A&OX4. He’s old enough to know what happens if he doesn’t take the medication because we have told him a number of times already. I’m not his father and I’m not ready to treat a competent adult like a child.
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I have other patients and I’m not going to waste my time watching a patient silently until he decides to take the medication. I’m charting that I left the medication next to him and told him he needs it and why and that I have other patients to take care of.
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It is stupid to watch a person while doing nothing when I should be working with my other patients. It’s also invasive as f*ck.
I see it like this: my manager and this group of doctors are not ready to respect a person’s autonomy whereas I’m not ready to ignore this same autonomy, even if it means a negative outcome. Respecting a consenting adult’s autonomy means respecting his bad choices as well. I feel this group of doctors and my manager are not ready to respect any patient’s autonomy.
At this moment, this is a hill I’m willing to die on. AITA?
ETA: I wrote about a group of doctors, because there are other doctors that don’t give me hard time if a patient refuses his medication, they simply chart it and move on. I like working with doctors like this because I feel they don’t judge and respect the patient’s autonomy as well.
If not taking medication is a frequent problem with them, I’d call for a psych evaluation. Could be as simple as the medication is making their mouth itchy or stomach hurt and they aren’t explaining that or connecting the dots.
Manager’s and a group of doctor’s POV: you are a nurse and it’s your job and duty to do that.
They’re completely right. If you disagree strongly enough, the only honorable thing you can do is quit. You are not making any kind of statement, or being “rebellious”, by insisting on doing a half-assed job. You’re simply being dishonest and providing inadequate care.
Nurses are overworked and spread too thin, but that’s not something your current behavior will fix, or even protest.
Plus, we know better than him what’s good for him.
They should. That’s their job, and what they went to school for. It is not a nurse’s place to override their decisions (except in emergencies, of course). That’s what you signed up for when you took the job. Hell, listening to your manager is a basic requirement of most jobs, healthcare or otherwise. That’s Employment 101.
Patients are often stubborn, ignorant, and it’s possible that several of them wouldn’t be in the hospital in the first place if they took their health seriously.
If you take someone’s autonomy so seriously that you’re willing to respect and tolerate their “bad choices”, that’s perfectly fine, but nursing is by no means the right job for you. It’s not the mindset that upsets me - it’s that you’re working in the worst, least compatible field possible. I hope you’re able to find something else soon.
how many years in nursing?
This is my job. I don’t want to do my job. Should I do my job?
Yes, you should do your job.
I’m not a nurse, but I think the way you’re charting is the correct way to protect your license. If they’re A&Ox4 then there’s probably not a legal/regulatory reason to sit and watch them, but it’s also probably not out of bounds for hospital policy to require staff to observe and confirm any intervention (including meds) provided while under their care.
Now, whether they’re going to take into account how much cumulative time/work that adds to the nurses and then staff accordingly is another story… (Hint: they won’t)
Now, whether they’re going to take into account how much cumulative time/work that adds to the nurses and then staff accordingly is another story… (Hint: they won’t)
nope they wont
Seems more like a question you should direct at your manager and coworkers, but you know you won’t like their answers, so you’re asking here where we lack context lol.
Id ask you to stop assuming
I’d ask you what hospital you work at.
No reason.
Imo it depends on the patient. If the patient says they take the meds but their signs - vitals, telemetry, routine labs, PE, etc show otherwise - then it’s your responsibility to confirm or deny patient medication adherence.
I’d like to say a functioning healthcare team means that the top level providers will trust their nurse’s judgement about the patients they are in charge of.
But at the end of the day this is about treating patients and ensuring that a standard of care is met. Part of that standard is allowing for shared decision making, non paternalistic care, etc.
But again, it is your responsibility to know what is happening with the patient. It’s not really that you’re forcing the patient to adhere, it’s to confirm if they take it or not.
Isn’t that a non-negotiable rule? I thought you always give patients medication on time and watch them take it. In the 2 weeks I’ve been an intern at a hospital, I’ve seen more than one person not take it or save it for later or wanting to wait for the next meal until eating the pill and then forgetting about it, or doing whatever with it. We were supposed to make sure and I don’t think there were exceptions to the rule. And honestly, doctors don’t tell patients if it’s important to take the medications before a meal or after, or 3h before a medical procedure and if it’s really important to do it right. Patients don’t even know, are sick and do silly stuff. Some of them have dementia, some look alright but aren’t.
It’s not “their autonomy”. Patients are sick, overburdened with information from doctors and suddenly 5 different medications to take. They are ill and experience pain. They’re not in a normal situation where they would always make good choices, or they (often) wouldn’t be in the hospital in the first place. I think you’re letting them down if you rely on the patients to do it right.
So don’t re-invent medicine and have your own take on it. As you said it’s just a job. If it’s part of the job to make sure some procedure is carried out correctly, do it. Not every stupid rule is super important, but be sure the rules you don’t follow aren’t the ones that are ‘written in blood’.
We other people also have things in our jobs we don’t like. Or that are sometimes not really necessary in certain situations. If you’re a professional, you just always do it right and always try to follow standard procedure.
I thought you always give patients medication on time and watch them take it.
if this is true in most hospitals I work in a strange one
My POV: nursing is not a calling but a job.
Well, if you think of it that way and your bosses are telling you to do a certain thing, you should do that thing. If you’re not doing the thing your bosses are telling you to do then maybe you’re not doing your job.
Sorry if that’s not what you wanted to hear, but I don’t see what other reasonable interpretation there is here.
The big bosses aren’t medical staff, they’re calling is not patient care, it’s profit.
What op is experiencing is delusion in the system and burnout.
OP is right. Document, cya, and move on.
All these downvotes and replies seem to be from people who want to think a hospital is altruistic place of healing. Unfortunately it’s an end stage capitalism hellscape that chews up and spits out most people who give a damn.
Oof this is definitely wrong. A blood thinner is one of the most important things whether a patient is taking or not. It’s the nurses job to let the doctor know whether the patient is compliant not only for medical reasons but for documentation. That’s outside the argument about profit in healthcare in US, that’s basic medicine. What if that patient falls and hits their head? Do we need to know if they’re on s blood thinner? What if they’re hemoglobin starts dropping? What if they need a procedure? What tif their platelets start dropping? Etc, etc, etc.
Don’t be a dick and not do your job, that makes your coworkers miserable and puts people in danger especially in medicine. I agree with burlit being and issue and chronic understaffing but be an adult and quit or move positions if you don’t like it.
I mean, I kind of agree here.
I’d go full chaotic lawful if you’re mentality is “not a calling”.
Follow the rules and directives as given.
It also sounds like you are on the way out of nursing. If you’re not passionate about it, the job will eat you alive without a second thought and you’re going to start seeing more and more things that irk you until you leave.
I’m also in the process of switching out of a “selfless calling” to what I hope is a fulfilling career.
Good luck with your next steps, whatever they may be.
thank you
What if they hoard the meds and then take them all at once?
It is a job and at a job you follow instructions you get even if you think they are stupid.
hey, fellow german, I think we both know why this shouldn’t be the norm.
So what happens if they don’t want to take it, or want to take it “later”? Are you expected to force-feed them? Call security? Hold yourself hostage until they change their mind?
I’m with you on instinct, but I have no idea what the regulations are like in healthcare.
my manager and this group of doctors are not ready to respect a person’s autonomy
This is why I hate hospitals. I’m there because I need medical help, not because I am incapable of running my own life.
Eh, if you’re in the hospital, do what you’re told. If you don’t want to listen then just fuckin leave.
Waffling in the middle is a waste of everyone’s time.
If you need medical help… why aren’t you accepting that help? Medication is often a part of that help. If you have problems with the medication, you should talk with your doctor, not act like a petulant child.
If a patient doesn’t want to take it, they just say they don’t want to take it, no one is force feeding people or calling security. Patients refuse medication all the time for many different reasons. In this example, the nurse should just document the patient refused and why, notify the doctor what happened, and continue on with their work. Not stand there in an hour long staring contest until the patient takes it.
It’s very important the medical staff know what things you have and haven’t actually taken while in the hospital (and before you got there too). If it’s a medication you really need, your doctor will probably come and explain why refusing is a bad idea. If people don’t like the plan, don’t want any treatment, or don’t want to stay in the hospital, they can just walk out and leave. It’s a hospital not a prison. Your doctor may just ask you to sign something just to document they explained to you why leaving is a bad idea.
It sounds like you’re on OP’s side to “chart it and move on”, which makes sense to me. I don’t quite understand what more OP is expected to do here.
Rather than documenting that the patient refused to take it at 7, taking the pill away, and then (time allowing) giving the patient another chance to take it later, OP wants to leave the medication with the patient and document that it was handed to the patient at 7. Unfortunately, doing that creates uncertainty, which isn’t acceptable in a medical context.
Thank you. That makes sense.
