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.

  • @[email protected]
    19•10 months ago

    Here’s my thoughts as a critical care PA:

    If the patient is AOx4 / has capacity and there is no reason to suspect they’re throwing out meds (or storing them for a bigger dose later, as sometimes happens with opiates), then I personally don’t care if you visualize it, although I share another commenters thoughts that I’m not sure what the big delay is in such patients.

    If they’re AOx4 and have capacity but there IS suspicion of deception, there needs to be a conversation with the patient, nursing, and the provider team. This patient absolutely has the right to decline medication, and they need to know that they will get better care if everyone is honest with each other.

    If they do not have capacity to refuse and there is suspicion that they are unable or unwilling to self administer the medication, yes you must watch them take it.

    Edit: for clarification, are the doctors mad that you can’t CONFIRM that they took the meds or mad that you aren’t CONVINCING a person to take a med they don’t want to take?