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.
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.
Except when there are bad outcomes because the actual patient status doesn’t match up with MAR? And then it becomes the M&M case of the week.
The nurse who created this post said they would report it to the doc, who then notes it down, so the MAR should match to my understanding. This is not about whether or not you should tell the doctor that the patient refuses to take the medication. This is about whether to force the patient to take the medication, and how.
In order to properly document it, there would need to be visual confirmation of the medication being taken, and if it’s refused the medication needs to not be in the patients access. Otherwise OP is not a reliable historian and is unfit for their job as they refuse to comply with standard of care.
I’m on clinical rotations right now , and I literally just asked the nurse next to me about this and she said OP is dead wrong.