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.
Wouldn’t it be worse for other patients if he stays in hospital longer because he made himself sick from not taking medicine rather than just making sure he does to clear the bed sooner?
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.
Why? Any number of reasons. Ultimately, it is the patient’s choice when to actually take them, or if to take them. There is a degree of realistic limit to that, particularly with dose and time sensitive medication, but you absolutely have that choice within those limits.
Should you be fucking around and not taking them on schedule? Hell no! Let the pros do their job unless there’s a good reason otherwise, and communicate any reason asap so it can get sorted. But it is the patient’s right to manage their care as long as they’re competent.
Now, as to why? Dry mouth, sore throat, nausea, concerns about timing of side effects (like drowsiness) interfering with something, there’s all kinds of good reasons to delay taking a medication. There’s also plenty of bad reasons lol.
And it’s important to remember as a patient that if you’re going to fuck around with things that most patients aren’t qualified to fuck around with (like dosage scheduling), that most facilities can turn that into a reason to turf your ass lol. It’s rare, but hospitals can kick our asses to the curb via transfer or other means if we’re unwilling to cooperate with our own care at all.
If you document that you gave it, you need to have seen them take it. If they’re being stubborn and are competent, document that you educated them on the consequences and that they still refused.
I get the autonomy thing and refusing care is cool and all. Totally their right. I just remind them what the adverse outcome for refusal could be, document that and move on. BUT if I’m charting that the patient took the medication, I’m 100% standing there to witness it because I’m not just gonna trust them on it and potentially falsely document. People cheek their meds, pocket them, take them at a later time with other meds to get high, or whatever the hell. DON’T blindly trust patients. But yeah. Basically - I just care about the legalities. Lol
For me, it’s all about reading people. If they’re really hmming and hawing, I might ask “what’s the matter?” to get a read on their concerns. Remind them of the benefits, that these are MD orders, maybe it’s a medication that they shouldn’t just stop cold, maybe they wanna talk to the MD first, maybe they had a bad experience and want to take an alternative med instead (and we can make that happen!), etc. Some are straight up scared to refuse😅 So I might remind them hey it’s totally your right to not take it. Depends on the patient really. But some give a firm “no” and I don’t argue with that.
Now all of the above is assuming I have time, because sometimes it’s just too dang busy. Med pass is usually a 10, maybe 30 seconds max interaction. Keep it moving.
The staring and angry reactions don’t phase me. Maybe it did when I was new. But you develop a thick skin real quick doing this job.
At the end of the day, med pass must be witnessed or you risk false documentation. It ensures time accuracy in record-keeping too, as in you (and pharmacy, and all other providers) know the patient took it at this time and not an hour/hours later. There are all sorts of med interactions and domino effects to consider.
As far as the not trusting patients thing - that doesn’t just come from nowhere. Obviously it would make all our lives easier if we could just trust people! But you see all types of scenarios in healthcare, whether it happens to you or a coworker. One day you’ll chart medication was given, maybe cardiac meds. Come in later and find the pills under their pillow or something. Maybe the patient codes later that night. I mean who knows. Just protect your license and don’t do risky shit that gets you burned. Because all it takes is one bad day.
You’re not there to make sure they take it, you’re there to document whether or not they took it. That much IS definitely your responsibility, to confirm that they did or did not take their meds. You’re not the asshole, you’re just looking at it wrong.
