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.
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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It doesn’t, you take the pills to the person, if they don’t take them immediately ask them to take the pills now, if their answer is a refusal chart it and leave, if their answer is something like “I’ll take them later”, explain that you need them to take it now, if they still refuse chart it and leave (with the pills obviously), possibly come back later, you have other patients to take care of and can’t waste time on a staring contest. But if you give pills to someone, put it in the chart that they’ve taken them at X time but they actually took it 3 hours later, doctors might act on that chart and cause problems to the patient and hospital. E.g. if the patient will have some surgery the next day the time they took their blood thinners is extremely relevant, the patient can’t be expected to know this, you as a nurse might know, the doctor who will read the chart and decide on the procedure knows but might be acting on wrong information if you didn’t watched the patient take the medicine. If the next day the doctor sees a refusal to take the medicine at the appropriate time he might choose to alter or stop the procedure, explain to the person why he’ll have to stay another day at the hospital and that this time he better take the pills at the appropriate time or he’ll have to stay another day, and not risk putting someone’s life in danger because a nurse decided to write a random time for when the patient took the pills. Think about it this way, if you wrote that the patient took the medicine at 7 but he actually took it at 10, and he died or had complications because he was still on blood thinners during surgery, who do you think will be to blame? The patient who was not told the medicine had a specific time? The doctor who has a paper signed by you that the medicine was given at 7? Nope, 100% the nurse who wrote the wrong time on the chart will be solely liable for this.
When I read the question I thought it’s stupid, he’s an adult, but the more I think about it the more it makes sense that nurses should chart only when they’re sure.
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I don’t think the commenter claimed to work in nursing.
If the patient won’t take it, can’t you document the refusal and move on?
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You are clearly in the wrong job.
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.
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”?
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.
That’s ridiculous. The doctor will the case 100% if there is a paper trail and witnesses of the patient refusing medication. The family will be forced to live with the consequences of the decisions of their family member. And do people really have to pay their own defense if they end up being proven innocent? If this situation were to play out where I live, the family would have to pay for the doctor’s lawyer, because it’s an expense only created by the families lawsuit. The doctor would still be out for some time, but if there is a risk of the family having to pay the doctor’s lawyer, it makes sure people only sue when they are certain that they will win the case, which reduces the number of lawsuits against doctors who respect their patients autonomy.
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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Could be a difference in international work culture? Or the nurses bent the truth a bit back when I was an intern there to make me do it because I was inexperienced. I work in a different field now. But I’m going to ask some of my relatives. I have family and friends who actually work as doctors and nurses.
One thing I can tell you, being a patient at a hospital really sucks. I’ve been there for minor stuff like getting rid of my tonsils. And everyone in the hospital is overworked. The doctors barely have enough time to treat you properly and they’re absent most of the time. And the nurses’ time is even more valuable because they do all the hard work. They told me not to shower, eat, and ask for more pain meds if needed. Other than that I wasn’t really able to ask complicated questions. I felt every minute they spent with me was taken away from the dozens of other patients the nurses had to attend to. And most of the other patients had proper medical conditions. So I just took the random pills they gave me without questioning. I was an otherwise heathy patient about 30 back then. And it was quite an ordeal to find out why they keep me there and when I was going to get released. Also the anasthesia sucked and stuck with me for the entire day. And the other patient in the room sucked because he slept for like 4 hours and was in pain again and would watch stupid morning television with sound from like 4:30am. I mean I was treated properly, everything turned out great and especially the nurses treated me really well within their time limits. But except for the meals, which were surprisingly good for hospital food, everything was just a sucky situation for me. I don’t know where exactly I was trying to go with this… My situation worked out well because of established standard procedures. I don’t hold a grudge against nurses. They are very well trained professionals here. And they really get out of their way to treat you kindly. And sometimes that is all you have left in a sucky hospital day as a patient. Even I (with a minor sickness) completely relied on them because nobody had the time to explain things to me so I could make my own decisions. I guess all I want to say is, please do your job properly, whatever this is, we people rely on you.
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.
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.
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I don’t think in terms of optics. I don’t care if it seems degrading or feels degrading. My philosophical and moral axioms are more about results, cause and effect, reality, etc.
Go to a homeless shelter. Or try dealing with children. There’s a time and place for uplifting people, but you also have to pay attention to what’s real. Think about the mental state of the person in that point in time. Learn to prioritize. Forcing a stubborn person to take pills is better than childishly clinging to ideas about personal autonomy.
I guess if you have very little life experience, don’t understand people, and haven’t developed a comprehensive, holistic perspective of humanity, then I could see how this would be a dilemma for someone.
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.
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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I’d ask you what hospital you work at.
No reason.
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.
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 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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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.
