Monday, September 7, 2009

Dear pt in rm 60,

Please stop trying to sabotage your own health. It kills me to see you every day, getting better, but not getting better as quickly as you could be. I know it sucks being in the hospital, but combating everything we do is just hurting yourself. Please meet us halfway at least. It's the least you can do for yourself.

Love, PurpleRN

She came in because the swelling in her legs had gotten so bad, she could barely move them under her own power. The unit she was on tried IV lasix a couple times a day but it kept dropping her BP. So they sent her to us for a Lasix drip.

The swelling in her legs caused her considerable pain, so she had Dilaudid on board. She was a clock-watcher. The moment enough time had passed, she'd ring for another hit. And get rather upset if it took more than 10 minutes to get her meds. I understand that being in pain sucks, but we have people circling the drain on our unit. Your legs are slightly less of a concern sometimes.

She's on fluid restrictions because of the edema. Fluid restrictions suck. Imagine some "high faluting" doctor saying, you can only drink 1.5 liters (~6 cups) of fluid today. Period. Well what if you don't budget properly and drink 5 cups of water in the first 12 hours of the day? Screwed, my friend. So she'd been sneaking drinks and not reporting them to the nurses. Her husband/partner-in-crime wasn't helping on that front either, showing up with fast-food meals.

She would go on "walks" with her husband (he pushed her in a wheelchair) a couple times a day, to the atrium near L&D down the hall. We explained that she was going out of telemetry range, and we couldn't monitor her heart out there. She didn't care. And she would come back smelling of cigarettes. Our campus has a strict non-smoking policy, and we told her we could get her the patch while she was in the hospital. She refused, saying it wouldn't work. I hate people who automatically say no without trying.

She threatened to leave AMA if she couldn't smoke, so the doctors let her go off campus with a security guard for cigarette breaks a couple times a day.

What the hell? "THRIVE" my ass! Just because a patient gets whiny doesn't mean you bend over backwards to thwart her recovery!

I bet you're asking, well why not just let her leave AMA? Because she said, "I'll just come back to the ER when I'm done with my smoke," and that creates more work for us. (Aside: I'm of the opinion that if you leave the hospital AMA, you are not allowed to seek medical help for at least 48 hours. If you die from your own stupidity, so be it)

Doesn't advocating for your patients include trying to protect them from themselves? Sure, she's doing better than she would be if she wasn't in the hospital, but she's not getting better as quickly as she could.

Last but not least, we've been very concerned about falls on our unit lately. Our patient population is such that they're mostly too unhealthy to get up unaided, but not with-it enough to realize they need help. Or too proud to ask for help. We even had a recent meeting on how to reduce falls. The only time I took care of this patient was when she came to us from the other unit. I told her that if she needed to get up, she needed to call me first. Obviously, since her legs were so swollen (and she is obese) she couldn't move very well.

My shtick is to say, "I know you don't want to bother me by calling for help, but I'd much rather help you to the bathroom safely than scrape you off the floor when you fall. Plus the paperwork is *insane*. Please don't make me fill out paperwork" Usually it gets a laugh and a promise to call before getting up.

Well she's been with us a few weeks now, and apparently thought she was in good enough shape to get up on her own. She ended up on the floor, requiring xrays and various other tests for broken things.

I know you don't want to be in the hospital anymore. I know you think 3/4 of our nurses are idiots. But you're not doing yourself or anyone else any favours by screwing up your recovery with what *you* think is right. Your treatment team (MDs, RNs, MSWs, PTs, etc) went through lots of schooling and training and hell to know what to do to get you better and get you on your way as fast as possible. Believe it or not, we know what we're doing.

It makes me wonder how we can properly advocate for patients that won't accept it. How can we encourage people to take ownership of their health? Noncompliance increases complications and drives up medical expenses, neither of which are in *anyone's* best interests.

Any ideas?

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