working at a hospital: should I remain in the room watching a patient until he takes a certain medication?

Submitted ⁨⁨9⁩ ⁨months⁩ ago⁩ by ⁨vestmoria@linux.community⁩ to ⁨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 ⁨9⁩ ⁨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.

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- HopingForBetter@kbin.social ⁨9⁩ ⁨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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jordanlund@lemmy.world ⁨9⁩ ⁨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.

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- trustnoone@lemmy.sdf.org ⁨9⁩ ⁨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.
  
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  - roguetrick@kbin.social ⁨9⁩ ⁨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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surewhynotlem@lemmy.world ⁨9⁩ ⁨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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WhiteOakBayou@lemmy.world ⁨9⁩ ⁨months⁩ ago
You can’t chart he took it off you don’t see him take it. You have to wait or chart a reason the med was delayed.

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- roguetrick@kbin.social ⁨9⁩ ⁨months⁩ ago
  You can put it in nurses notes, or depending on the EHR put a "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."
  
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  - WhiteOakBayou@lemmy.world ⁨9⁩ ⁨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.
    
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Hikermick@lemmy.world ⁨9⁩ ⁨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

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baldingpudenda@lemmy.world ⁨9⁩ ⁨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.

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ruckblack@sh.itjust.works ⁨9⁩ ⁨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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- vestmoria@linux.community ⁨9⁩ ⁨months⁩ ago
  Id ask you to stop assuming
  
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rufus@discuss.tchncs.de ⁨9⁩ ⁨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 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.

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- vestmoria@linux.community ⁨9⁩ ⁨months⁩ ago
  
  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
  
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  - rufus@discuss.tchncs.de ⁨9⁩ ⁨months⁩ ago
    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.
    
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The_Picard_Maneuver@startrek.website ⁨9⁩ ⁨months⁩ ago
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)

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- vestmoria@linux.community ⁨9⁩ ⁨months⁩ ago
  
  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
  
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GenderNeutralBro@lemmy.sdf.org ⁨9⁩ ⁨months⁩ ago
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.

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- squirmy_wormy@lemmy.world ⁨9⁩ ⁨months⁩ ago
  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.
  
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- Zorque@kbin.social ⁨9⁩ ⁨months⁩ ago
  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.
  
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- Ranvier@sopuli.xyz ⁨9⁩ ⁨months⁩ ago
  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. 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.
  
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  - GenderNeutralBro@lemmy.sdf.org ⁨9⁩ ⁨months⁩ ago
    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.
    
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LesserAbe@lemmy.world ⁨9⁩ ⁨months⁩ ago
Yes, you should verify whether they’ve taken it.

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Kalkaline@lemmy.zip ⁨9⁩ ⁨months⁩ ago
What if they hoard the meds and then take them all at once?

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- krashmo@lemmy.world ⁨9⁩ ⁨months⁩ ago
  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.
  
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