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dad (linux.community)
submitted 11 months ago* (last edited 11 months ago) by vestmoria@linux.community to c/nostupidquestions@lemmy.world

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:

  • 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.

  • 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.

  • 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.

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[-] FaceDeer@kbin.social 93 points 11 months ago

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.

[-] HopingForBetter@kbin.social 18 points 11 months ago

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.

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[-] surewhynotlem@lemmy.world 60 points 11 months ago

This is my job. I don't want to do my job. Should I do my job?

Yes, you should do your job.

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[-] jordanlund@lemmy.world 58 points 11 months ago

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.

[-] trustnoone@lemmy.sdf.org 20 points 11 months ago

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.

[-] roguetrick@kbin.social 7 points 11 months ago

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.

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[-] flicker@lemmy.world 4 points 11 months ago

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."

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[-] WhiteOakBayou@lemmy.world 45 points 11 months ago* (last edited 11 months ago)

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"?

[-] roguetrick@kbin.social 16 points 11 months ago* (last edited 11 months ago)

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.

[-] WhiteOakBayou@lemmy.world 8 points 11 months ago

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.

[-] roguetrick@kbin.social 7 points 11 months ago* (last edited 11 months ago)

We're on the same page. That's what I meant about a patient refusing to take it "right now." That's a refusal and you just document it in the notes and try again after you round on everybody else.

That said, the floor and the ED act a bit different when we're talking about scheduled medications. Things can be a bit more flexible on the floor.

[-] WhiteOakBayou@lemmy.world 9 points 11 months ago

Yeah, this reads like an AITA post and the answer to op is yes lol. I feel like this is 100% not an autonomy issue like op said either. This is hopefully the pt's home meds or something but what if it was something that needs levels? The 5 rights are for pt safety and right time is one of the easiest to remember. I think your reply explains it best.

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[-] magnetosphere@kbin.social 36 points 11 months ago* (last edited 11 months ago)

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.

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[-] Hikermick@lemmy.world 21 points 11 months ago

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

[-] Hedgehawk@lemmy.world 20 points 11 months ago

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?

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[-] LesserAbe@lemmy.world 20 points 11 months ago

Yes, you should verify whether they've taken it.

[-] spittingimage@lemmy.world 19 points 11 months ago

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.

[-] rufus@discuss.tchncs.de 18 points 11 months ago* (last edited 11 months ago)

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.

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[-] mhague@lemmy.world 18 points 11 months ago* (last edited 11 months ago)

Jesus Christ. What a psychopath. You're talking about dying on a hill when it will be others who die for your belief.

[-] Thermal_shocked@lemmy.world 6 points 11 months ago

No shit. Was an entire house md episode dedicated to the patient not taking his meds when nurse left

[-] DaneGerous@lemmy.world 5 points 11 months ago

The patient AND a dog died.

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[-] schnurrito@discuss.tchncs.de 15 points 11 months ago

It is a job and at a job you follow instructions you get even if you think they are stupid.

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[-] ruckblack@sh.itjust.works 13 points 11 months ago

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.

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[-] baldingpudenda@lemmy.world 13 points 11 months ago

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.

[-] djquadratic@kbin.social 7 points 11 months ago

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.

[-] Toes@ani.social 7 points 11 months ago

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.

[-] june@lemmy.world 6 points 11 months ago

What hospital do you work for?

I ask because I want to know which one to avoid should I ever need to go.

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[-] Kalkaline@lemmy.zip 5 points 11 months ago

What if they hoard the meds and then take them all at once?

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this post was submitted on 14 Jan 2024
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