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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.
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.
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.
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 don't get this, why is there a delay at all? The times I've been in the hospital, they hand me the pills and a cup of water, there's no expectation that I can choose when to take the pill, it's immediate.
This is the typical case I think too. Usually so that nurse charts it straight away. This is so that another nurse wont give the same pill/dose during shift changes and so that if something happens and a doctor needs to administer alternative medication, they know what's in the patients system already.
I've never heard of a nurse having to sit there waiting for the patient to randomly choose a time to take it.
Oh, it happens plenty. Let's just say the nursing home nurses have it down to a science to speed folks up with all the patients they're administering medication to. Usually part of our report to other nurses on shift change, and what strategies we're using. Some folks want to talk, some folks are trying to exercise the very little control they have in a situation where their life has completely spiraled out.
Whenever I administer medication I tell the patient what they're taking as I hand it to them, and say, "Can you take this for me please?" I hold my hand out ready to take the empty pill cup from them so I can throw it away. There's no room for interpretation of anything other than "take this now."
See, that's what I was thinking. Even if the patient doesn't want to take it, most will because they don't want to inconveniece you.
You can't chart he took it if you don't see him take it. You have to wait or chart a reason the med was delayed. Why does your ehr even have a box for "left it next to him"?
You can put it in nurses notes, or depending on the EHR put an administration "note" in the MAR. But you have to actually put it there and then your manager will yell at you. Point is, you need to be sure they actually took a medication you documented you administered at the time you said you administered it.
This stuff isn't "my bosses" though but "standard nursing care."
On the point of patient's refusing meds, they're allowed to refuse. Nobody's gonna fire you for patients refusing their meds. You just document it as "refused." Now if the patient later says to the doctor that they didn't actually refuse and you just didn't feel like pushing the issue, that's another thing. Put a nurses note as to why they refused in their own words if you want to CYA on that. Doctor has to talk to them a discontinue the medication anyway if they're refusing, so you need a note.
On a particularly difficult patient, like what you're describing, you put in the nurses notes each time you attempted to administer medication and they refused. Those type of red flag notes are always fun to see before you come on shift.
This pt isn't refusing meds though. I've been a nurse a long time, only ER but still, putting in note to the ehr instead of doing one's job is bad practice. They either take it or refuse. In acute care there's no "probably took it later" option. People can refuse whatever. I tell my patients (who can leave) this isn't hospital jail but this guy seems to be talking about dumping a cup of pills and leaving.
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.
This reply seems like management/ hr reply… just as salty as op.
It’s so perfectly fine to respect someone’s autonomy there is a form they can sign- refusal of care. Explain the situation, sign form or take meds. Or, here’s another form- and there is the door. Forcing anything on a competent adult is battery I believe, no matter how beneficial.
Like OP said, chart and move on.
People are weird and react weird to some people. Ask another nurse to try, or ask to swap patients.
Also, sometimes nurses do know better. They see the patient as a whole, and a lot more than the doctor.
Also x2, managers are there mostly in a non medical (and non union) capacity, but to make sure the hospital runs as profitably as possible.
This is definitely not a manager or HR reply this reads like a reply from a fellow nurse or doctor.
This is not the field to fuck around and provide inadequate care in, to make moral judgement against medical ones. This is a field with lives literally at stake and there is no room for people who don't take that seriously. Full stop.
Yeah, I am salty. Some nurses are antivaxxers, ffs. People look to them for their “expertise”, but nurses often have little or no medical education, and some don’t even accept proven medical science. I have no doubt that a few nurses have helped kill people, by reinforcing their bad decisions and ignorance.
If a nurse knows more about a patient than a doctor, then have a conversation with the doctor. Don’t just roll your eyes and let the doctor keep making decisions that aren’t helping the patient. A lot of hospital accidents happen because of poor communication. Don’t perpetuate the problem.
Yeah, the healthcare-for-profit system is fucked. That doesn’t address the core issue, though, which is a nurse giving themselves permission to ignore management/experts and do their job poorly.
Maybe it's not about whether the patient takes the medication or not rather you are visually confirming and documenting that they took it or refused it. Should there be a mishap or lawsuit involving this person the hospital would use that person's reluctance to follow medical advice as a defense. Just playing devil's advocate here, I'll bet a lot of hospital policies are written to protect from liability
Yes, you should verify whether they've taken it.
With medication it tends to be pretty important to know what was taken, when it was taken and how much was taken. Leaving the meds with the pt means you can't know for sure when and how much was taken, or if anything was taken at all. And that's a problem. How's a doctor supposed to make any decision with care if they don't know for sure whether the patient has been getting the meds as ordered?
it's easy. assume the patient took them when they were told to. if they lie to a doctor, they have to face the consequences. at least that's how I'd handle it if I was a doctor.
And then when they die, their family sues the doctor for not making sure the patient took his medicine. Even if the doctor wins the case, the time and expense to fight it isn't worth it. Letting the patient face the consequences of his actions only works in a world where people accept the consequences of their actions, but we live in a world where everyone loves to blame someone else instead.
OP, your facility should have written guidelines about what to do in this situation. Following those would be much more sensible than relying on internet randos for advice, because it won't get you fired.
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 sometimes ill and experience pain. They're not in a normal situation where they would always make good choices. I think you're letting them down if you rely on the patients to do it right in that situation.
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.
Jesus Christ. What a psychopath. You're talking about dying on a hill when it will be others who die for your belief.
No shit. Was an entire house md episode dedicated to the patient not taking his meds when nurse left
The patient AND a dog died.
Die for their belief? What belief are you talking about
Not taking pills, or taking them improperly, can be fatal. OP doesn't care because they have a personal belief. They said that they would die on that hill, which is a poor choice of words because other people might literally die for their belief.
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.
Work in a hospital, not a nurse. Usually nurses bring meds with water and hand then to the pt. They either check on the lines, pumps, etc or chart for a minute or two. Then ask if there's anything they need. By then they usually have taken the meds and the RN leaves. There's only so many times you can tell a pt why they need to take them. I work with psychiatric pts and usually, if they refuse the RN just notes that they refused.
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.
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.
What if they hoard the meds and then take them all at once?
Then congrats to this competent adult, they have probably killed themselves. That's their choice to make.
To OP's point it's not their job to prevent someone from doing something stupid but rather to educate and provide an alternative. You can lead a horse to water and all that.
It is literally their job to ensure the patient has taken the medication prescribed to them as directed by the doctor. It's a controlled environment. It's a hospital.
They're in your care though, you need to CYA and be able to document if they took their medication at the correct time.
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)
I don't think so, I mentioned this scenario in another answer, imagine they took the pills to the patient at 7, the patient only took them at 10, but the chart says he took it at 7. The next day the doctor looks at his chart and decides enough time has passed and a surgical procedure can be done to the patient. Because he took it at 10 that's not true and because he's on blood thinners there are complications and the patient dies. Who's legally at fault? The doctor has a paper trail to explain why he did what he did, this leaves the blame entirely in the hands of the person who signed a paper saying the patient took the pills at 7.
OMG this community gives me brain health issues, I'm blocking it
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.
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.