this post was submitted on 14 Jan 2024
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No Stupid Questions

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submitted 10 months ago* (last edited 10 months ago) by [email protected] to c/[email protected]
 

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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[–] [email protected] 18 points 10 months ago* (last edited 10 months ago) (1 children)

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.