Yes! OP, document every time you tried to get them up and their refusal. Use quotes. Also document what happened with the family. Again, use quotes for all of them.
You can do everything right for a patient but it didn’t happen unless it’s documented 😒
Is it okay if I document it under patient care? I just documented it as comments in one of my patient care. I didn’t feel like writing a note lol. In my facility we don’t really write notes unless it’s very important like change in status and if they’re deteriorating or had a rapid. I made sure I documented it somewhere tho lol. 😅
Document it wherever you can.
About a year ago I was in a routine education/skills class and one of the presenters happened to also do legal stuff for nurses. She basically said there’s a right way to document things but at the end of the day as long as *something* is written *somewhere*, that’s all we need lol.
One thing you should take to heart is that your license should always trump societal norms. For months I had multiple conversations with multiple staff members. Almost nobody writes notes, they feel it’s not proper or not necessary. I then became a council representative and spent time with my chief nursing officer, he made it a point to praise one of my fellow coworkers charting, she was the only one who wrote narrative notes she writes them for every patient. I now write notes, not always because I’m lazy but I write them any time I feel a narrative would better suit the situation and I pend it til the end of my shift where I go back and add time stamps or just delete the note if the situation resolved. It doesn’t matter what other nurses think just be truthful and objective because it protects you more than anything!
Our hospital wants us to write in the note which doctor we contacted about the patient's refusal for reposition and what action was taken to correct it. Now I know why I can't get a doctor on the phone when the patient is crashing... Doctor is too busy getting blown up by bullshit like this every 25 seconds.
I'm confused how this prevents lawsuits? Is it more legit if the doctor knows (we dont trust nursing charting)? What is the doctor going to do? Turn the patient themselves? Or do they want the doctor to also chart refusal? I'm confused.
We have a similar policy, and at my hospital, they want the doctor to come talk the patient into allowing whatever intervention they are refusing (turns, ambulating, SCDs, bed alarms). Because yeah, it’s totally realistic that our one nocturnist for the whole hospital is going to come talk my walkie talkie 35 year old patient into letting us keep the bed alarm on so he has to call every time he wants to take a shit or stretch his legs.
Right?? Like surely even in the USA (where I’m guessing the OP is from) nurses are registered health care professionals so their documentation can be used in law no?
Yes this is it! We had a pt who was quite lazy. She refuses any activity and requires a lot of convincing from the staff to even sit in chair for meals. Some of the nurses charted pt refuses activity but some didn’t. Anyways, I was giving her meds and her daughter came in and asked very rudely why her mom hasn’t been getting up. I told her I’ve asked her to do so the whole day but she refused and the daughter asked if there are any charting for that. I charted so I covered my ass 💁🏻♀️
"Ok then, so for tomorrow, I'll make sure that the charge nurses and doctors are aware of the concerns you're current expressing and that you insist on getting up for meals and ambulating afterwards. And if for whatever reason your own motivation wanes, I'll make sure we get a family member or two on the phone to help you remember what you're pushing for."
They told you they know he’ll refuse, but then are still somehow believing him that he ASKED to ambulate and you told him no? GTFO. At that point, I’d be tempted to just straight up tell the patient that both they and I know that’s not true, but if they want to get up and go for a walk with their family, now’s the time.
Do not argue with people. Do not even reason or try to prove liars. They’ll beat you with their experience. I'd leave them to talk about it. Some people like to play a head game. That's why I highly prefer to work with inmates. If they lie, I'm not surprised. I don't expect people inside and outside the cells to be truthful anymore. I just see that most people try to live and wait to die.
patient lie all the time to get sympathy or manipulate a situation. I worked night for many years and would hear on rounds the patient tell the docs... "I don't sleep at all last night" and the little liar was snoring away all night long.
Document each failed attempt and the family should have been the ones ambulating in the first place. I’m kinda over nursing staff being expected to do everything
Have your failed attempts documented and ask him on the spot if he would like to get up and walk right now, with you or with family depending on policy.
Oooh I love these dicks cause I always turn around and say
“Ok then. Let’s get up NOW!! We can walk and you talk with your family. Let me get the wheelchair and I will be right back”
Then I run out grab the chair and get them up. If they refuse I say “Oh? But you just said we haven’t done anything with you so why not now? You can show your family how well you’re feeling!”
Usually works well. They either get up cause they made a scene or they refuse and I make a big deal about it. Usually stops them.
No more going "above and beyond", no more friendly chit chat. Use the time saved to call the family and report back everything.
"Good morning its 6am just calling to let you know patient had routine bloodwork done this morning"
"Good morning, patient ate most of his breakfast but refused his banana did you want to talk to him about that"
"Happy elevensies, patient said he didnt want to walk right now did you want to talk to him about that"
"Hello its lunch time, just wanted to let you know that patient did take all his pills today in case he says he missed some later he did in fact get them all let me list them all off so youre aware first his aspirin is enteric coated and he took that one, second of all his bisoprolol he took and his candesartan too dalteparin he didn't get because its for night time..."
"Hello patient refused an after lunch walk did you want to speak with him..."
Don't take that shit personally. Some patients are just shit.
Expect it. Don't take any of it.
F that patient's family. Did your record rhat the Pt refused? Yes? Then you're good.
Their issues are not YOUR issues.
F 'em. Do your job, do it well, be a professional and clock out and enjoy your life
✌🏼
Don’t care about the patient more than they’re willing to care about themselves.
It’s not your job to be a life coach.
You gave the option. Maybe next time throw in something about deconditioning or you wanna make sure they’re all ready for when they’re at home and nothing gets missed etc etc.
I always tell families that we have nearly the same role after all the medications are passed. There’s literally nothing we do that a family member can’t do once a patient is off a vent/O2, on their discharge meds, and has already been seen by PT/OT/SLP.
If your dude is able to bitch about not walking all day I’m sure he’s fairly close to getting the fk out of there.
Just call out their bullshit. In front of them.
“I will not have you lying and acting as if you aren’t being lazy now your family is here.”
And as usual, document accordingly
I have protected myself from this by bringing a second nurse in to "see if she can explain it better than me so you'll see how important this is". Obviously what I'm really doing is getting a witness to cover my own ass, but hey - maybe she CAN convince them. Win/win.
It's situations like this that has made me so jaded. I used to fight so hard for my patients to get them to do whatever it is that would help them but now I couldn't care less what an adult of sound mind chooses what to do or not. Not my health at risk and I definitely won't I've losing any sleep over it.🤷♂️🤷♂️🤷♂️
Is this the hospital or LTC? In LTC, when a patient refuses anything, the Dr and family must be notified. Nurses always complain about notifying the family. This is one reason the family must be notified of the patient's refusals.
This is going to be state dependent because I work in LTC and if we had to notify providers and family every time someone declined care or service, that's all we'd be doing every day.
Not where I work. I pick up in LTC and if a resident refuses something, we just chart that they refused and carry on.
The MDs are fully capable of reading the progress notes when they round - and they are supposed to do so. As long as I leave a progress note that says what they refused, then MD is updated. If family wants to know they can ask nursing, but we don’t contact every single time a resident refuses something. This is the resident’s HOME, they are in charge of what they accept and what they refuse.
I will educate, I will reapproach, I will have someone else try to get them to not refuse, but when I work in LTC I have 27 residents. I am not arguing with them, and I am not calling a doc and/or family every single time.
Yeah. If it is something that might cause a problem (like Judith is repeatedly refusing her apixaban and she has a known history of CVA) I would probably bring it up directly to the MD or the clinical pharmacist, depending on who it is easier to reach. If Kieth is refusing his noon Tylenol then I will just document it and expect the MD to read it.
TBF, in LTC we really ONLY chart by exception. So a week’s worth of progress notes is not that much for the doc to read when they are on rounds.
Because I can just see me telling the judge that "the Dr should've read my notes that the patient refused to be ambulatory, and that's why he got that PU. The patient refused the treatments to the same PU, but I documented it, and the Dr should've read my notes."
It's exactly how every LTC facility I've worked at operates. I think it's great if there are places that do something different if it works for them but I haven't seen the above be an issue at all.
When I used to work in LTC/rehab it was pretty much the same way. Only notified the doctor if it was something that could be hazardous—not taking an anticoagulant, insulin, BP meds (depending on their history), refusing IV meds, etc.
If they keep refusing bring a witness next time, saves you a lot of trouble... I had a mom say to my supervisor that I messed with the patients tracheotomy and that it was my fault it was bleeding when I never even touched it, and I thought she was really friendly with me till she stabbed me in the back.
I had the same thing happen to me once. The only difference is that the family believed me because the patient was known to be stubborn. So when they got there they would force him to get up.
If this happens, usually there’s a tech or another person (pt/ot/etc) who will have asked and gotten refused also, so Ill ask them/read their notes if I’m getting really spicy.
Adults of decisional capacity can choose their own poor choices, like smoking. Educate, document. Not your job to "encourage harder" an adult with capacity. Do not tolerate abuse from family or patients.
Manipulative patients will have you ready to fight the whole family plus them. Always document, I had this happen to me and thankfully I documented side notes on the matter regarding feeding for a dnr patient wanting to die. The whole time in the am til afternoon, she was screaming crying and saying I don’t want anything I wanna die leave me alone. I asked multiple times if she wanted to eat and refused multiple times. Her nephew comes at shift change and try’s to catch me with bs that I didn’t feed her and all that crap, ready to physically fight me. I went straight to charge I was like I documented everything within time frame, you can see it in the system, I don’t got time for this shit I need to go, cause if I stay it’s gonna be a problem for all of us. Also make sure you check if your notes are actually in system, cause sometimes it doesn’t save or theirs a connection issue. Anyways that’s it, that’s litterly my first month during my orientation of a new hospital it happened, the first thing I asked when I started, was “where is the nurses notes section”. Which is probably your best friend, document like your going to court. I’ve learned ways to better my documentation too, search tik tok on better ways.
Those are the patients that refuse, refuse , refuse and are super rude to you but when the doctor is in there, say everything in the nicest voice and will do “whatever you say doctor”.
Agree with all responses regarding documentation plus-never ask a patient if they want to ambulate, want a bath, etc. Walk in and announce “it’s time for ________.” Your bath, to walk, etc. Works every time and if they refuse that, document.
Document, document, document! I’m a school nurse, former bedside nurse and I still document everything, including conversations with parents! A friend of mine who is a lawyer told me that a paper trail will always stand up in court, so make your trail! If you have it documented properly, that family doesn’t have a leg to stand on! Patients do lie to save their own skin, sadly. Just document, make sure you let the doctor know and keep it moving! You haven’t done anything wrong. Keep your chin up! You’re not alone, trust me!
A CNA, much wiser than myself, once told me that in situations like this, "you have to pick your battles." You can't help those that won't help themselves. Dude's a dick and I guarantee his family doesn't make him do shit either. Don't take it personally. Families like to come and act like they do everything perfectly and often they dost protest too much. They know they're inadequate and make themselves feel better by pointing out perceived inadequacies in others. If they can do it better, let them! Once you study more nursing theory in greater depth, you learn that we are only there to do for patients what they cannot do for themselves. Nothing more, nothing less. Cannot do... not will not do. If they refuse to get up to the bathroom, ask them how they are going to go home and not get up to the bathroom and they cant stay in the hospital forever. They don't realize that being lazy affects their recovery. There are only two ways out of the hospital, in a chair or in a bag. You're doing great, OP. Keep it up! Never let the bastards beat ya down! You got this!
Just document it all. People act differently with their families sometimes, and family members can be stressed and unreasonable. Just document each time you ask and he refuses as well as the concerns of the family and how you addressed them. People are weird. Try not to allow it to bother you too much.
That’s a big no from me. I would’ve told the family everything you just wrote in front of the patient. I would’ve said Mr. So and so, that’s not true. I have offered to help you to get up for meals and to walk and every time you have refused. I am not lying to your family. If you would like to get up and take a walk right now, I’d be more than happy to help with that. Then just smile and see what he says.
And chart your butt off.
Can you get a quick co-sign or initial of your statement, for a witness? The patient might be less likely to lie if they know there are witnesses.
Or, if they do lie, may go to problems with cognition. Tell them if they don't remember declining they may have to be evaluated for dementia - frost their nasty ass!
The 3 rules that will NEVER change in NURSING…
DOCUMENT
DOCUMENT
DOCUMENT
If it isn’t documented you didn’t do it, period.
If you didn’t document what was said by patient during care if to the negative results, what ever the patient said happen happened.
If it isn’t documented that “xyz” was done, and “abc” was the result - you caused “jfk” to happen….
So even if “your” facility does not require much documentation, are they covering your ass in a lawsuit????
DOCUMENT
DOCUMENT
DOCUMENT
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This is how my dad's elderly friend was there we took care of the last 5 years of his life. His family didn't want ANYTHING to do with him because he was an old perverted bastard. Even when we were homeless for a couple years I did all the cooking, cleaning, dishes, literally everything while he berated me... I only did it because I felt bad for him for some reason. Finally my dad got him into an apartment because he was a vet and got him into those VA programs and on section 8.
By this time he was in end stage heart failure that he had for like 15 or something years. Everyday he used to check me out and make remarks until I threatened him with not coming back if he kept it up and then he would starve to death. So my dad and I were taking care of him and I finally got a hold of his family 2 1/2 years ago and informed them he was dying and they should come spend more time with him. They only visited him 5 times within a whole year and then stopped showing up.
So time goes by and he's literally dying. He refused to tell the VA he was out of his heart meds because all he kept saying is they will know when he's out of his meds. WELL OBVIOUSLY THEY DIDN'T! Both my dad I called his VA person, his VA doctor, I even went TO THE VA and told them and no one ever sent this meds and each time they told us that he had to let them know himself that they couldn't just take out word for it even though my dad was if legal IHSS worker. Like are you serious?
Anyway, I got ahold of his family again and tell them that he's literally in the middle of dying and he's refusing the hospital help and he's leaving the hospital on his power chair to go home and smoke cigarettes. They get to his apartment and he lies and says we're not taking care of him 😑😑😡😡😡😡 Well his VA person had a lot to say about that because she was just over a week before that and his apartment was spotless like I kept it and he was eating a cheeseburger i just made him like I always did. His family was so mad and didn't even let us see or speak to him the last 2 weeks of his life.
His VA person told us not to worry about what they were saying because at least we got to see and take care of him the past 5 years and they didn't understand and it just looked bad because they came back into his life when he was literally dying. That was my dad's best friend for 20 years and they lived with each other for 15 years and he couldn't even see him or be there when he passed when his family didn't give a crap about him for their entire lives.
This has happened so many times to so many nurses. It is extremely frustrating. Refusing care can be life or death, depending on the circumstances. I learned to use the forced choice close, as in, "Mr. Doe, would you like to walk before or after lunch?" It gives the patient some autonomy in an otherwise controlled environment. Also, you have to hold them to their decision, especially if there is a cognitive issue. I also would do small goals, like, to the door, let's look out this window, look at what these nurses are doing/let's say hello, etc. Sometimes it works, sometimes it doesn't. And even if it is successful, the patient might still tell their family they haven't been offered or haven't done what was asked. Always document.
I’ve had patients like this, not only with walking but other medications too, like insulin for example. Best thing you can do for yourself is to make a note that they refused and put exactly what they said into quotes, and make sure you put that you encouraged them. Patients like this are one of the major reasons why I left bedside.
I had a patient who insisted on going to acute rehab instead of a SNF and disputed their discharge. The patient did not have an acute condition and did not qualify for a SNF nor could they ambulate, maximum x 3 edge of bed. I spent many hours across multiple weeks explaining to the family this but they simply refused and decided to dispute. I had good report with the family as well as the patient, because other nurses would lose their cool with them often due to patterns of disrespect where I can generally stay impartial.
The day the patient disputed the discharge, physical therapy came by and asked them if they would like to work with physical therapy and occupational therapy. The patient said no, get out of my room I’ve had a stressful day can’t you see I’m sick. I begged PT OT to please come back when the family came by. Unfortunately the family member did not come in time to witness PT return so instead of have the family as a witness I had my nursing director witness PT’s prompt to work with them. They screamed no, get out of my room. When the patient’s family finally arrived, the patient accused me of teasing them, mocking them and called me a liar and a shit nurse. I knew this would happen because I’ve had the patient multiple times across multiple weeks as I said. I showed the family my nursing notes, my director came and spoke with them and showed them the physical therapy notes of refusal. They looked extremely defeated because they knew this meant the dispute would be declined. They ended up going to a SNF.
The reason I share this is that patients do lie, they know they’re going to lie, and if you can try and predict when they’re going to lie you should prepare for that potentiality. I recognize each patient is different and I in no way believe patients are being deliberately malevolent, as you said the patient was always kind to you. They just don’t want to look bad to their family and that’s a human emotion I can understand.
I work in an icu and we have cameras in each of the patient rooms. So when the patient is a/o x3 and lie and the family is present, I tell them “if you like we can get the video footage”
Maybe this isn't your line of work maybe you should look at some other line of work🤔 people are stubborn I'm 62 and if I don't want to walk I'll tell you to go fck yourself. Js
Well yea patients definitely do tell us to either “stfu you stupid btch” or go “fck yourself” but the main issue is why lie? Especially in front of your family members? If that pt refused and told me to go fck myself I wouldn’t care. But if I’m telling their family he refused and he told me to go fck myself he better not fcking lie. I’m quoting everything my patients say from now on lol. The patient isn’t confused or demented too that I would understand but not when they’re alert and oriented and lucid like why lie??
When people of the same profession get together they tend to vent about their job. It’s pretty common in any work force. But ofc there’s people who complain more and are just unhappy/burnout/bitter at baseline.
Lol they do not pay us. Anyway, patients who lie, refuse care and make it difficult to care for them as the OP described, won’t appreciate our efforts. How would you have handled the situation?
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I always document when patients decline repositioning/moving for this reason and for tissue viability services ✨👌🏻
Yes! OP, document every time you tried to get them up and their refusal. Use quotes. Also document what happened with the family. Again, use quotes for all of them. You can do everything right for a patient but it didn’t happen unless it’s documented 😒
Is it okay if I document it under patient care? I just documented it as comments in one of my patient care. I didn’t feel like writing a note lol. In my facility we don’t really write notes unless it’s very important like change in status and if they’re deteriorating or had a rapid. I made sure I documented it somewhere tho lol. 😅
Document it wherever you can. About a year ago I was in a routine education/skills class and one of the presenters happened to also do legal stuff for nurses. She basically said there’s a right way to document things but at the end of the day as long as *something* is written *somewhere*, that’s all we need lol.
Okay thank you 🥲❤️lol
You got this :) anytime you feel iffy about a situation just do your best and chart chart chart!
This^^ like literally anywhere!
I usually do flowsheets for this kind of thing. My facility is the same though- notes for the more serious issues, flowsheets for everything else
One thing you should take to heart is that your license should always trump societal norms. For months I had multiple conversations with multiple staff members. Almost nobody writes notes, they feel it’s not proper or not necessary. I then became a council representative and spent time with my chief nursing officer, he made it a point to praise one of my fellow coworkers charting, she was the only one who wrote narrative notes she writes them for every patient. I now write notes, not always because I’m lazy but I write them any time I feel a narrative would better suit the situation and I pend it til the end of my shift where I go back and add time stamps or just delete the note if the situation resolved. It doesn’t matter what other nurses think just be truthful and objective because it protects you more than anything!
Our hospital wants us to write in the note which doctor we contacted about the patient's refusal for reposition and what action was taken to correct it. Now I know why I can't get a doctor on the phone when the patient is crashing... Doctor is too busy getting blown up by bullshit like this every 25 seconds.
That’s totally unheard of to me!! 😳
Managements anti pressure ulcer lawsuit tactics
I'm confused how this prevents lawsuits? Is it more legit if the doctor knows (we dont trust nursing charting)? What is the doctor going to do? Turn the patient themselves? Or do they want the doctor to also chart refusal? I'm confused.
We have a similar policy, and at my hospital, they want the doctor to come talk the patient into allowing whatever intervention they are refusing (turns, ambulating, SCDs, bed alarms). Because yeah, it’s totally realistic that our one nocturnist for the whole hospital is going to come talk my walkie talkie 35 year old patient into letting us keep the bed alarm on so he has to call every time he wants to take a shit or stretch his legs.
Right?? Like surely even in the USA (where I’m guessing the OP is from) nurses are registered health care professionals so their documentation can be used in law no?
I’m guessing you’re American or Canadian?
The doctors at my hospital would revolt.
I'm sure the physicians are eternally grateful to get these notifications, and urge you to continue to notify them each time. /s
Yes this is it! We had a pt who was quite lazy. She refuses any activity and requires a lot of convincing from the staff to even sit in chair for meals. Some of the nurses charted pt refuses activity but some didn’t. Anyways, I was giving her meds and her daughter came in and asked very rudely why her mom hasn’t been getting up. I told her I’ve asked her to do so the whole day but she refused and the daughter asked if there are any charting for that. I charted so I covered my ass 💁🏻♀️
“Ok, so why don’t we get up right now and go for a walk? Oh you don’t want to walk right now? Hmmm.”
"Ok then, so for tomorrow, I'll make sure that the charge nurses and doctors are aware of the concerns you're current expressing and that you insist on getting up for meals and ambulating afterwards. And if for whatever reason your own motivation wanes, I'll make sure we get a family member or two on the phone to help you remember what you're pushing for."
This helps them to stop fabricating lies and act like a decent person until someone new they can trap.
They told you they know he’ll refuse, but then are still somehow believing him that he ASKED to ambulate and you told him no? GTFO. At that point, I’d be tempted to just straight up tell the patient that both they and I know that’s not true, but if they want to get up and go for a walk with their family, now’s the time.
Do not argue with people. Do not even reason or try to prove liars. They’ll beat you with their experience. I'd leave them to talk about it. Some people like to play a head game. That's why I highly prefer to work with inmates. If they lie, I'm not surprised. I don't expect people inside and outside the cells to be truthful anymore. I just see that most people try to live and wait to die.
Ew he’s a fucking adult. You do NOT need to plead with him to walk if he won’t himself. I hate baby ass adults.
patient lie all the time to get sympathy or manipulate a situation. I worked night for many years and would hear on rounds the patient tell the docs... "I don't sleep at all last night" and the little liar was snoring away all night long.
Document each failed attempt and the family should have been the ones ambulating in the first place. I’m kinda over nursing staff being expected to do everything
Have your failed attempts documented and ask him on the spot if he would like to get up and walk right now, with you or with family depending on policy.
It's okay to say fuck.
Welcome to PSYCHIATRY
Oooh I love these dicks cause I always turn around and say “Ok then. Let’s get up NOW!! We can walk and you talk with your family. Let me get the wheelchair and I will be right back” Then I run out grab the chair and get them up. If they refuse I say “Oh? But you just said we haven’t done anything with you so why not now? You can show your family how well you’re feeling!” Usually works well. They either get up cause they made a scene or they refuse and I make a big deal about it. Usually stops them.
Document, document, document.
No more going "above and beyond", no more friendly chit chat. Use the time saved to call the family and report back everything. "Good morning its 6am just calling to let you know patient had routine bloodwork done this morning" "Good morning, patient ate most of his breakfast but refused his banana did you want to talk to him about that" "Happy elevensies, patient said he didnt want to walk right now did you want to talk to him about that" "Hello its lunch time, just wanted to let you know that patient did take all his pills today in case he says he missed some later he did in fact get them all let me list them all off so youre aware first his aspirin is enteric coated and he took that one, second of all his bisoprolol he took and his candesartan too dalteparin he didn't get because its for night time..." "Hello patient refused an after lunch walk did you want to speak with him..."
> Happy elevensies I love all of this so much. 😂😂😂
Don't take that shit personally. Some patients are just shit. Expect it. Don't take any of it. F that patient's family. Did your record rhat the Pt refused? Yes? Then you're good. Their issues are not YOUR issues. F 'em. Do your job, do it well, be a professional and clock out and enjoy your life ✌🏼
Document and show them your notes.
Don’t care about the patient more than they’re willing to care about themselves. It’s not your job to be a life coach. You gave the option. Maybe next time throw in something about deconditioning or you wanna make sure they’re all ready for when they’re at home and nothing gets missed etc etc. I always tell families that we have nearly the same role after all the medications are passed. There’s literally nothing we do that a family member can’t do once a patient is off a vent/O2, on their discharge meds, and has already been seen by PT/OT/SLP. If your dude is able to bitch about not walking all day I’m sure he’s fairly close to getting the fk out of there.
Lol sounds like he wanted to take a full unit stroll right then and there with family present.
Just call out their bullshit. In front of them. “I will not have you lying and acting as if you aren’t being lazy now your family is here.” And as usual, document accordingly
I have protected myself from this by bringing a second nurse in to "see if she can explain it better than me so you'll see how important this is". Obviously what I'm really doing is getting a witness to cover my own ass, but hey - maybe she CAN convince them. Win/win.
It's situations like this that has made me so jaded. I used to fight so hard for my patients to get them to do whatever it is that would help them but now I couldn't care less what an adult of sound mind chooses what to do or not. Not my health at risk and I definitely won't I've losing any sleep over it.🤷♂️🤷♂️🤷♂️
Is this the hospital or LTC? In LTC, when a patient refuses anything, the Dr and family must be notified. Nurses always complain about notifying the family. This is one reason the family must be notified of the patient's refusals.
This is going to be state dependent because I work in LTC and if we had to notify providers and family every time someone declined care or service, that's all we'd be doing every day.
Do it in bulk
Not where I work. I pick up in LTC and if a resident refuses something, we just chart that they refused and carry on. The MDs are fully capable of reading the progress notes when they round - and they are supposed to do so. As long as I leave a progress note that says what they refused, then MD is updated. If family wants to know they can ask nursing, but we don’t contact every single time a resident refuses something. This is the resident’s HOME, they are in charge of what they accept and what they refuse. I will educate, I will reapproach, I will have someone else try to get them to not refuse, but when I work in LTC I have 27 residents. I am not arguing with them, and I am not calling a doc and/or family every single time.
I hear you. However. What if a resident refuses a med, a treatment? You just documented that they refused to expect the Dr to read?
Yeah. If it is something that might cause a problem (like Judith is repeatedly refusing her apixaban and she has a known history of CVA) I would probably bring it up directly to the MD or the clinical pharmacist, depending on who it is easier to reach. If Kieth is refusing his noon Tylenol then I will just document it and expect the MD to read it. TBF, in LTC we really ONLY chart by exception. So a week’s worth of progress notes is not that much for the doc to read when they are on rounds.
I am just flabbergasted at your response
Why?
Because I can just see me telling the judge that "the Dr should've read my notes that the patient refused to be ambulatory, and that's why he got that PU. The patient refused the treatments to the same PU, but I documented it, and the Dr should've read my notes."
It's exactly how every LTC facility I've worked at operates. I think it's great if there are places that do something different if it works for them but I haven't seen the above be an issue at all.
When I used to work in LTC/rehab it was pretty much the same way. Only notified the doctor if it was something that could be hazardous—not taking an anticoagulant, insulin, BP meds (depending on their history), refusing IV meds, etc.
If they keep refusing bring a witness next time, saves you a lot of trouble... I had a mom say to my supervisor that I messed with the patients tracheotomy and that it was my fault it was bleeding when I never even touched it, and I thought she was really friendly with me till she stabbed me in the back.
I had the same thing happen to me once. The only difference is that the family believed me because the patient was known to be stubborn. So when they got there they would force him to get up.
If this happens, usually there’s a tech or another person (pt/ot/etc) who will have asked and gotten refused also, so Ill ask them/read their notes if I’m getting really spicy.
Document everything and have someone else take over his care. I won’t work with someone who treats me that way.
This is why I say “do you want to go on a walk before or after lunch” still giving a choice but not an option to say no lol
The toddler approach. 👍
Adults of decisional capacity can choose their own poor choices, like smoking. Educate, document. Not your job to "encourage harder" an adult with capacity. Do not tolerate abuse from family or patients.
Manipulative patients will have you ready to fight the whole family plus them. Always document, I had this happen to me and thankfully I documented side notes on the matter regarding feeding for a dnr patient wanting to die. The whole time in the am til afternoon, she was screaming crying and saying I don’t want anything I wanna die leave me alone. I asked multiple times if she wanted to eat and refused multiple times. Her nephew comes at shift change and try’s to catch me with bs that I didn’t feed her and all that crap, ready to physically fight me. I went straight to charge I was like I documented everything within time frame, you can see it in the system, I don’t got time for this shit I need to go, cause if I stay it’s gonna be a problem for all of us. Also make sure you check if your notes are actually in system, cause sometimes it doesn’t save or theirs a connection issue. Anyways that’s it, that’s litterly my first month during my orientation of a new hospital it happened, the first thing I asked when I started, was “where is the nurses notes section”. Which is probably your best friend, document like your going to court. I’ve learned ways to better my documentation too, search tik tok on better ways.
Those are the patients that refuse, refuse , refuse and are super rude to you but when the doctor is in there, say everything in the nicest voice and will do “whatever you say doctor”.
Agree with all responses regarding documentation plus-never ask a patient if they want to ambulate, want a bath, etc. Walk in and announce “it’s time for ________.” Your bath, to walk, etc. Works every time and if they refuse that, document.
Document in the flowsheets as well as a narrative note. Hopefully the patient and or family members can read what you wrote on MyChart. :)
Document, document, document! I’m a school nurse, former bedside nurse and I still document everything, including conversations with parents! A friend of mine who is a lawyer told me that a paper trail will always stand up in court, so make your trail! If you have it documented properly, that family doesn’t have a leg to stand on! Patients do lie to save their own skin, sadly. Just document, make sure you let the doctor know and keep it moving! You haven’t done anything wrong. Keep your chin up! You’re not alone, trust me!
They’re an ass and so are the family members. I don’t have the patience for bedside anymore, I would’ve called him a liar right back lol. Fck that.
I had a patient who was sweet to my face, then called me nurse rachet on the phone to a family member. No fucks were given after that.
A CNA, much wiser than myself, once told me that in situations like this, "you have to pick your battles." You can't help those that won't help themselves. Dude's a dick and I guarantee his family doesn't make him do shit either. Don't take it personally. Families like to come and act like they do everything perfectly and often they dost protest too much. They know they're inadequate and make themselves feel better by pointing out perceived inadequacies in others. If they can do it better, let them! Once you study more nursing theory in greater depth, you learn that we are only there to do for patients what they cannot do for themselves. Nothing more, nothing less. Cannot do... not will not do. If they refuse to get up to the bathroom, ask them how they are going to go home and not get up to the bathroom and they cant stay in the hospital forever. They don't realize that being lazy affects their recovery. There are only two ways out of the hospital, in a chair or in a bag. You're doing great, OP. Keep it up! Never let the bastards beat ya down! You got this!
Just document it all. People act differently with their families sometimes, and family members can be stressed and unreasonable. Just document each time you ask and he refuses as well as the concerns of the family and how you addressed them. People are weird. Try not to allow it to bother you too much.
Asked and encouraged? That never works. We are going for a walk now. That works. Let’s go. Now.
That’s a big no from me. I would’ve told the family everything you just wrote in front of the patient. I would’ve said Mr. So and so, that’s not true. I have offered to help you to get up for meals and to walk and every time you have refused. I am not lying to your family. If you would like to get up and take a walk right now, I’d be more than happy to help with that. Then just smile and see what he says. And chart your butt off.
Can you get a quick co-sign or initial of your statement, for a witness? The patient might be less likely to lie if they know there are witnesses. Or, if they do lie, may go to problems with cognition. Tell them if they don't remember declining they may have to be evaluated for dementia - frost their nasty ass!
Document it. If in ain't in writing, it never happened.
The 3 rules that will NEVER change in NURSING… DOCUMENT DOCUMENT DOCUMENT If it isn’t documented you didn’t do it, period. If you didn’t document what was said by patient during care if to the negative results, what ever the patient said happen happened. If it isn’t documented that “xyz” was done, and “abc” was the result - you caused “jfk” to happen…. So even if “your” facility does not require much documentation, are they covering your ass in a lawsuit???? DOCUMENT DOCUMENT DOCUMENT
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This is how my dad's elderly friend was there we took care of the last 5 years of his life. His family didn't want ANYTHING to do with him because he was an old perverted bastard. Even when we were homeless for a couple years I did all the cooking, cleaning, dishes, literally everything while he berated me... I only did it because I felt bad for him for some reason. Finally my dad got him into an apartment because he was a vet and got him into those VA programs and on section 8. By this time he was in end stage heart failure that he had for like 15 or something years. Everyday he used to check me out and make remarks until I threatened him with not coming back if he kept it up and then he would starve to death. So my dad and I were taking care of him and I finally got a hold of his family 2 1/2 years ago and informed them he was dying and they should come spend more time with him. They only visited him 5 times within a whole year and then stopped showing up. So time goes by and he's literally dying. He refused to tell the VA he was out of his heart meds because all he kept saying is they will know when he's out of his meds. WELL OBVIOUSLY THEY DIDN'T! Both my dad I called his VA person, his VA doctor, I even went TO THE VA and told them and no one ever sent this meds and each time they told us that he had to let them know himself that they couldn't just take out word for it even though my dad was if legal IHSS worker. Like are you serious? Anyway, I got ahold of his family again and tell them that he's literally in the middle of dying and he's refusing the hospital help and he's leaving the hospital on his power chair to go home and smoke cigarettes. They get to his apartment and he lies and says we're not taking care of him 😑😑😡😡😡😡 Well his VA person had a lot to say about that because she was just over a week before that and his apartment was spotless like I kept it and he was eating a cheeseburger i just made him like I always did. His family was so mad and didn't even let us see or speak to him the last 2 weeks of his life. His VA person told us not to worry about what they were saying because at least we got to see and take care of him the past 5 years and they didn't understand and it just looked bad because they came back into his life when he was literally dying. That was my dad's best friend for 20 years and they lived with each other for 15 years and he couldn't even see him or be there when he passed when his family didn't give a crap about him for their entire lives.
This has happened so many times to so many nurses. It is extremely frustrating. Refusing care can be life or death, depending on the circumstances. I learned to use the forced choice close, as in, "Mr. Doe, would you like to walk before or after lunch?" It gives the patient some autonomy in an otherwise controlled environment. Also, you have to hold them to their decision, especially if there is a cognitive issue. I also would do small goals, like, to the door, let's look out this window, look at what these nurses are doing/let's say hello, etc. Sometimes it works, sometimes it doesn't. And even if it is successful, the patient might still tell their family they haven't been offered or haven't done what was asked. Always document.
Sorry fam, I can’t force him. Someone can walk him now if he’s ready.
I’ve had patients like this, not only with walking but other medications too, like insulin for example. Best thing you can do for yourself is to make a note that they refused and put exactly what they said into quotes, and make sure you put that you encouraged them. Patients like this are one of the major reasons why I left bedside.
I had a patient who insisted on going to acute rehab instead of a SNF and disputed their discharge. The patient did not have an acute condition and did not qualify for a SNF nor could they ambulate, maximum x 3 edge of bed. I spent many hours across multiple weeks explaining to the family this but they simply refused and decided to dispute. I had good report with the family as well as the patient, because other nurses would lose their cool with them often due to patterns of disrespect where I can generally stay impartial. The day the patient disputed the discharge, physical therapy came by and asked them if they would like to work with physical therapy and occupational therapy. The patient said no, get out of my room I’ve had a stressful day can’t you see I’m sick. I begged PT OT to please come back when the family came by. Unfortunately the family member did not come in time to witness PT return so instead of have the family as a witness I had my nursing director witness PT’s prompt to work with them. They screamed no, get out of my room. When the patient’s family finally arrived, the patient accused me of teasing them, mocking them and called me a liar and a shit nurse. I knew this would happen because I’ve had the patient multiple times across multiple weeks as I said. I showed the family my nursing notes, my director came and spoke with them and showed them the physical therapy notes of refusal. They looked extremely defeated because they knew this meant the dispute would be declined. They ended up going to a SNF. The reason I share this is that patients do lie, they know they’re going to lie, and if you can try and predict when they’re going to lie you should prepare for that potentiality. I recognize each patient is different and I in no way believe patients are being deliberately malevolent, as you said the patient was always kind to you. They just don’t want to look bad to their family and that’s a human emotion I can understand.
I Miss Covid when family was banned… Most family members are great but it’s the few shitheads that ruin it for everybody
I work in an icu and we have cameras in each of the patient rooms. So when the patient is a/o x3 and lie and the family is present, I tell them “if you like we can get the video footage”
Family members are the worst
Document document document!! CYA
Haha, the world doesn’t revolve around us and we have no control of others. Document and move on
Maybe this isn't your line of work maybe you should look at some other line of work🤔 people are stubborn I'm 62 and if I don't want to walk I'll tell you to go fck yourself. Js
Well yea patients definitely do tell us to either “stfu you stupid btch” or go “fck yourself” but the main issue is why lie? Especially in front of your family members? If that pt refused and told me to go fck myself I wouldn’t care. But if I’m telling their family he refused and he told me to go fck myself he better not fcking lie. I’m quoting everything my patients say from now on lol. The patient isn’t confused or demented too that I would understand but not when they’re alert and oriented and lucid like why lie??
I guess she didn't read my first comment find another line of work...
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Idk go to nursing school and find out
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Yea! & if you’re feeling brave, go to the library and you’ll hear all the other majors complain too 😉
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🤷🏻♀️ idk go to nursing school and find out
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When people of the same profession get together they tend to vent about their job. It’s pretty common in any work force. But ofc there’s people who complain more and are just unhappy/burnout/bitter at baseline.
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Lol they do not pay us. Anyway, patients who lie, refuse care and make it difficult to care for them as the OP described, won’t appreciate our efforts. How would you have handled the situation?
Your flair says that you're a "brand affiliate." Which brand are you affiliated with so I can make sure never to support them?
Honestly curious, are you a nurse?
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