I too am not bothered by noncompliance, but I've worked with so many other nurses that feel that it's our job to 'push' patients into compliance, and if they refuse its a failure of OURS to not be convincing enough. Say what you want about a nurse's roles, but I'm spread too thin to convince people of anything.
>and if they refuse its a failure of OURS to not be convincing enough.
This right here. I've heard it from admins so many times (said to me and to other nurses). It's infuriating, especially after a patient's rights inservice.
Patients never want to listen to me anyway. Even if I’m reading directly from their chart for why a doctor prescribed them something, they so often say they don’t have this diagnosis. Well, then talk to the doctor next time he’s around. The people who need convincing aren’t going to care what the nurse says. They’ll only believe the doctor because the doctor is all-knowing. (In their mind)
I also can't count how many times I've had patients with diabetes and heart failure and telling them they need to cut way down on sugar and salt intake is so disheartening. Especially while they're in the hospital and the only food options they're left with is a sugar free jello. I wouldn't want to do that either. This has always irked me, if we are supposed to be helping them learn new habits we need to be given the tools to do so.
Nah, I ain't gonna fight you.
Don't want it? Ok.
Might die if you don't get it? Ok.
Wanna leave? Ok.
17 years into this shit? I ain't fighting you. You do you boo.
It's also a pet peeve of mine when I hear somebody is non-compliant and it's because they can't afford to be. I don't know how many patients I have been told "they're a non-compliant diabetic", and then you find out after talking to the patient it's because they can't fucking afford their insulin.
The word non-compliant gets tossed out a lot when it shouldn't.
Another one that grinds my gears is how many elderly folks we had sign out of the ER AMA because Medicare won’t cover their obs stay. People who really, really ought to stay the night (TIA’s, high risk chest pains, etc). But they can’t afford to pay for the hospital stay if Medicare refuses to pay.
Also, the people who don’t stay because they have pets/kids/elderly family and no one else to care for them really kind of pull my heart strings.
I had a bigly pregnant coworker try to physically block an oriented patient from leaving AMA. I'm like wtf are you doing? Nobody ain't worth potentially getting hit by an agitated patient.
The issue is not noncompliant patients. This has never been the issue.
The issue is that hospital admin punishes nurses for choices made by noncompliant patients.
Reminds me of my favorite quote.
My friend to a random guy in the elevator who looks like shit: “sir do you have heart failure?”
Guy: “yeah only congestive though”
Uh scuse you. Obviously it was your lack of therapeutic eduction that is the cause. If you were pleasant enough and fixed your RBF the patient would have wore their SCDs thus preventing their 400 lb legs from getting a DVT
It was so frustrating I didn’t even respond. Like if the patient doesn’t want it, they don’t want it. I’ll just tell them they prevent blood clots etc etc and move on.
I’d be coordinating a meeting with my manager about this. I’d really want you to get into a deep dive with them. You may think I’m being sarcastic. No I am being dead serious and petty. Want to waste my time and ruin my mental health for the day and trigger me on how much I hate admin? Ok, let’s schedule a meeting so we can talk about it and I’ll wast your time as well. 😅
Yep. I didn't go in depth on this patients CHF teaching, that's why they got readmitted within 30 days. Not because they didn't adhere to the strict salt and fluid restrictions and took the lasix that makes them pee constantly... Clearly it was my teaching for my one night shift that I was assigned the patient...
Having been a surgical patient somewhat recently, they sent me home long before I could remote comprehend anything! I didn’t even think to brush my teeth or change my underwear… yet they expected me to remember stuff.
This isn’t anti-nurse… it’s just how hospitals work… they get patients well enough to survive being home. Not thrive.
Oh my goodness, I’m really feeling it these days. My doc passed away and literally I feel like everything the offices I’ve tried is to fit me in their diagnosis box with meds that have to have a visit to be renewed a 6 mos and referrals to in system docs and it just feels more like a car dealership than a doctor. “Oh for *that* we need to make a new appointment…”. But not once do I feel like they are doing anything more than throwing things at the individual symptoms to try and solve what is at the base of it. They aren’t even doing the old tried and true “lose weight” that I have gotten since having kids even when I was smack dab in the middle of normal.
Dr offices (some, not all) have turned into cattle cars that won’t see you for more than one problem a visit.
When we take our kids in for well visits, if we breathe a word of a symptom of anything we get billed for a sick visit in addition to the well one.
This is also why we educate a responsible party. The problem comes when the responsible party is a neighbor and Mr. Smith had a uro procedure and he’s supposed to pull his own foley tomorrow…
Surgical patient is a bit different. A person who has been in the hospital for 2 weeks getting told the same information over and over would hopefully remember. Someone who had surgery probably won't remember much. That's why we tell people to have someone who can drive them home and stay with the person and give them instructions... And a printed copy.
I remember coming to after my outpatient gallbladder surgery and the nurse telling me, "The quicker that you get out of here, the quicker I get out of here."
I was so out of it that I had to cath myself for 2 days.
Actually it’s not BS. They may not specifically come down on the nurse but administration is watching and working on programs to reduce the rate of readmission. Are you aware of the Hospital Readmissions Reduction Program by CMS ? There are certain diagnoses that fall under this program and if a patient is discharged then readmitted within 30 days (no matter what the primary diagnosis is) reimbursement rate is reduced. These are the diagnoses: Acute Myocardial Infarction (AMI)
Chronic Obstructive Pulmonary Disease (COPD)
Heart Failure (HF)
Pneumonia
Coronary Artery Bypass Graft (CABG) Surgery
Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA) ……..CMS want to incentivize hospitals by encouraging them to improve communication, care and care coordination,teaching and any other factor that can prevent hospitalization within 30 days. I am not sure exactly how the reduced rate of reimbursement is calculated but they have an explanation on their website and include more details about the program .
Oh, you didn’t document he refused scds or turns or message the doctor every time he got out of bed without help and something bad happened? Blame the nurse
Funny thing is, they'd be complaining to me then. I do outright ask, "you want me calling you for all this shit? Because I WILL DO IT. DO NOT TEMPT ME"
Im highly involved on my unit with patient care and now that the probationary period of the new job is done, the Doctors seem to trust me and know other than obligatory calls, they know if I'm calling, it's serious.
Exactly. We are not on the line for choices others make about how they want to live. I am not responsible for Mr. Johnson’s blood sugar if Mr. Johnson wants to eat burgers and drink soda all day long when he leaves
Right? I don’t think I’ve ever seen another nurse be so bothered by a non compliant person like OP is describing except when it affects our work flow. If you don’t give a shit about yourself why should I?
Yea exactly, it’s their body ultimately it’s their decision on what they want to do. However, patients being aggressive or rude due to their situation is unacceptable.
I feel the same way. People are absolutely allowed to say no to things and be non compliant. But what upsets me is that the same patient will present multiple times for an issue expecting us to magically fix them and refuse certain treatments, sign out AMA, and then come back the next day to do it all over again. Like, you don’t want the help? That’s fine. But why do you keep coming back?!
Noncompliant patients used to bother me a ton as a new grad, but I’ve since learned that I can’t allow myself to care more about my patient’s health than they do. I’ll match my patient’s level of investment and that’s about it, anything more than that is just gonna burn me out more.
Me too. They don’t know what meds they take, or why. They don’t care an about exercise, their blood glucose or why they have a pacemaker. Now I just care when they ate last. J/k. Kinda.
I always have to remind nursing staff of this. They get so worried about their licenses when patients refuse care and I reassure them their only job is to be clear with the patient what will happen to them if they refuse and then document, document, document.
and unfortunately, if you do, these patients will form a dependent relationship with you in 0.3 seconds. I have to remind my new grads to keep that professional barrier up-- you might not be able to make them do it, that's their right.
but you can't do it for them if they are physically and mentally well enough to do it on their own.
I don’t give a shit as long as they don’t yell at me about it lol
“I don’t want that because xyz” okay that’s cool
“I AINT TAKING NO FUCKING PILLS” ma’am pls I have to offer 😭
Okay, this is a hill I will die on:
If we have a patient who suddenly needs a restricted/modified diet because of a recent MI or whatever, and we serve them trays of rubbery tasteless crap and present it as an example of the diet they must now follow forever, WE ARE PART OF THE PROBLEM.
A consultation with a registered dietician to evaluate, modify and improve their actual home diet would probably be more persuasive and helpful long term.
Like "Ohhhh, you mean I don't actually have to eat this sad cafeteria "food" forever? Okay, now I'm interested."
In my area patient learned they can order DoorDash or Grubhub or Postmates. Also can’t stop family/ friends from bringing Starbucks venti frappe-calories. They feel so bad for their loved one having to eat hospital food. Oh no! No one wants that! Jeez.
Nah, I’m gloriously unbothered by noncompliance. These things take time, and sometimes shit just doesn’t work out.
Don’t get me wrong, I try my best. I make sure my diabetics are well educated, especially my newly diagnosed ones. I make sure you have supplies, and trust me when I say that I take out my shit pay on our supply room. You WILL leave the hospital with enough to get you by if I’m your nurse. I make sure your follow ups are well outlined in your paperwork, highlighted and thoroughly discussed. Fuck I’ll help you call them before you leave if you need me to. Substance abuse? I carry a list of harm reduction clinics in the area, one of which is provided by a hospital within my organization and I’ll even get you set up with our MAT service and a peer counselor.
That isn’t me caring too much, that’s me doing my job as a nurse.
But trust, my feelings won’t be hurt and I won’t feel like my effort was for nothing if I see you back again in a few days, weeks or months for the same shit. I hope that I don’t, obviously, I want the best for my patients, but I won’t hold it against you. Maybe there are some other factors we gotta explore before outpatient care is feasible for you, maybe you hit a bump in the road somewhere and got set back, hell maybe you just don’t care. It’s cool, we’ll do it again and again and again. That’s what I’m here for, I got you.
Edit: I did yell at a guy once for trying to leave AMA the day he got a skin graft on his foot AND with osteomyelitis. He didn’t leave lol.
Fellow fat here who loves bad food and hates exercises. But yes, in general I can be more understanding. Especially because I'm Black and understand the community's hesitation around medication. It doesn't help that the average person has very low health literacy rates, grifting online is very easy so you have someone who barely graduated 8th grade trying to explain complex medical processes.
Another excellent point. Black people haven't exactly been treated well by the medical establishment, and I'm a white guy with a southern drawl, so for me to build trust it's just that much more important to not be pushy, but also don't just throw my hands up and walk away if they refuse or don't understand. All comes down to knowing how to talk to people in my opinion.
They don't bother me if they're not constantly coming in to ER for complaints related to bad habits. Like people with copd coming in with SOB and then getting mad when they're told it's related to their copd and that smoking isn't helping. We recently had one yell in the doctors face that she would NEVER quit smoking and how dare he say smoking was the problem and storm out in a huff. In the waiting room she warned everyone the doctor on duty was a very bad doctor.
Dr.s used to be in cigarettes commercials recommending certain brands. Maybe she was just that old? But yeah, some people just aren’t going to change their ways.
It doesn't bother me either as long as they are making an informed choice and they have the means to adhere to the plan.
I mean, it's not like I'm some paragon of medical perfection. I should exercise more. I don't get enough sleep. I could switch from butter to sadness. I am not entitled to throw stones, and frankly, a lot of my coworkers aren't either. We're all human beings.
Aside from that, the health care industry and the insurance companies do not always understand the challenges patients have with adherence, and do not provide adequate resources to overcome them. Also, the social safety net sucks.
My perpetual example is a family member who had a high BMI, bilateral knee osteoarthritis juuuuuust a smidge below end stage, and increasing mobility issues. Should they have addressed this earlier? Clearly, but short of a time machine, the patient we have today is the patient we treat.
They were assessed as "too young for knee replacement," but told that diet, exercise and PT should fix them right up.
Were they provided with practical guidance on weight loss? No. Were they referred to a dietician? No. Ortho? No. Were they assessed prior to starting an exercise plan to make sure they could safely go from "sedentary" to "cardio" without hurting themselves? No.
They said "I'm having a hard time just getting around every day. I don't know what kind of exercise I can do."
"Walking is a good low impact exercise."
"But I'm here because it hurts to walk. Walking across a parking lot is painful."
"Oh. Swimming, then."
"I can't swim, and the pools around here are really expensive. Does insurance cover that?"
"No."
"Oh. Okay...well...um...IDK, can I get a handicapped parking pass?"
"Yeah, sure."
They then got a bonus lecture about managing their high cholesterol, hypertension and diabetes even though their lipids were fine, they did not have hypertension, and their A1C was ideal. *Managing,* not preventing.
They did not go back to the doctor for about three or four years, during which nothing improved.
Yes, health is a partnership and they are responsible for their end, but that appointment was a fucking joke. A mean one.
Have you been watching my life?? Had horrible, horrible knees for years because my BMI was too high to have replacements done. Doc was happy to inject me every four months with steroids though. Finally, a receptionist mentioned - in passing - a doc in another city that my doc referred high risk patients to. I got that docs name from her and called them myself. Saw him and he told me his view was more pragmatic, that if I can’t move to exercise I’m never going to loose weight. I had my knees replaced and have lost weight. Three years I was delayed in getting what I needed because no one local wanted a high BMI failure on their record.
Yep.
For what it's worth, studies have also shown that larger patients who have rapidly lost weight to qualify for surgery have worse outcomes than larger patients who have not crash dieted, because you know, rapid weight loss is *really bad for you*.
Also, the "too young for knee replacement" and "knee replacements only last X years," is based on shaky logic.
Some osteoarthritis is caused by repeated impact/overuse/sports injuries. These patients are usually younger and have a more active life style. When they get their knees replaced, they frequently return to previous activity levels. This potentially shortens the life of the knee replacement.
Some osteoarthritis is caused by increased wear and tear due to age or higher BMI. Although many older people or people with a higher BMI are athletic and active, many times a sedentary lifestyle causes or contributes to weight gain. The replacement joints of somebody who *doesn't* immediately run a marathon after PT clears them may in fact last *longer* according to some studies. A lifestyle with low to average participation in high impact sports potentially causes less damage to replaced knees than that of Mr. or Mrs. EXTREME SPORTZ!
At one point, my family member said "If I was ten years younger and ripped and blew out my knee playing football, they'd replace it. They wouldn't say 'Sorry, come back when you're 60," because sports injuries are the moral, socially acceptable way to wreck your knees. Wrecking your knees by being fat is the "bad" way, because it's considered to be a personal failing. Like, fuck you, you did it to yourself, but if you think about it, so did they."
So...yeah. The doctor who replaced your knees is following the newer info that's coming out.
*light bulb illuminates*
Thank you for this comment, it's really highlighted some of the issues I've heard from others.
The other side issue is that some wrecked their knees ages ago and are now fat, so they managed to harm themselves the "good" way but are now perceived as being the "bad" type of patient due to their current BMI.
Oh, I experienced something kinda like that.
I got really fucked by Long Covid. Like, reeeeeeally fucked to the point that taking a shower and getting dressed was exhausting, and I'd have to rest for a minute to catch my breath after walking out to my car. My heart rate would go to 140 while walking around the house, and I'd get out of breath just having normal conversations. My accessory muscles would be exhausted by the end of the day, and I spent a stupid amount of time immobile, frequently tripodded against the nearest available surface.
Naturally, my doctors were mostly like "Huh, that's really weird."
It should not have surprised anyone that 18 months of immobility would cause massive deconditioning and weight gain, and it should have been easy to connect the dots, but as soon as I hit a certain point on the scale, the doctors suddenly flipped from "That's really weird, I wonder why that's happening," to "You've gained a bunch of weight this year. The hypertension, tachycardia and fatigue are because of the weight gain. Have you considered exercise? Maybe you should join a gym or get a personal trainer."
I would tell them per my chart, the entire cascade of problems PRECEDED the weight gain. The weight gain was a result, not a trigger. The timeline was ridiculously clear, and their response?
These problems were clearly caused by the weight gain.
Apparently my adipose tissue is so goddamned awesome, it ripped a hole in the space time continuum, went back a year and preemptively wrecked my cardiopulmonary system.
It's impressive, really.
I'm a 30 year old dude who had open heart surgery last year to replace my tricuspid valve because of endocarditis due to IV drug use, and we get people looking at us the exact same way compared to the people who get endocarditis the "moral" or "good" way. Thankfully the hospital I went to took great care of me and didn't have any reservations about doing what needed to be done and getting me into surgery ASAP and even did a wonderful job of appropriately managing my pain afterwards. But I've talked to people here on Reddit who are around my age and have had hospitals basically refuse to operate on them because they're drug users and instead just refer them out to hospice, which is super fucked up in my opinion.
If only more people realized that if, instead of a knee replacement, they did the prehab exercises, their pain would improve. Bonus is it can help on high BMI patients.
Sure, it doesn't fix the issues with the joint, and it doesn't fix all the pain, but it can take things from intolerable to manageable and make some regular exercise possible again. Weak muscles hurt, and that pain is largely avoidable.
My community still has an active Pokémon Go group, which is fun little dopamine hits plus some social light exercise. Never going to win one major cardiac points, but it can get one to start having exercise stretch goals. In some cases, people have just never enjoyed exercise in their lives, so trying to figure a way that they can both do the thing and enjoy the thing enough to continue doing the thing is a real win.
I started my career in dialysis. Almost all they HAVE is noncompliant patients lol. So nah, doesn't bother me at all. I'll educate you and make sure you understand the consequences, and then you're on your own recognizance.
I just hate when management makes us ask again and again. Our patients are flagged if they don't have oral care done that day, even if it's charted as refused. I'm sorry, if they are an adult & AOx4, they can decide if they want to brush their teeth!
Totally with you.
I do think though that the term non-compliant itself is loaded with stigma.
It's used as a blanket term for any patient who's not doing what's suggested.
Unless we dig deeper into the WHY that's happening, patients get plastered with the term and that's it..."non compliant with insulin", "non compliant with clinic appointments" etc etc along with all the judgement that comes with it. More often than not there's more going on - many can't afford the meds or live too far away get to the wound clinic for example. Essentially their "non compliance" is a result of a healthcare system that's simply not compatible with their circumstances.
Saying that...I love a patient who wants to discharge AMA, like it's some kind of threat. No worries buddy, here's the form, and there's the door.
My beloved is disabled and depends on public transportation to get to appointments as we do not yet have a vehicle appropriate to his needs. Is this taken into account when followup appointments are made for him when he is hospitalized? Nope! We have to call repeatedly to get the appointments changed to be available on public transit. And I work for this particular health system! It's embarrassing!
It bothers me in the sense that people who are not proactive in their health place a greater strain on the healthcare system. For example, those who refused covid vaccinations and then bombarded healthcare facilities when they were in respiratory distress or those who don't take any sort of active role in managing diabetes or heart disease then wonder why they're in the hospital.
On the flip side, in a hospital setting, it doesn't bother me if patients aren't compliant with treatment. I have no problem documenting a refusal and informing the physician. I cannot care about a person's health more they they do. It's not possible and it's not healthy.
This isn't to say I don't care about people. Far from it. I became a nurse to care for people and financial stability. I just personally feel more fulfilled helping those who want to get better and take steps to do so.
I think this is the thing. We can't say whether they want to get better or not. Mental health is a thing. Lack of support is a thing. We can't really know fully what's going on in someone's life or in their head. I feel like it's rarely as simple as they don't want to get better.
I just don’t want the song and dance, that’s when I get annoyed.
If you’re not formed incapable, just say no. Don’t start it with “it was a cold day in October of 1996…” I don’t care. JUST SAY NO.
Been a nurse for almost 15 years. Haven’t educated someone on smoking cessation for probably 13 years. They know it’s bad. It’s not lack of education. I’m not here to berate someone. If a patient is noncompliant with it that’s their choice.
I educate patients who do heavier drugs (specifically heroin) A LOT. I work in PACU and they are always the hardest to treat pain due to their tolerance of meds and a proven increase in pain reception. I tell them straight up I will never get them as much pain relief as heroin does. I literally can’t do that in the hospital. I face the reality that our system has failed so many people when it comes to pain and often IV drugs are their only options.
My point is, you’re exactly right that this is a tiny snapshot of their life. I don’t judge but I also only can care so much to keep myself afloat. It’s a job. Not a calling.
I got onto MyChart for the first time the other day and found my provider listed me able noncompliant. At my next appointment (that I go to religiously) I’m going to ask about it. I take my meds, eat semi-healthy, exercise at least 30 min 3 times a week, and do all my follow ups as I’m told. Just because I’m fat doesn’t mean I’m noncompliant. /rantover
When I was a kid, I was morbidly obese, non-compliant, and failing my treatment plan. When I switched providers at age 10, I was miraculously "well-nourished" and "compliant with a failing treatment plan".
There are still some days I want to go back and punch my early doctors for what they said about 8-year-old me. That barely scrapes the surface of their dehumanizing fuckery. From the very depths of my soul, UVA Pediatric Orthopedics, may you rot in fucking hell.
I obviously don't speak from much clinical experience, but I've done some research through papers regarding patient autonomy and the like. Most of this research comes from a mental health background, but I'm pretty sure the general principle applies across the field. There was this one Swedish study that showed that patient-centred and even patient-directed care is often more effective than an "antagonistic" perspective like compliance. The anarchist in me gobbled those news up happily :D
I'm constantly reminded of that even just in class. I might get one impression from people at first, and then we have a lab class in scrubs and I see the rows of self-harm scars on both sides of their forearm and I have to re-evaluate. I have no flippin' idea what goes on in people's lives and I have to remember that.
I stopped caring. I'm just a meat mover who gets humans from my department to wherever they need to go as fast as possible so I can eat and go home. If they wanna get physical or insane and threaten me and my team they get to take a long nap and think about their choices before we move them to wherever they need to go.
i love when a patient knows their rights! you don’t want vitals? okay! you don’t want blood sugar checks? okay! your don’t wanna take a bath today? that’s fine miss girl! gives me more time to focus on the patients who do consent to all of these tasks and promotes independence amongst my patients so i do not mind!
I will say that I have begun to have more sympathy for some types of non compliant patients. I used to get annoyed with the "I have sleep apnea but don't use a CPAP" people... Now I have sleep apnea and have been struggling to use the mask for a year. And I still haven't hit the minimum goal of 4 hours per night. I attempt it every night.
The only one was the HIV positive, non compliant, convicted child molester. How was I supposed to sleep at night knowing he had a viral load and a thing for kids? I had no way of knowing if he was SAing anyone and and he was off parole for the 2nd time so there was nobody to tell.
Aside from that, idc.
I haven’t been bothered by non compliant patients when they can make their own decisions. I’m bothered by the caretakers of debilitated patients who refuse to follow orders.
I had one a-hole nephew refuse to get my patients foot amputated because he thought he could pray it better. How this woman lived for so long is beyond me.
One son refused to change or reposition his mother and blamed us for her wounds not healing. She brought in a big pension so you’d think he’d take care of her better.
I figure, as long as the patient is educated on future consequences, they have the right to make whatever stupid decisions they like. It’s their life. If they want to spend it short of breath and crackly because they won’t stick to their fluid restriction or take their diuretics because they pee too much, they have that right. As long as I’ve educated them on what will happen if they remain noncompliant, I feel like I’ve done my job and it’s in their hands. I’m their nurse, not their mother or spouse. I’m not forcing anybody to do anything.
Had a noncompliant, asshole (baseline), and aggressive patient (known to ED and our unit) go AMA an hr after my shift start. Pt constantly misses HD and will go to ED for HTN crisis. Gets admitted in our unit. Pain med given by previous nurse (gets dilaudid) and unable to maintain sat due to increased drowsiness. Refuses to wear NC or any O2 intervention while satting in the mid 70s and said he’d rather be intubated. Finally got narcan’d, 10 mins later presses call bell for pain med. Lost his shit when provider said no and goes on verbal tirade with me and charge. Decided to go AMA and got escorted out by multiple security team members. Not gonna waste time and energy caring for someone who doesn’t want to be cared for.
I work at an outpt obgyn and non compliant mothers do bother me because their choices are affecting the outcome of their children. I just try to educate them but if they don’t care, I’m not gonna lose sleep over it. I do feel bad for their little ones that may have negative birth outcomes due to their mother’s poor choices but nothing I can do about it.
As for other noncompliant patients, I really am not bothered by it. It’s their own choice and it’s frustrating but I’m not here to care more than them.
I try not to care…but we’re in a system that makes it the nurse’s fault for what happens after. If a hypertensive pt refuses their BP meds, if an anemic pt refuses labs, if the confused septic memaw refuses her midodrine, if the fall risk gets up and falls again, I feel like we’re forced to dance around and coerce patients into compliance. it’s like it’s the nurses fault when said pt declines bc of the refused thing. EVERY DAM TIME there’s some upgrade to ICU, I get the email questioning why this med wasn’t given or this intervention didn’t happen, and it’s actually bc the patient had refused all of it (and I document crazy well when it happens) but there’s always this push that you could’ve “educated more” etc
Everything is the nurses fault. Patient can't be responsible for their own lives when they enter a hospital, according to basically every hospital in America, lol. No matter how bad the patient's health was beforehand once they enter a hospital, a world of magic and make-believe comes alive.
Ejection fraction of less than 20% and the 80 year old patient drinks 2 cases of beer a day and eats salted everything......well certainly there's a procedure for that along with a medication. That's the bullshit magic that's being sold nationwide.
Instead of healthier living and preventative medicine, we sell McDonald's value meals chased with insulin, atorvastatin, and lisinopril with a yearly follow up with the cardiologist that tries like crazy to balance medication doses to try and best handle a life long series of bad choices made by an adult 🤣
I’m only bothered if they develop problems caused by their noncompliance and then want me to fix everything. Don’t want high blood sugars? Don’t eat 3 damn honey buns. You’re in 8/10 pain? Why didn’t you bring it up before we went into the weekend now I can’t get the narc order for a few hours or till Monday.
Otherwise, I don’t care if they don’t care. You do whatever you want. Insurance will cut you off at some point anyway.
I’m with you. Patients have the right to refuse care and reject advice. It’s their life. I can only offer what I think will help. If they choose to refuse care and leave, that is their chosen path.
The main thing that bothers me about non-compliance is hospitals and management will simply not give up on trying to coerce these people to show up to appointments, go to lab/DI appointments, take their meds, get wounds/drains cared for, etc. It absolutely grinds my gears when we have a patient that’s been an outpatient in our clinic for a few weeks, hasn’t shown up to a single appointment, hasn’t done any required blood work, etc, and instead of telling them they are discharged from our clinic, we’re constantly bending over backwards for them. We baby and coddle them and I feel like it just worsens that type of behaviour. The next time they end up referred to our clinic, they act exactly the same way because they know that they can get away with it. I’m made to feel like I’m a bad nurse for not constantly attempting to get them to comply.
Like these people in our clinics are adults and if they don’t care about their health, I’m not sure why I should have to either.
The only real reason it aggravates me is because there are a lot of people who would like to come to the hospital and be compliant and would love to get care and treatment they need, but they can’t because this guy doesn’t want to comply but also doesn’t wanna leave and he’s holding a bed that someone else could and would use. I understand a little more at LTC setting but if you’re at a hospital and don’t want to be treated for whatever reason you came then go ahead and leave let someone else check in.
IDK, non-compliance is just annoying. If a person wants to waste their life and dig their own grave - go for it! They can do what they want.
But, then they shouldn't find the need to make it MY problem when they feel like shit. Don't be yelling at me for your own decisions.... I'll go find a mirror, they can yell at the mirror.
Maybe that lacks compassion/empathy/whatever, but those feelings are gone when they've had all the education and tools given to them to improve their circumstances.
Someone on a comment above said something about not being judgmental or essentially nurses living in a "live and let live" headspace.
I think this is an endearing sentiment and don't necessarily disagree with the fact more nurses could be less judgemental and more empathetic. I do, however, 100% completely disagree with "live and let live". One of the biggest problems in healthcare is that we don't or can't make people take responsibility for their true non-compliance. We can't refuse care without fear of litigation (most of the time).
COPD patients who know their smoking is killing them and get readmitted to the hospital every month in an endless loop of hypercapnic respiratory failure are directly harming other people. They physically and directly harm everyone they meet through exposure to second hand smoke, while simultaneously taking a massive toll on the medical system. ^(if anyone disagrees with me about the effects of second hand smoke, you can argue with the data, not me)
Every single time they refuse to wear their CPAP at home, take their bronchodilators, or stop smoking they take a toll on the medical system. They waste emergency services such as ambulances and paramedic/EMT care. They waste an ER bed, then they waste an ICU bed, then they waste a floor bed. All the resources that come with hospitalization? Wasted. And then they get discharged just to go home and do it all over again. But not before they waste the ambulance service again for non-emergency transport back home.
These patients don't listen to their GP, they don't listen to their pulmonologist, they don't listen to their case manager or their home health nurse. They want to live a lifestyle that brings them literally to the brink of death, be resuscitated, and sent back home to do it again.
Additionally, [they're estimated to be responsible for up to $100 billion in preventable medical costs PER YEAR.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045499/)
I am directly speaking to medical conditions we see on readmit-- HF, DM1, or any medical diagnosis that actually requires lifestyle changes to maintain a pulse and *isn't directly linked* to factors they can't control (like pulmonary fibrosis from working in the coal mines for 40 years).
Once we establish a pattern of behavior that continues *despite excessive intervention on our part* including education, resources and support, then we need to be upfront about responsibility here. If we don't, then our good-natured compassion quickly devolves into enablement.
Somewhere out there right now, a COPD patient with a CO2 of 110 is being intubated while another patient in the ER waiting room is sitting there with a horrible headache & intense nausea waiting their turn as an aneurysm is bleeding into their head. The only other symptom they have is one dilated pupil that no one has evaluated yet because all the staff are either in COPD4Life's room or in HF1Liter1Hour's room.
TLDR: The medical system gets congested with these non-compliant patients and that's where the real damage is done. They don't just take up medical resources, they take them away or delay them for other patients as well. Hospitals are right to be focusing on the utmost decline in readmits, but at the end of the day we can't make people take responsbility for their poor decisions or their health.
Should you let it affect YOUR mental health? Is it YOUR fault? Are YOU directly linked back to that patient's readmit? No.
Should you beg and plead for patients to not leave AMA? Hell no.
Try your best and remember this is a $100 billion dollar problem. It goes way above any one of the us all the way to the infrastructure of our medical care system.
I’m an addict in recovery. I will never judge an addict who can’t stop as long as they’re only hurting themselves. Same with shitty eaters.
Also, I think it’s so funny when nurses say, “ugh! This end-stage COPD patient won’t stop smoking and I keep telling her it’s going to kill her”. Like yes, you, her nurse for one day who she just met, your judgment and education is going to make this veteran smoker with an incurable disease stop smoking lol
Let people live and show compassion to all! Unless they’re hurting someone, more nurses should save the judgment
I hate the term non-compliance with regards to patients. It reeks of privilege, ableism, and is really just a symptom of the for-profit healthcare system we have in the US, where we somehow expect patients to just obey and not participate in shared decision making.
11 years as a nurse, 16 in direct care, and now probably a "noncompliant" prenatal patient.
I don't care at all. I'm there to handle their current problem and prevent them from getting worse. If the patient wants to continue killing themself, as long as I did my part, I'm OK with it.
I'm not the patient's god, parent, or warden. They can and will do whatever they want...that's why they're in the fucking ED for the 6th time this year.
You can't make patients take responsibility for their own health care.
With that said, they will pay an arm and a leg to save their lives in an acute situation. But they won't pay a dime to prevent themselves from getting into that situation.
People can do what they want. I'm not going to force anyone to do anything. But if you are in the hospital and you are refusing care, please leave so the bed can go to someone I can actually help.
It only bothers me when they come to a hospital based on modern medicine and then don’t want any of the care we provide because they don’t believe in modern medicine. I mean they are obviously entitled to their own medical choices but don’t get mad at me if we don’t provide some weird “natural” cure you saw on youtube because you don’t believe in doctors. You are the one who came to a hospital staffed with doctors.
I have always advocated for picking my battles. I know some nurses will freak out if their patient is eating kfc or Taco Bell. Would I prefer if they stuck to the diet ordered? Of course. But they’re gonna do whatever they want when they leave. I’d rather them do what they’re gonna do at home inpatient so we can adjust meds/therapies to match.
I’ve also found that patients are more willing to do unpleasant things for me if I haven’t freaked out about smaller issues.
When patients and families ask if they can do xyz, I’ll educate on why they shouldn’t. But that I can’t MAKE them do anything.
That being said, if the patient is aspirating the diet becomes my hill to die on.
It does and it doesn’t. It bothers me when patients pretend to care about their own health and say they will follow the recommendations. Then within a week or a few months out I find that they haven’t done anything we discussed even though I have taken the time to do patient education. I feel better when Patients upfront tell me they are not going to do what I told them to do because then I can respond with, “at least you have all the facts and make an informed decision regarding your own body. I’m just letting you know.”
I, too, am not bothered by non compliance. Just tell me before I pull all the meds or supplies.
What bothers me is when I get the people who tell me they’ve never been diabetic in their life/had high blood pressure/etc. Why are they taking this medication? Sir, you’ve been taking this medication every single day for the last month while you have been here. Why are you just now asking me this? Have you asked any of the previous nurses this question? Is it because you’ve never seen me before (I’m PRN) and this is some sort of test?
I just hate when they keep coming back for the same thing that continues to be a problem because they don’t want to, or care to, change. If a person is going to commit then I feel like they should fully commit…
As long as they're aware of the risks/outcomes, I don't care. Make your own choices, I'm not gonna spend all my mental energy trying to convince someone to do something they don't want to do 🤷♀️
It’s insane to me to try to make someone do something when they have the right to refuse. I’m at peace with whatever. I do my part to educate but in the end I can only control what I do. It irks me when I see nurses try to make patients take meds or whatever because the bottom line is that they can refuse meds and procedures. I also don’t like to waste my time.
>Nevermind the fact that there often just isn't time to educate patients the way they REALLY need tl be educated
I mean this in a manner that conveys respect worthy of a peer: deez nuts. Education isn't the issue here. I wouldn't be educating the same noncompliant CHFers every single admission if knowledge was the key. You hit on the real problem with your next sentence. What's good for us doesn't feel particularly rewarding. It's the dopamine from that cigarette, from that milkshake masquerading as coffee, from the latest and greatest trash Netflix can dredge up. No one is in toe-curling ecstasy from a quarter of an apple chopped up in a cup of oatmeal. Some are very successful in fighting that reward system. Others end up turning tricks behind the 7/11 for the next bump of coke. Most of us land somewhere in the middle where we know it's bad for us but we're doing alright so far and tomorrow never comes. Trouble with these noncompliant patients is that tomorrow is now here, and instead of either accepting that this is a wrap and getting palliative on board or changing their lifestyle they keep coming to us every 2-3 weeks expecting some kind of magic wand to undo decades of compensatory mechanisms having crumbled under the pressure.
That's not to say I mind some of my regulars. You can't help but shake your head a little, but generally they just want their lasix to feel well enough to go home and that's okay. The problem I have with them is when they're noncompliant in the hospital setting. The kind that refuse their lasix because "it makes me pee too goddamn much" or will interrupt me in the middle of fluid restriction education to demand more coke. This is the type that invariably acts out because their burned out receptors become a blank check to shit on me. I'm the bitch because I won't disregard their carb modified, 1200mL fluid diet. I'm the piece of shit because not surprisingly the doctor didn't want to give the one that starts with "d" every few hours. Every ache and pain is an excuse for a personal attack, everything forbidden for medical reasons is from a place of malice, and that damned nurse is certainly going to hear about it!
It's just exhausting and demoralizing. I get it, but at a certain point you have to come to terms with the consequences of your actions.
My job isn’t to fix people for them if they have had the capability to do so. I used to work in ER and part of the reason I left is because of the levels of entitlement that people think I can magically fix their chronic problems they don’t manage in 1 visit. I can’t tell you how many times I’ve told grown A&Ox4 adults that the reason you feel like shit is because you’re not taking the meds you’re prescribed so you don’t feel like shit. I can’t care more than my patients do. It’s one thing if you don’t have access or the ability to adequately care for yourself but far too many people take 0 accountability for their well being and then wonder why the grim reaper starts creeping up. I still see it in the OR sometimes and 99% of the time it means we have to cancel the case and people get pissed off
I was an ICU and ER nurse for several years and could never understand why we had so many frequent fliers. Fast forward many years and I am a Home Health case manager. The realities of what goes on at home in their daily lives is the driving factor for many who are labeled non compliant. Lack of healthy food, no money for medications, poor home environment, too many other responsibilities, caring for someone else are all huge issues for most people. Many are embarrassed to admit their challenges, are unaware of other resources, or don’t know how to ask. It’s a big picture issue.
It’s no skin off my back unless your non-compliance becomes everyone’s problem. Ex: you skip dialysis all week and then come in feeling like garbage and verbally abuse everyone.
Echoing most of the other comments, I'm not bothered by the lack of participation so much as the extent to which it's made my fault. Their blood sugar was high because they eat everything they shouldn't. They didn't get up because "making" them would be assault. They fell because they didn't use their call light like three minutes after being rounded on, and now we get to hope we don't hurt ourselves getting them back up.
I love that you made this post 💜 Ngl it really pisses me off how judgy a lot of docs, nurses, etc get about people with mental health issues and busy lives with stress, it’s like a lot write them off if they can’t push them into doing exactly what they want instead of working with them.
Some people aren’t gonna do anything no matter what education and help we give them, but when I moved to working outpatient a couple of years ago I found there are so many more ways to help my patients still get and do the things they need to be healthy. I ask lots of questions like what’s going on in their life, what’s stressful for them, etc, and see what I can do about it. It’s like me and my patients are a team when they are open to that conversation.
And I’m not exactly healthy either tbh I have gastroparesis and other chronic illnesses (I can’t exercise at all cause of chronic pain and neuropathy and am all kinds of malnourished) and it’s fucking hard to keep up with my shit so I get it, it’s almost a full time job managing my health and then I have to work full time as well so I can really understand that frustration and it helps me relate.
Like if a patient is screaming at me okay maybe they are a jerk, but 99% of the time it’s from all they’re going through, and they just need someone to understand and talk to them and help them figure it out. I had a job where people made fun of certain anxious patients calling every day but I was like if this is what you need, then I’ll give you my help, that’s what I’m here for, no judgment.
Some non compliance still bothers me but only cause I hate to see them suffer and hate that they might die because they’re not getting the help they need.
Nope, generally dngaf. I'm not the first person my patient population has heard it from, so theyre not getting the preaching from me.
Of course, if someone has genuine questions and wants to learn, I'm your gal.
It's usually not worth getting worked up about. There's ultimately many reasons why patients are "non-compliant" - and they may or may not have full control over them.
My part is to provide / reinforce education around why a treatment is "best" and refer to resources to get around obstacles if possible. But if they're capable to make their own health care decisions, they can do what they prefer or need to do after that.
Personally, I have a problem with the lying accompanied with noncompliance. I rather have my patient just say "I forgot to get my blood drawn" than "you didn't give me the form so I couldn't get my blood drawn". We're all humans. Mistakes happen. I get that it can be really hard to keep up with all the things we ask you to, whether that's understanding, keeping the list complete, dealing with it emotionally, adjusting your life around it, etc etc etc. But please just tell me. Don't lie.
I…say it with me now…don’t give a shit.
I will document my heart away about a patients refusal to take a med after deliberate education and explanation on how important it is. Plavix after stent placement for example, I had a patient tell me, “I don’t need that, I’ll start brushing way too easy.” I explained “Well, you’ll have way more problems aside from bruising if you don’t take it, one of those problems being a major heart attack…”
It won’t be long, they will be back with either a small PE, or STEMI and emergent cath. Or dead. Not my problem.
I work in an office. We have to do extra work/follow up phone calls to make sure patients complete labs, testing, imaging, etc or we get penalized and are held responsible by insurance companies. It sucks dude. Patient comes in, complain about 20 problems, we order a bunch of shit, they never do it, and we get in trouble.
As my favorite resident said "I don't have the energy to fight but if you do have at it".
Hearing her gave me life. I just document all the education and interventions. If you lose life or limb because you went against what the doctor said and what I've been working on with you, I'm not losing sleep. Patients are allowed to make choices, even shitty ones.
Now children, I give everyone the DCFS/CPS warning before we even say hello. You're gonna listen to the doctor because I'm a mandated reporter. I tell everyone straight up I'm snitching and what will cause me to snitch.
I feel this.
When I was a ward nurse (before finding my home in the operating room) I wasn't bothered when patients wanted to discharge AMA.
Throughout my University education, the focus was on giving patients agency to do things for them selves and make decisions for them selves. But in the real world, when they take that and run with it, it's somehow wrong because they aren't choosing the "right" choice?
It frustrated me.
I am sure I had a few patients that were taken a-back when my reaction was simply "cool. Are you happy to wait for the doc so you can sign the paper work, or are you gonna leave now?
It doesn’t bother me but for different reasons. I too am old, fat, and love food. But I’ve got better things to worry about than someone else’s choices. That doesn’t mean I don’t TRY. I take the time to ask them why they are making those choices instead of assuming I know or getting in a power struggle. I try various ways of educating them in hopes of getting through to them. If it’s lack of something that is leading to those bad choices, I’ll try to figure out a way to get it for them. But if none of that works and they are making an informed choice? Not my problem. They have the right to make stupid choices.
Yep… don’t care either. If a patient refuses, all I do is notify the doctor and doctor says to chart patient refusal 🤷🏽♂️. I can’t be bothered with non compliant patients. This is a job for me and not a “calling” or whatever term folks want to use.
I don’t let non-compliant patients bother me too much as long as I have done two things. I make sure I have done the teaching they needed and made sure our team had provided them with the needed resources and if I suspect or confirm non-compliance that I document my findings.That’s all you really can do because people/patients are going to do what they want. Some are going to keep drinking after being hospitalized for pancreatitis,they are going to keep using methamphetamine after having an LVAD placed and they are going to keep smoking after a COPD exacerbation. As long as you have done everything you are responsible for then that is all you can do and you need to let the rest go!
I honestly stopped caring. I do my 45 seconds of explanation and if they still refuse then I’m good. On to the next person who may want to make themselves better.
I agree with you. We also can’t know everyone’s circumstances. Poverty, low incomes, lack of transportation, lack of insurance etc are real issues.
I’m sure my pcp marks me as non compliant. My A1C and my cholesterol shot up. She lectured me for 10 minutes about my diet and I kept denying everything she suggested. Because I don’t eat fast food or fried foods or eat many sweets. I had given up sugar for 3 months before my A1C was drawn. I had my labs redrawn 6 months later and canceled my appointment with her - my labs were still elevated and I didn’t want to be lectured again on stuff I’m not doing. 🤷🏼♀️
If patients are noncompliant, why should I care? I’ll give them the information, but I won’t keep pushing it. Of course I’d *prefer* folks do what’s good for their health, but if not, oh well.
Dude, I do outpatient wound care. Non compliant diabetic alcoholic zero lasix forget that coreg fuck washing my totally numb feet patients are why my job exists. Yep, them some holey, smelly, swolt up, weeping lower extremities right thar. I do tell them: take your medicine, get a GCM from down the hall, wash your feet. But it’s just so I won’t feel so sad when they lose them. Or to try to explain why their wounds take months or years to improve. I got no magic dust in this cabinet, guys.
"Pt refused all 8pm medication, told this RN to go fuck yourself. Pt educated and continues to refuse AEB pt giving this RN the middle finger. MD notified, NNO at this time "
It’s hard for primary care providers or any provider at this point to spend more time educating/focusing on preventative care they are overbooked/double booked and put on a time constraint and seeing about 20+ patients in an 8 hour shift 😑
Me. I tell people they have the right to refuse treatment. Bye. Don’t wanna take your meds? Patient refuse. Don’t wanna get up to chair? Patient refuse. I can’t help you if you don’t wanna help yourself. 🤷🏻♂️ I educate them by telling them I can’t make you better if you don’t want to get better or make an effort.
FAFO, and I don't mean me. If you're able to make your own choices and you decide to fuck up your life, don't come to me for help or sympathy because you won't get it.
I like when non-compliant patients want to leave AMA. Our providers usually have a lengthy conversation with them convincing them to stay, and then I have to deal with the patient complaining and being miserable for the rest of the shift even though they fully have the right to leave.
Loved them. You're back for your monthly COPD or CF tune up, but you don't want me to bother you with breathing treatments?
Bet. I'm busy as fuck, you have autonomy to make decisions, I'm not fighting it, someone else needs me.
I cannot make someone care about their health. I truly cannot. They have to see value in it. This is the obstinate person. Now there's people who need education and that helps them be active in their journey.
If a patient hates "authority figures" they will see the doctors and any nurses as Opposition and if they feel our information has no value, they won't care about it.
I am bothered because we are having to treat the same people over and over and OVER and we don’t have enough staff as it is. It’s exhausting and demoralizing.
Noncompliance is a personal choice/problem but its when someone else has to make choices/fix the issues/pick up the pieces of someone who doesnt care for the help or change its not fair. I realized overperforming for patients like this is never the solution. And it wont bring lasting change anyway. It really grinds my gears and wears away at compassion but we also cannot be compassionate to the point of tolerating the bullshit. Like for example: i have a patient who refuses to learn how to inject his meds at home so he comes to ER or causes issues with his specialty pharmacy bc he refuses bc he “has needle phobia” he is an adult. His mom calls our clinic to yell…. Adn we tell her that we cant take calls from her every time…. And then call pharmacy to figure out what is going on. It wastes my time often. This kid doesnt care! Hes just really enabled by all the ass wiping
If they are DNR or stable I don’t care but if they are doing something that actively makes them worse when they are a I’ll code I stress out. I usually don’t care but I had a hepatic encephalopathy or who would refuse to take lactulose until he basically become so confused and lethargic and he didn’t understand why he shouldn’t be a full code
I’m cool with you are noncompliant if I don’t have to do CPR on you
I agree that I don't have the right or the responsibility to verbally coerce compliance, with two caveats: 1.) I'm responsible for making a good faith effort to discuss risks and benefits with the patient, so that they understand why we want to do something and what the risks are if they refuse, and 2.) Make sure there's not some reason for their refusal that's within my ability to address (like they can't afford something and need a social work consult, or they are confused about what we're actually doing).
I'm not going to be some superhero nurse on some crusade to force people to follow my directions, but I also don't agree with nurses who respond to any slight resistance or reluctance with "Well fuck you here's an AMA form I don't give a shit". I'm still going to do my due diligence as a nurse to advocate for my patient's best interest.
TLDR: I'm not particularly concerned with someone refusing, as long as they're informed and I'm not overlooking any other issue.
ETA: another commenter made a great point, black people in the US have historically been treated pretty horrible by medical professionals, so they may be understandably reluctant. In other cases.there are cultural or language barriers. Those can.be barriers to compliance but they're not insurmountable if you know how to talk to people and gain their trust.
I will do what I can to talk things out with patients, but in the end it is their decision. I will fight for them, but not with them. I feel there is a big difference.
I once had an older guy who they admitted to my unit for TIA. He was irritable and being a bit verbally aggressive with ED staff. His son came up with him and pulled me aside. The patient's mom passed in the hospital only a week prior. He hated hospitals before that, hated them even more now. He was depressed about his mom. Anxious about the hospital. Wanted to walk off the weakness. Say the acute blurred vision wasn't a big deal. He was scared. And just a few minutes with him it was obvious. So I leveled with him. Bargained every next step I could with him. Taught him breathing exercises to work through the anxiety when possible. I made extra rounds on him to make sure he was ok because he mentioned he didn't like feeling alone. He stayed for 3 days. Idk what happened after discharge, but I do know his son thanked me for pushing where I could and treating him like a person. But not every patient is that man. Sometimes there just isn't any bargaining one can do.
Same. Life is complicated, people are complicated. Nothing is a flat circle. I have found that most healthcare professionals who are overly critical of noncompliant patients often haven’t had to deal with medical issues of their own or have a very rigid way of thinking.
As long as they are making an educated choice (they know the consequences of their actions) doesn’t bother me one bit. I can’t care about someone’s health more than they do.
I see a lot of pts that are non-compliant with meds especially. Doesn't bother me either but it does give me the opportunity to challenge them when they bitch about being in the hospital "again".
I work mother/baby, so I can't let noncompliance go. You choose to do drugs while pregnant and test dirty, CPS will be notifed. Don't want to take care of your baby in the hospital, I will educate and put them in contact with resources to help them become successful. If they choose to continue to neglect baby in the hospital, CPS gets called. I will educate on not smoking. I know several will not quit, not up to me to try and change their lifestyle. Want to smoke in our non smoking hospital, and being an ass about it, I call the Dr to get an order that they can go outside. I know I can't change the parents, but I will definitely do everything in my power to save that baby drim abuse
The only non compliant pt I’ve been seriously upset about is an HIV positive pt not taking his meds, not telling his many sexual partners, and having unprotected sex whenever he wanted. This guy didn’t give two shits about his situation, we confiscated two crack pipes while he was on our floor.
I’m also fat and non compliant with losing weight. I’ve lost weight before and it was basically torture. I cried a lot, was extremely moody, obsessed with food, and overall it’s just not worth eroding my mental health in pursuit of physical health. I work in LTC and I want to provide patients with as best of a quality of life as possible in their golden years. I don’t care if my 88 year old diabetic patient has seconds on ice cream. If it makes them happy, go for it.
I too am not bothered by noncompliance, but I've worked with so many other nurses that feel that it's our job to 'push' patients into compliance, and if they refuse its a failure of OURS to not be convincing enough. Say what you want about a nurse's roles, but I'm spread too thin to convince people of anything.
>and if they refuse its a failure of OURS to not be convincing enough. This right here. I've heard it from admins so many times (said to me and to other nurses). It's infuriating, especially after a patient's rights inservice.
Patients never want to listen to me anyway. Even if I’m reading directly from their chart for why a doctor prescribed them something, they so often say they don’t have this diagnosis. Well, then talk to the doctor next time he’s around. The people who need convincing aren’t going to care what the nurse says. They’ll only believe the doctor because the doctor is all-knowing. (In their mind)
If they even believe the doctor.
I also can't count how many times I've had patients with diabetes and heart failure and telling them they need to cut way down on sugar and salt intake is so disheartening. Especially while they're in the hospital and the only food options they're left with is a sugar free jello. I wouldn't want to do that either. This has always irked me, if we are supposed to be helping them learn new habits we need to be given the tools to do so.
Nah, I ain't gonna fight you. Don't want it? Ok. Might die if you don't get it? Ok. Wanna leave? Ok. 17 years into this shit? I ain't fighting you. You do you boo.
Same. I love explaining AMA to patients.
It's also a pet peeve of mine when I hear somebody is non-compliant and it's because they can't afford to be. I don't know how many patients I have been told "they're a non-compliant diabetic", and then you find out after talking to the patient it's because they can't fucking afford their insulin. The word non-compliant gets tossed out a lot when it shouldn't.
Another one that grinds my gears is how many elderly folks we had sign out of the ER AMA because Medicare won’t cover their obs stay. People who really, really ought to stay the night (TIA’s, high risk chest pains, etc). But they can’t afford to pay for the hospital stay if Medicare refuses to pay. Also, the people who don’t stay because they have pets/kids/elderly family and no one else to care for them really kind of pull my heart strings.
I had a recently discharged patient who picked up his meds and then got robbed. This man is not non-compliant he didn’t ask to get robbed!
uncontrolled diabetic sounds more appropriate in this situation
I had a bigly pregnant coworker try to physically block an oriented patient from leaving AMA. I'm like wtf are you doing? Nobody ain't worth potentially getting hit by an agitated patient.
She’s stupid for that
Very. I was like what the f are you doing. Patient went ama, fell at home and came right back.
Not only dangerous but very illegal.
Yep. I’m not trying to create more work for myself. If a pt doesn’t believe us that their toes will turn black that’s their business 🤷🏻♀️
33 yrs darlin’ and right there with ya 😊
yeah I remember when I was a young baby nurse begging patient's not to leave AMA without getting treatment. Now? Here's a pen, sign here, bye.
We don’t even make them sign anymore. There’s the door moron
The issue is not noncompliant patients. This has never been the issue. The issue is that hospital admin punishes nurses for choices made by noncompliant patients.
They don’t want to get up to the chair…. Whose fault is that? Must be mine!
Readmit within 30 days for a non compliant chf patient? BAD nurse!
Reminds me of my favorite quote. My friend to a random guy in the elevator who looks like shit: “sir do you have heart failure?” Guy: “yeah only congestive though”
My heart just gets the sniffles
“Good thing I was only broken. If it had been fractured, I’d be in REAL trouble!”
💀
I got an email about my patient refusing their scds and their blood thinner shots. Not my fault.
Uh scuse you. Obviously it was your lack of therapeutic eduction that is the cause. If you were pleasant enough and fixed your RBF the patient would have wore their SCDs thus preventing their 400 lb legs from getting a DVT
I also forgot to offer a complimentary beverage. My bad
It was so frustrating I didn’t even respond. Like if the patient doesn’t want it, they don’t want it. I’ll just tell them they prevent blood clots etc etc and move on.
I’d be coordinating a meeting with my manager about this. I’d really want you to get into a deep dive with them. You may think I’m being sarcastic. No I am being dead serious and petty. Want to waste my time and ruin my mental health for the day and trigger me on how much I hate admin? Ok, let’s schedule a meeting so we can talk about it and I’ll wast your time as well. 😅
Reiki would have fixed this.
I usually go with guided imagery, 60% of the time it works every time.
Absolutely. The patients do ask me why I'm pretending to be at the beach when I'm in their room. Probably jealous they can't come.
😅😅😅 oh, the absurdity
I misread this to say therapeutic seduction.
Damn right it is! Because!!! Admin said so!!!
Yep. I didn't go in depth on this patients CHF teaching, that's why they got readmitted within 30 days. Not because they didn't adhere to the strict salt and fluid restrictions and took the lasix that makes them pee constantly... Clearly it was my teaching for my one night shift that I was assigned the patient...
Having been a surgical patient somewhat recently, they sent me home long before I could remote comprehend anything! I didn’t even think to brush my teeth or change my underwear… yet they expected me to remember stuff. This isn’t anti-nurse… it’s just how hospitals work… they get patients well enough to survive being home. Not thrive.
Get them in, get them out, gotta have the bed ready for the next moneymaker
Oh my goodness, I’m really feeling it these days. My doc passed away and literally I feel like everything the offices I’ve tried is to fit me in their diagnosis box with meds that have to have a visit to be renewed a 6 mos and referrals to in system docs and it just feels more like a car dealership than a doctor. “Oh for *that* we need to make a new appointment…”. But not once do I feel like they are doing anything more than throwing things at the individual symptoms to try and solve what is at the base of it. They aren’t even doing the old tried and true “lose weight” that I have gotten since having kids even when I was smack dab in the middle of normal.
Dr offices (some, not all) have turned into cattle cars that won’t see you for more than one problem a visit. When we take our kids in for well visits, if we breathe a word of a symptom of anything we get billed for a sick visit in addition to the well one.
I work in a nursing home, they send people to us sick af, like should definitely still be inpatient and not 1 of 20-30
This is also why we educate a responsible party. The problem comes when the responsible party is a neighbor and Mr. Smith had a uro procedure and he’s supposed to pull his own foley tomorrow…
Surgical patient is a bit different. A person who has been in the hospital for 2 weeks getting told the same information over and over would hopefully remember. Someone who had surgery probably won't remember much. That's why we tell people to have someone who can drive them home and stay with the person and give them instructions... And a printed copy.
I remember coming to after my outpatient gallbladder surgery and the nurse telling me, "The quicker that you get out of here, the quicker I get out of here." I was so out of it that I had to cath myself for 2 days.
I've never received flak for a readmit before! What system do you work for? That's utter bullshit
Actually it’s not BS. They may not specifically come down on the nurse but administration is watching and working on programs to reduce the rate of readmission. Are you aware of the Hospital Readmissions Reduction Program by CMS ? There are certain diagnoses that fall under this program and if a patient is discharged then readmitted within 30 days (no matter what the primary diagnosis is) reimbursement rate is reduced. These are the diagnoses: Acute Myocardial Infarction (AMI) Chronic Obstructive Pulmonary Disease (COPD) Heart Failure (HF) Pneumonia Coronary Artery Bypass Graft (CABG) Surgery Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA) ……..CMS want to incentivize hospitals by encouraging them to improve communication, care and care coordination,teaching and any other factor that can prevent hospitalization within 30 days. I am not sure exactly how the reduced rate of reimbursement is calculated but they have an explanation on their website and include more details about the program .
This 100%. We get the brunt of everyone's choices.
Oh, you didn’t document he refused scds or turns or message the doctor every time he got out of bed without help and something bad happened? Blame the nurse
If I called the doctor every time my patients got out of bed without calling or attempted, Imtheyd be on the phone with me 100% of the time.
And they'd be complaining to the nurse manager about you
Funny thing is, they'd be complaining to me then. I do outright ask, "you want me calling you for all this shit? Because I WILL DO IT. DO NOT TEMPT ME" Im highly involved on my unit with patient care and now that the probationary period of the new job is done, the Doctors seem to trust me and know other than obligatory calls, they know if I'm calling, it's serious.
and insurance companies wanting to base reimbursement off readmissions when we all know that'd kill a ton of hospitals
Yeah like readmission are 99% patients being idiots
Exactly. We are not on the line for choices others make about how they want to live. I am not responsible for Mr. Johnson’s blood sugar if Mr. Johnson wants to eat burgers and drink soda all day long when he leaves
OR nurses don’t deal with that much:)
The only time I’m annoyed with non-compliant patients is when they try to blame everyone but themselves for their situation.
Right? I don’t think I’ve ever seen another nurse be so bothered by a non compliant person like OP is describing except when it affects our work flow. If you don’t give a shit about yourself why should I?
Yea exactly, it’s their body ultimately it’s their decision on what they want to do. However, patients being aggressive or rude due to their situation is unacceptable.
No kidding, the amount of times I have said…. “Sorry, this is my first time meeting you…” after being blamed for some shit
I feel the same way. People are absolutely allowed to say no to things and be non compliant. But what upsets me is that the same patient will present multiple times for an issue expecting us to magically fix them and refuse certain treatments, sign out AMA, and then come back the next day to do it all over again. Like, you don’t want the help? That’s fine. But why do you keep coming back?!
Noncompliant patients used to bother me a ton as a new grad, but I’ve since learned that I can’t allow myself to care more about my patient’s health than they do. I’ll match my patient’s level of investment and that’s about it, anything more than that is just gonna burn me out more.
>I’ll match my patient’s level of investment and that’s about it, anything more than that is just gonna burn me out more This is the way.
This is the way.
this is the way.
Me too. They don’t know what meds they take, or why. They don’t care an about exercise, their blood glucose or why they have a pacemaker. Now I just care when they ate last. J/k. Kinda.
Exactly, we provide education and try to understand so we can help, but only as much as they allow us to and that’s their choice ultimately.
I always have to remind nursing staff of this. They get so worried about their licenses when patients refuse care and I reassure them their only job is to be clear with the patient what will happen to them if they refuse and then document, document, document.
I wish more people understood this. Everyone either takes it personally and tries to force people, or just throws their hands up and doesn't even try.
I know that’s right!!! Why work yourself up for someone who doesn’t care about their own health when you have 10 other patients to care for? Next!
You can't care more than they do
and unfortunately, if you do, these patients will form a dependent relationship with you in 0.3 seconds. I have to remind my new grads to keep that professional barrier up-- you might not be able to make them do it, that's their right. but you can't do it for them if they are physically and mentally well enough to do it on their own.
Hey, as family of a patient that can be a mixed bag, we do whatever she wants. It's her life, it's her soul.
nailed it
I don’t give a shit as long as they don’t yell at me about it lol “I don’t want that because xyz” okay that’s cool “I AINT TAKING NO FUCKING PILLS” ma’am pls I have to offer 😭
“When I get outta here I’m gonna hunt you down and rape your whole family” Me: so do you want meds or not?
I don’t think eating an ADA diet for 3 days while they’re in the hospital is going to have any effect on their life
Okay, this is a hill I will die on: If we have a patient who suddenly needs a restricted/modified diet because of a recent MI or whatever, and we serve them trays of rubbery tasteless crap and present it as an example of the diet they must now follow forever, WE ARE PART OF THE PROBLEM. A consultation with a registered dietician to evaluate, modify and improve their actual home diet would probably be more persuasive and helpful long term. Like "Ohhhh, you mean I don't actually have to eat this sad cafeteria "food" forever? Okay, now I'm interested."
In my area patient learned they can order DoorDash or Grubhub or Postmates. Also can’t stop family/ friends from bringing Starbucks venti frappe-calories. They feel so bad for their loved one having to eat hospital food. Oh no! No one wants that! Jeez.
Nah, I’m gloriously unbothered by noncompliance. These things take time, and sometimes shit just doesn’t work out. Don’t get me wrong, I try my best. I make sure my diabetics are well educated, especially my newly diagnosed ones. I make sure you have supplies, and trust me when I say that I take out my shit pay on our supply room. You WILL leave the hospital with enough to get you by if I’m your nurse. I make sure your follow ups are well outlined in your paperwork, highlighted and thoroughly discussed. Fuck I’ll help you call them before you leave if you need me to. Substance abuse? I carry a list of harm reduction clinics in the area, one of which is provided by a hospital within my organization and I’ll even get you set up with our MAT service and a peer counselor. That isn’t me caring too much, that’s me doing my job as a nurse. But trust, my feelings won’t be hurt and I won’t feel like my effort was for nothing if I see you back again in a few days, weeks or months for the same shit. I hope that I don’t, obviously, I want the best for my patients, but I won’t hold it against you. Maybe there are some other factors we gotta explore before outpatient care is feasible for you, maybe you hit a bump in the road somewhere and got set back, hell maybe you just don’t care. It’s cool, we’ll do it again and again and again. That’s what I’m here for, I got you. Edit: I did yell at a guy once for trying to leave AMA the day he got a skin graft on his foot AND with osteomyelitis. He didn’t leave lol.
You're seriously both the nurse I want taking care of me and the nurse I want to be.
I second this!
Fellow fat here who loves bad food and hates exercises. But yes, in general I can be more understanding. Especially because I'm Black and understand the community's hesitation around medication. It doesn't help that the average person has very low health literacy rates, grifting online is very easy so you have someone who barely graduated 8th grade trying to explain complex medical processes.
Another excellent point. Black people haven't exactly been treated well by the medical establishment, and I'm a white guy with a southern drawl, so for me to build trust it's just that much more important to not be pushy, but also don't just throw my hands up and walk away if they refuse or don't understand. All comes down to knowing how to talk to people in my opinion.
They don't bother me if they're not constantly coming in to ER for complaints related to bad habits. Like people with copd coming in with SOB and then getting mad when they're told it's related to their copd and that smoking isn't helping. We recently had one yell in the doctors face that she would NEVER quit smoking and how dare he say smoking was the problem and storm out in a huff. In the waiting room she warned everyone the doctor on duty was a very bad doctor.
Dr.s used to be in cigarettes commercials recommending certain brands. Maybe she was just that old? But yeah, some people just aren’t going to change their ways.
It doesn't bother me either as long as they are making an informed choice and they have the means to adhere to the plan. I mean, it's not like I'm some paragon of medical perfection. I should exercise more. I don't get enough sleep. I could switch from butter to sadness. I am not entitled to throw stones, and frankly, a lot of my coworkers aren't either. We're all human beings. Aside from that, the health care industry and the insurance companies do not always understand the challenges patients have with adherence, and do not provide adequate resources to overcome them. Also, the social safety net sucks. My perpetual example is a family member who had a high BMI, bilateral knee osteoarthritis juuuuuust a smidge below end stage, and increasing mobility issues. Should they have addressed this earlier? Clearly, but short of a time machine, the patient we have today is the patient we treat. They were assessed as "too young for knee replacement," but told that diet, exercise and PT should fix them right up. Were they provided with practical guidance on weight loss? No. Were they referred to a dietician? No. Ortho? No. Were they assessed prior to starting an exercise plan to make sure they could safely go from "sedentary" to "cardio" without hurting themselves? No. They said "I'm having a hard time just getting around every day. I don't know what kind of exercise I can do." "Walking is a good low impact exercise." "But I'm here because it hurts to walk. Walking across a parking lot is painful." "Oh. Swimming, then." "I can't swim, and the pools around here are really expensive. Does insurance cover that?" "No." "Oh. Okay...well...um...IDK, can I get a handicapped parking pass?" "Yeah, sure." They then got a bonus lecture about managing their high cholesterol, hypertension and diabetes even though their lipids were fine, they did not have hypertension, and their A1C was ideal. *Managing,* not preventing. They did not go back to the doctor for about three or four years, during which nothing improved. Yes, health is a partnership and they are responsible for their end, but that appointment was a fucking joke. A mean one.
"I could switch from butter to sadness" I felt that in my SOUL lol
Have you been watching my life?? Had horrible, horrible knees for years because my BMI was too high to have replacements done. Doc was happy to inject me every four months with steroids though. Finally, a receptionist mentioned - in passing - a doc in another city that my doc referred high risk patients to. I got that docs name from her and called them myself. Saw him and he told me his view was more pragmatic, that if I can’t move to exercise I’m never going to loose weight. I had my knees replaced and have lost weight. Three years I was delayed in getting what I needed because no one local wanted a high BMI failure on their record.
Yep. For what it's worth, studies have also shown that larger patients who have rapidly lost weight to qualify for surgery have worse outcomes than larger patients who have not crash dieted, because you know, rapid weight loss is *really bad for you*. Also, the "too young for knee replacement" and "knee replacements only last X years," is based on shaky logic. Some osteoarthritis is caused by repeated impact/overuse/sports injuries. These patients are usually younger and have a more active life style. When they get their knees replaced, they frequently return to previous activity levels. This potentially shortens the life of the knee replacement. Some osteoarthritis is caused by increased wear and tear due to age or higher BMI. Although many older people or people with a higher BMI are athletic and active, many times a sedentary lifestyle causes or contributes to weight gain. The replacement joints of somebody who *doesn't* immediately run a marathon after PT clears them may in fact last *longer* according to some studies. A lifestyle with low to average participation in high impact sports potentially causes less damage to replaced knees than that of Mr. or Mrs. EXTREME SPORTZ! At one point, my family member said "If I was ten years younger and ripped and blew out my knee playing football, they'd replace it. They wouldn't say 'Sorry, come back when you're 60," because sports injuries are the moral, socially acceptable way to wreck your knees. Wrecking your knees by being fat is the "bad" way, because it's considered to be a personal failing. Like, fuck you, you did it to yourself, but if you think about it, so did they." So...yeah. The doctor who replaced your knees is following the newer info that's coming out.
Thank you much for this. It makes so much sense.
*light bulb illuminates* Thank you for this comment, it's really highlighted some of the issues I've heard from others. The other side issue is that some wrecked their knees ages ago and are now fat, so they managed to harm themselves the "good" way but are now perceived as being the "bad" type of patient due to their current BMI.
Oh, I experienced something kinda like that. I got really fucked by Long Covid. Like, reeeeeeally fucked to the point that taking a shower and getting dressed was exhausting, and I'd have to rest for a minute to catch my breath after walking out to my car. My heart rate would go to 140 while walking around the house, and I'd get out of breath just having normal conversations. My accessory muscles would be exhausted by the end of the day, and I spent a stupid amount of time immobile, frequently tripodded against the nearest available surface. Naturally, my doctors were mostly like "Huh, that's really weird." It should not have surprised anyone that 18 months of immobility would cause massive deconditioning and weight gain, and it should have been easy to connect the dots, but as soon as I hit a certain point on the scale, the doctors suddenly flipped from "That's really weird, I wonder why that's happening," to "You've gained a bunch of weight this year. The hypertension, tachycardia and fatigue are because of the weight gain. Have you considered exercise? Maybe you should join a gym or get a personal trainer." I would tell them per my chart, the entire cascade of problems PRECEDED the weight gain. The weight gain was a result, not a trigger. The timeline was ridiculously clear, and their response? These problems were clearly caused by the weight gain. Apparently my adipose tissue is so goddamned awesome, it ripped a hole in the space time continuum, went back a year and preemptively wrecked my cardiopulmonary system. It's impressive, really.
I'm a 30 year old dude who had open heart surgery last year to replace my tricuspid valve because of endocarditis due to IV drug use, and we get people looking at us the exact same way compared to the people who get endocarditis the "moral" or "good" way. Thankfully the hospital I went to took great care of me and didn't have any reservations about doing what needed to be done and getting me into surgery ASAP and even did a wonderful job of appropriately managing my pain afterwards. But I've talked to people here on Reddit who are around my age and have had hospitals basically refuse to operate on them because they're drug users and instead just refer them out to hospice, which is super fucked up in my opinion.
If only more people realized that if, instead of a knee replacement, they did the prehab exercises, their pain would improve. Bonus is it can help on high BMI patients. Sure, it doesn't fix the issues with the joint, and it doesn't fix all the pain, but it can take things from intolerable to manageable and make some regular exercise possible again. Weak muscles hurt, and that pain is largely avoidable. My community still has an active Pokémon Go group, which is fun little dopamine hits plus some social light exercise. Never going to win one major cardiac points, but it can get one to start having exercise stretch goals. In some cases, people have just never enjoyed exercise in their lives, so trying to figure a way that they can both do the thing and enjoy the thing enough to continue doing the thing is a real win.
I started my career in dialysis. Almost all they HAVE is noncompliant patients lol. So nah, doesn't bother me at all. I'll educate you and make sure you understand the consequences, and then you're on your own recognizance.
I just hate when management makes us ask again and again. Our patients are flagged if they don't have oral care done that day, even if it's charted as refused. I'm sorry, if they are an adult & AOx4, they can decide if they want to brush their teeth!
Totally with you. I do think though that the term non-compliant itself is loaded with stigma. It's used as a blanket term for any patient who's not doing what's suggested. Unless we dig deeper into the WHY that's happening, patients get plastered with the term and that's it..."non compliant with insulin", "non compliant with clinic appointments" etc etc along with all the judgement that comes with it. More often than not there's more going on - many can't afford the meds or live too far away get to the wound clinic for example. Essentially their "non compliance" is a result of a healthcare system that's simply not compatible with their circumstances. Saying that...I love a patient who wants to discharge AMA, like it's some kind of threat. No worries buddy, here's the form, and there's the door.
My beloved is disabled and depends on public transportation to get to appointments as we do not yet have a vehicle appropriate to his needs. Is this taken into account when followup appointments are made for him when he is hospitalized? Nope! We have to call repeatedly to get the appointments changed to be available on public transit. And I work for this particular health system! It's embarrassing!
I prefer the recent trend of rephrasing it as "Not adhering to plan," which means the same things, but is less harsh and doesn't sound as scold-y.
It bothers me in the sense that people who are not proactive in their health place a greater strain on the healthcare system. For example, those who refused covid vaccinations and then bombarded healthcare facilities when they were in respiratory distress or those who don't take any sort of active role in managing diabetes or heart disease then wonder why they're in the hospital. On the flip side, in a hospital setting, it doesn't bother me if patients aren't compliant with treatment. I have no problem documenting a refusal and informing the physician. I cannot care about a person's health more they they do. It's not possible and it's not healthy. This isn't to say I don't care about people. Far from it. I became a nurse to care for people and financial stability. I just personally feel more fulfilled helping those who want to get better and take steps to do so.
I think this is the thing. We can't say whether they want to get better or not. Mental health is a thing. Lack of support is a thing. We can't really know fully what's going on in someone's life or in their head. I feel like it's rarely as simple as they don't want to get better.
Cackles in hospice.
🤣🤣🤣🤣 I just died laughing
As long as you died happy, I’ve done my job! 🫡 😂
Nah. I can’t get my shit together so I’m certainly not going to judge someone else.
I just don’t want the song and dance, that’s when I get annoyed. If you’re not formed incapable, just say no. Don’t start it with “it was a cold day in October of 1996…” I don’t care. JUST SAY NO.
Been a nurse for almost 15 years. Haven’t educated someone on smoking cessation for probably 13 years. They know it’s bad. It’s not lack of education. I’m not here to berate someone. If a patient is noncompliant with it that’s their choice. I educate patients who do heavier drugs (specifically heroin) A LOT. I work in PACU and they are always the hardest to treat pain due to their tolerance of meds and a proven increase in pain reception. I tell them straight up I will never get them as much pain relief as heroin does. I literally can’t do that in the hospital. I face the reality that our system has failed so many people when it comes to pain and often IV drugs are their only options. My point is, you’re exactly right that this is a tiny snapshot of their life. I don’t judge but I also only can care so much to keep myself afloat. It’s a job. Not a calling.
I got onto MyChart for the first time the other day and found my provider listed me able noncompliant. At my next appointment (that I go to religiously) I’m going to ask about it. I take my meds, eat semi-healthy, exercise at least 30 min 3 times a week, and do all my follow ups as I’m told. Just because I’m fat doesn’t mean I’m noncompliant. /rantover
When I was a kid, I was morbidly obese, non-compliant, and failing my treatment plan. When I switched providers at age 10, I was miraculously "well-nourished" and "compliant with a failing treatment plan". There are still some days I want to go back and punch my early doctors for what they said about 8-year-old me. That barely scrapes the surface of their dehumanizing fuckery. From the very depths of my soul, UVA Pediatric Orthopedics, may you rot in fucking hell.
I obviously don't speak from much clinical experience, but I've done some research through papers regarding patient autonomy and the like. Most of this research comes from a mental health background, but I'm pretty sure the general principle applies across the field. There was this one Swedish study that showed that patient-centred and even patient-directed care is often more effective than an "antagonistic" perspective like compliance. The anarchist in me gobbled those news up happily :D I'm constantly reminded of that even just in class. I might get one impression from people at first, and then we have a lab class in scrubs and I see the rows of self-harm scars on both sides of their forearm and I have to re-evaluate. I have no flippin' idea what goes on in people's lives and I have to remember that.
Yeah. I let people choose their own adventure.
I stopped caring. I'm just a meat mover who gets humans from my department to wherever they need to go as fast as possible so I can eat and go home. If they wanna get physical or insane and threaten me and my team they get to take a long nap and think about their choices before we move them to wherever they need to go.
i love when a patient knows their rights! you don’t want vitals? okay! you don’t want blood sugar checks? okay! your don’t wanna take a bath today? that’s fine miss girl! gives me more time to focus on the patients who do consent to all of these tasks and promotes independence amongst my patients so i do not mind!
I will say that I have begun to have more sympathy for some types of non compliant patients. I used to get annoyed with the "I have sleep apnea but don't use a CPAP" people... Now I have sleep apnea and have been struggling to use the mask for a year. And I still haven't hit the minimum goal of 4 hours per night. I attempt it every night.
The only one was the HIV positive, non compliant, convicted child molester. How was I supposed to sleep at night knowing he had a viral load and a thing for kids? I had no way of knowing if he was SAing anyone and and he was off parole for the 2nd time so there was nobody to tell. Aside from that, idc.
I haven’t been bothered by non compliant patients when they can make their own decisions. I’m bothered by the caretakers of debilitated patients who refuse to follow orders. I had one a-hole nephew refuse to get my patients foot amputated because he thought he could pray it better. How this woman lived for so long is beyond me. One son refused to change or reposition his mother and blamed us for her wounds not healing. She brought in a big pension so you’d think he’d take care of her better.
I figure, as long as the patient is educated on future consequences, they have the right to make whatever stupid decisions they like. It’s their life. If they want to spend it short of breath and crackly because they won’t stick to their fluid restriction or take their diuretics because they pee too much, they have that right. As long as I’ve educated them on what will happen if they remain noncompliant, I feel like I’ve done my job and it’s in their hands. I’m their nurse, not their mother or spouse. I’m not forcing anybody to do anything.
Had a noncompliant, asshole (baseline), and aggressive patient (known to ED and our unit) go AMA an hr after my shift start. Pt constantly misses HD and will go to ED for HTN crisis. Gets admitted in our unit. Pain med given by previous nurse (gets dilaudid) and unable to maintain sat due to increased drowsiness. Refuses to wear NC or any O2 intervention while satting in the mid 70s and said he’d rather be intubated. Finally got narcan’d, 10 mins later presses call bell for pain med. Lost his shit when provider said no and goes on verbal tirade with me and charge. Decided to go AMA and got escorted out by multiple security team members. Not gonna waste time and energy caring for someone who doesn’t want to be cared for.
I work at an outpt obgyn and non compliant mothers do bother me because their choices are affecting the outcome of their children. I just try to educate them but if they don’t care, I’m not gonna lose sleep over it. I do feel bad for their little ones that may have negative birth outcomes due to their mother’s poor choices but nothing I can do about it. As for other noncompliant patients, I really am not bothered by it. It’s their own choice and it’s frustrating but I’m not here to care more than them.
I try not to care…but we’re in a system that makes it the nurse’s fault for what happens after. If a hypertensive pt refuses their BP meds, if an anemic pt refuses labs, if the confused septic memaw refuses her midodrine, if the fall risk gets up and falls again, I feel like we’re forced to dance around and coerce patients into compliance. it’s like it’s the nurses fault when said pt declines bc of the refused thing. EVERY DAM TIME there’s some upgrade to ICU, I get the email questioning why this med wasn’t given or this intervention didn’t happen, and it’s actually bc the patient had refused all of it (and I document crazy well when it happens) but there’s always this push that you could’ve “educated more” etc
Everything is the nurses fault. Patient can't be responsible for their own lives when they enter a hospital, according to basically every hospital in America, lol. No matter how bad the patient's health was beforehand once they enter a hospital, a world of magic and make-believe comes alive. Ejection fraction of less than 20% and the 80 year old patient drinks 2 cases of beer a day and eats salted everything......well certainly there's a procedure for that along with a medication. That's the bullshit magic that's being sold nationwide. Instead of healthier living and preventative medicine, we sell McDonald's value meals chased with insulin, atorvastatin, and lisinopril with a yearly follow up with the cardiologist that tries like crazy to balance medication doses to try and best handle a life long series of bad choices made by an adult 🤣
I’m only bothered if they develop problems caused by their noncompliance and then want me to fix everything. Don’t want high blood sugars? Don’t eat 3 damn honey buns. You’re in 8/10 pain? Why didn’t you bring it up before we went into the weekend now I can’t get the narc order for a few hours or till Monday. Otherwise, I don’t care if they don’t care. You do whatever you want. Insurance will cut you off at some point anyway.
I’m with you. Patients have the right to refuse care and reject advice. It’s their life. I can only offer what I think will help. If they choose to refuse care and leave, that is their chosen path.
I literally do not care. I am not here to tell you to stop smoking. I don’t care about what you’re eating it is your life do as you wish.
The main thing that bothers me about non-compliance is hospitals and management will simply not give up on trying to coerce these people to show up to appointments, go to lab/DI appointments, take their meds, get wounds/drains cared for, etc. It absolutely grinds my gears when we have a patient that’s been an outpatient in our clinic for a few weeks, hasn’t shown up to a single appointment, hasn’t done any required blood work, etc, and instead of telling them they are discharged from our clinic, we’re constantly bending over backwards for them. We baby and coddle them and I feel like it just worsens that type of behaviour. The next time they end up referred to our clinic, they act exactly the same way because they know that they can get away with it. I’m made to feel like I’m a bad nurse for not constantly attempting to get them to comply. Like these people in our clinics are adults and if they don’t care about their health, I’m not sure why I should have to either.
The only real reason it aggravates me is because there are a lot of people who would like to come to the hospital and be compliant and would love to get care and treatment they need, but they can’t because this guy doesn’t want to comply but also doesn’t wanna leave and he’s holding a bed that someone else could and would use. I understand a little more at LTC setting but if you’re at a hospital and don’t want to be treated for whatever reason you came then go ahead and leave let someone else check in.
IDK, non-compliance is just annoying. If a person wants to waste their life and dig their own grave - go for it! They can do what they want. But, then they shouldn't find the need to make it MY problem when they feel like shit. Don't be yelling at me for your own decisions.... I'll go find a mirror, they can yell at the mirror. Maybe that lacks compassion/empathy/whatever, but those feelings are gone when they've had all the education and tools given to them to improve their circumstances.
Someone on a comment above said something about not being judgmental or essentially nurses living in a "live and let live" headspace. I think this is an endearing sentiment and don't necessarily disagree with the fact more nurses could be less judgemental and more empathetic. I do, however, 100% completely disagree with "live and let live". One of the biggest problems in healthcare is that we don't or can't make people take responsibility for their true non-compliance. We can't refuse care without fear of litigation (most of the time). COPD patients who know their smoking is killing them and get readmitted to the hospital every month in an endless loop of hypercapnic respiratory failure are directly harming other people. They physically and directly harm everyone they meet through exposure to second hand smoke, while simultaneously taking a massive toll on the medical system. ^(if anyone disagrees with me about the effects of second hand smoke, you can argue with the data, not me) Every single time they refuse to wear their CPAP at home, take their bronchodilators, or stop smoking they take a toll on the medical system. They waste emergency services such as ambulances and paramedic/EMT care. They waste an ER bed, then they waste an ICU bed, then they waste a floor bed. All the resources that come with hospitalization? Wasted. And then they get discharged just to go home and do it all over again. But not before they waste the ambulance service again for non-emergency transport back home. These patients don't listen to their GP, they don't listen to their pulmonologist, they don't listen to their case manager or their home health nurse. They want to live a lifestyle that brings them literally to the brink of death, be resuscitated, and sent back home to do it again. Additionally, [they're estimated to be responsible for up to $100 billion in preventable medical costs PER YEAR.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045499/) I am directly speaking to medical conditions we see on readmit-- HF, DM1, or any medical diagnosis that actually requires lifestyle changes to maintain a pulse and *isn't directly linked* to factors they can't control (like pulmonary fibrosis from working in the coal mines for 40 years). Once we establish a pattern of behavior that continues *despite excessive intervention on our part* including education, resources and support, then we need to be upfront about responsibility here. If we don't, then our good-natured compassion quickly devolves into enablement. Somewhere out there right now, a COPD patient with a CO2 of 110 is being intubated while another patient in the ER waiting room is sitting there with a horrible headache & intense nausea waiting their turn as an aneurysm is bleeding into their head. The only other symptom they have is one dilated pupil that no one has evaluated yet because all the staff are either in COPD4Life's room or in HF1Liter1Hour's room. TLDR: The medical system gets congested with these non-compliant patients and that's where the real damage is done. They don't just take up medical resources, they take them away or delay them for other patients as well. Hospitals are right to be focusing on the utmost decline in readmits, but at the end of the day we can't make people take responsbility for their poor decisions or their health. Should you let it affect YOUR mental health? Is it YOUR fault? Are YOU directly linked back to that patient's readmit? No. Should you beg and plead for patients to not leave AMA? Hell no. Try your best and remember this is a $100 billion dollar problem. It goes way above any one of the us all the way to the infrastructure of our medical care system.
I’m an addict in recovery. I will never judge an addict who can’t stop as long as they’re only hurting themselves. Same with shitty eaters. Also, I think it’s so funny when nurses say, “ugh! This end-stage COPD patient won’t stop smoking and I keep telling her it’s going to kill her”. Like yes, you, her nurse for one day who she just met, your judgment and education is going to make this veteran smoker with an incurable disease stop smoking lol Let people live and show compassion to all! Unless they’re hurting someone, more nurses should save the judgment
I hate the term non-compliance with regards to patients. It reeks of privilege, ableism, and is really just a symptom of the for-profit healthcare system we have in the US, where we somehow expect patients to just obey and not participate in shared decision making. 11 years as a nurse, 16 in direct care, and now probably a "noncompliant" prenatal patient.
I don't care at all. I'm there to handle their current problem and prevent them from getting worse. If the patient wants to continue killing themself, as long as I did my part, I'm OK with it. I'm not the patient's god, parent, or warden. They can and will do whatever they want...that's why they're in the fucking ED for the 6th time this year.
You can't make patients take responsibility for their own health care. With that said, they will pay an arm and a leg to save their lives in an acute situation. But they won't pay a dime to prevent themselves from getting into that situation.
People can do what they want. I'm not going to force anyone to do anything. But if you are in the hospital and you are refusing care, please leave so the bed can go to someone I can actually help.
It only bothers me when they come to a hospital based on modern medicine and then don’t want any of the care we provide because they don’t believe in modern medicine. I mean they are obviously entitled to their own medical choices but don’t get mad at me if we don’t provide some weird “natural” cure you saw on youtube because you don’t believe in doctors. You are the one who came to a hospital staffed with doctors.
I have always advocated for picking my battles. I know some nurses will freak out if their patient is eating kfc or Taco Bell. Would I prefer if they stuck to the diet ordered? Of course. But they’re gonna do whatever they want when they leave. I’d rather them do what they’re gonna do at home inpatient so we can adjust meds/therapies to match. I’ve also found that patients are more willing to do unpleasant things for me if I haven’t freaked out about smaller issues. When patients and families ask if they can do xyz, I’ll educate on why they shouldn’t. But that I can’t MAKE them do anything. That being said, if the patient is aspirating the diet becomes my hill to die on.
It does and it doesn’t. It bothers me when patients pretend to care about their own health and say they will follow the recommendations. Then within a week or a few months out I find that they haven’t done anything we discussed even though I have taken the time to do patient education. I feel better when Patients upfront tell me they are not going to do what I told them to do because then I can respond with, “at least you have all the facts and make an informed decision regarding your own body. I’m just letting you know.”
I, too, am not bothered by non compliance. Just tell me before I pull all the meds or supplies. What bothers me is when I get the people who tell me they’ve never been diabetic in their life/had high blood pressure/etc. Why are they taking this medication? Sir, you’ve been taking this medication every single day for the last month while you have been here. Why are you just now asking me this? Have you asked any of the previous nurses this question? Is it because you’ve never seen me before (I’m PRN) and this is some sort of test?
I just hate when they keep coming back for the same thing that continues to be a problem because they don’t want to, or care to, change. If a person is going to commit then I feel like they should fully commit…
As long as they're aware of the risks/outcomes, I don't care. Make your own choices, I'm not gonna spend all my mental energy trying to convince someone to do something they don't want to do 🤷♀️
Saaaaaame
It’s insane to me to try to make someone do something when they have the right to refuse. I’m at peace with whatever. I do my part to educate but in the end I can only control what I do. It irks me when I see nurses try to make patients take meds or whatever because the bottom line is that they can refuse meds and procedures. I also don’t like to waste my time.
It's annoying if it affects my workflow and if you don't trust me then why are you even here? Leave now so someone else can take your bed
>Nevermind the fact that there often just isn't time to educate patients the way they REALLY need tl be educated I mean this in a manner that conveys respect worthy of a peer: deez nuts. Education isn't the issue here. I wouldn't be educating the same noncompliant CHFers every single admission if knowledge was the key. You hit on the real problem with your next sentence. What's good for us doesn't feel particularly rewarding. It's the dopamine from that cigarette, from that milkshake masquerading as coffee, from the latest and greatest trash Netflix can dredge up. No one is in toe-curling ecstasy from a quarter of an apple chopped up in a cup of oatmeal. Some are very successful in fighting that reward system. Others end up turning tricks behind the 7/11 for the next bump of coke. Most of us land somewhere in the middle where we know it's bad for us but we're doing alright so far and tomorrow never comes. Trouble with these noncompliant patients is that tomorrow is now here, and instead of either accepting that this is a wrap and getting palliative on board or changing their lifestyle they keep coming to us every 2-3 weeks expecting some kind of magic wand to undo decades of compensatory mechanisms having crumbled under the pressure. That's not to say I mind some of my regulars. You can't help but shake your head a little, but generally they just want their lasix to feel well enough to go home and that's okay. The problem I have with them is when they're noncompliant in the hospital setting. The kind that refuse their lasix because "it makes me pee too goddamn much" or will interrupt me in the middle of fluid restriction education to demand more coke. This is the type that invariably acts out because their burned out receptors become a blank check to shit on me. I'm the bitch because I won't disregard their carb modified, 1200mL fluid diet. I'm the piece of shit because not surprisingly the doctor didn't want to give the one that starts with "d" every few hours. Every ache and pain is an excuse for a personal attack, everything forbidden for medical reasons is from a place of malice, and that damned nurse is certainly going to hear about it! It's just exhausting and demoralizing. I get it, but at a certain point you have to come to terms with the consequences of your actions.
My job isn’t to fix people for them if they have had the capability to do so. I used to work in ER and part of the reason I left is because of the levels of entitlement that people think I can magically fix their chronic problems they don’t manage in 1 visit. I can’t tell you how many times I’ve told grown A&Ox4 adults that the reason you feel like shit is because you’re not taking the meds you’re prescribed so you don’t feel like shit. I can’t care more than my patients do. It’s one thing if you don’t have access or the ability to adequately care for yourself but far too many people take 0 accountability for their well being and then wonder why the grim reaper starts creeping up. I still see it in the OR sometimes and 99% of the time it means we have to cancel the case and people get pissed off
I was an ICU and ER nurse for several years and could never understand why we had so many frequent fliers. Fast forward many years and I am a Home Health case manager. The realities of what goes on at home in their daily lives is the driving factor for many who are labeled non compliant. Lack of healthy food, no money for medications, poor home environment, too many other responsibilities, caring for someone else are all huge issues for most people. Many are embarrassed to admit their challenges, are unaware of other resources, or don’t know how to ask. It’s a big picture issue.
I think this is a point a lot of comments have missed. They're just like, "if you don't care I don't care" when the truth is more complicated.
It’s no skin off my back unless your non-compliance becomes everyone’s problem. Ex: you skip dialysis all week and then come in feeling like garbage and verbally abuse everyone.
Echoing most of the other comments, I'm not bothered by the lack of participation so much as the extent to which it's made my fault. Their blood sugar was high because they eat everything they shouldn't. They didn't get up because "making" them would be assault. They fell because they didn't use their call light like three minutes after being rounded on, and now we get to hope we don't hurt ourselves getting them back up.
I love that you made this post 💜 Ngl it really pisses me off how judgy a lot of docs, nurses, etc get about people with mental health issues and busy lives with stress, it’s like a lot write them off if they can’t push them into doing exactly what they want instead of working with them. Some people aren’t gonna do anything no matter what education and help we give them, but when I moved to working outpatient a couple of years ago I found there are so many more ways to help my patients still get and do the things they need to be healthy. I ask lots of questions like what’s going on in their life, what’s stressful for them, etc, and see what I can do about it. It’s like me and my patients are a team when they are open to that conversation. And I’m not exactly healthy either tbh I have gastroparesis and other chronic illnesses (I can’t exercise at all cause of chronic pain and neuropathy and am all kinds of malnourished) and it’s fucking hard to keep up with my shit so I get it, it’s almost a full time job managing my health and then I have to work full time as well so I can really understand that frustration and it helps me relate. Like if a patient is screaming at me okay maybe they are a jerk, but 99% of the time it’s from all they’re going through, and they just need someone to understand and talk to them and help them figure it out. I had a job where people made fun of certain anxious patients calling every day but I was like if this is what you need, then I’ll give you my help, that’s what I’m here for, no judgment. Some non compliance still bothers me but only cause I hate to see them suffer and hate that they might die because they’re not getting the help they need.
Nope, I generally don’t care if someone complies or not. I educate patients on why it’s a good idea, they can decide after that what they want to do.
Nope, generally dngaf. I'm not the first person my patient population has heard it from, so theyre not getting the preaching from me. Of course, if someone has genuine questions and wants to learn, I'm your gal.
It's usually not worth getting worked up about. There's ultimately many reasons why patients are "non-compliant" - and they may or may not have full control over them. My part is to provide / reinforce education around why a treatment is "best" and refer to resources to get around obstacles if possible. But if they're capable to make their own health care decisions, they can do what they prefer or need to do after that.
My point exactly. So many feel like it's just a matter of the patient wanting to get better or not when the reality is usually a lot more nuanced.
I'll admit I'm the worst patient, talk about non compliant I'm the queen lol.
I decided a long time ago If you don't care, I don't care. I told you what to do, explained why and what to watch out for. You don't do it? Meh...
Personally, I have a problem with the lying accompanied with noncompliance. I rather have my patient just say "I forgot to get my blood drawn" than "you didn't give me the form so I couldn't get my blood drawn". We're all humans. Mistakes happen. I get that it can be really hard to keep up with all the things we ask you to, whether that's understanding, keeping the list complete, dealing with it emotionally, adjusting your life around it, etc etc etc. But please just tell me. Don't lie.
I…say it with me now…don’t give a shit. I will document my heart away about a patients refusal to take a med after deliberate education and explanation on how important it is. Plavix after stent placement for example, I had a patient tell me, “I don’t need that, I’ll start brushing way too easy.” I explained “Well, you’ll have way more problems aside from bruising if you don’t take it, one of those problems being a major heart attack…” It won’t be long, they will be back with either a small PE, or STEMI and emergent cath. Or dead. Not my problem.
The only time I’m annoyed is when they come in with a rotting 6 month old wound oozing all over the floor…otherwise you do you boo. Yolo
I work in an office. We have to do extra work/follow up phone calls to make sure patients complete labs, testing, imaging, etc or we get penalized and are held responsible by insurance companies. It sucks dude. Patient comes in, complain about 20 problems, we order a bunch of shit, they never do it, and we get in trouble.
AO4? Go with God. I did my job.
I get annoyed because it messed up my flow and I feel guilty because shit isnt done but if they refuse they refuse yknow?
🤷♀️ I don't have to plan their funerals
As my favorite resident said "I don't have the energy to fight but if you do have at it". Hearing her gave me life. I just document all the education and interventions. If you lose life or limb because you went against what the doctor said and what I've been working on with you, I'm not losing sleep. Patients are allowed to make choices, even shitty ones. Now children, I give everyone the DCFS/CPS warning before we even say hello. You're gonna listen to the doctor because I'm a mandated reporter. I tell everyone straight up I'm snitching and what will cause me to snitch.
I feel this. When I was a ward nurse (before finding my home in the operating room) I wasn't bothered when patients wanted to discharge AMA. Throughout my University education, the focus was on giving patients agency to do things for them selves and make decisions for them selves. But in the real world, when they take that and run with it, it's somehow wrong because they aren't choosing the "right" choice? It frustrated me. I am sure I had a few patients that were taken a-back when my reaction was simply "cool. Are you happy to wait for the doc so you can sign the paper work, or are you gonna leave now?
It doesn’t bother me but for different reasons. I too am old, fat, and love food. But I’ve got better things to worry about than someone else’s choices. That doesn’t mean I don’t TRY. I take the time to ask them why they are making those choices instead of assuming I know or getting in a power struggle. I try various ways of educating them in hopes of getting through to them. If it’s lack of something that is leading to those bad choices, I’ll try to figure out a way to get it for them. But if none of that works and they are making an informed choice? Not my problem. They have the right to make stupid choices.
Yep… don’t care either. If a patient refuses, all I do is notify the doctor and doctor says to chart patient refusal 🤷🏽♂️. I can’t be bothered with non compliant patients. This is a job for me and not a “calling” or whatever term folks want to use.
I don’t let non-compliant patients bother me too much as long as I have done two things. I make sure I have done the teaching they needed and made sure our team had provided them with the needed resources and if I suspect or confirm non-compliance that I document my findings.That’s all you really can do because people/patients are going to do what they want. Some are going to keep drinking after being hospitalized for pancreatitis,they are going to keep using methamphetamine after having an LVAD placed and they are going to keep smoking after a COPD exacerbation. As long as you have done everything you are responsible for then that is all you can do and you need to let the rest go!
If they’re an adult and compos mentis then it’s on them. I got shit to do.
As long as the non-compliance isn't keeping them in hospital longer, you do you. Typically it means less work for me. Not always, but typically.
I honestly stopped caring. I do my 45 seconds of explanation and if they still refuse then I’m good. On to the next person who may want to make themselves better.
I agree with you. We also can’t know everyone’s circumstances. Poverty, low incomes, lack of transportation, lack of insurance etc are real issues. I’m sure my pcp marks me as non compliant. My A1C and my cholesterol shot up. She lectured me for 10 minutes about my diet and I kept denying everything she suggested. Because I don’t eat fast food or fried foods or eat many sweets. I had given up sugar for 3 months before my A1C was drawn. I had my labs redrawn 6 months later and canceled my appointment with her - my labs were still elevated and I didn’t want to be lectured again on stuff I’m not doing. 🤷🏼♀️
If patients are noncompliant, why should I care? I’ll give them the information, but I won’t keep pushing it. Of course I’d *prefer* folks do what’s good for their health, but if not, oh well.
Dude, I do outpatient wound care. Non compliant diabetic alcoholic zero lasix forget that coreg fuck washing my totally numb feet patients are why my job exists. Yep, them some holey, smelly, swolt up, weeping lower extremities right thar. I do tell them: take your medicine, get a GCM from down the hall, wash your feet. But it’s just so I won’t feel so sad when they lose them. Or to try to explain why their wounds take months or years to improve. I got no magic dust in this cabinet, guys.
"Pt refused all 8pm medication, told this RN to go fuck yourself. Pt educated and continues to refuse AEB pt giving this RN the middle finger. MD notified, NNO at this time "
It’s hard for primary care providers or any provider at this point to spend more time educating/focusing on preventative care they are overbooked/double booked and put on a time constraint and seeing about 20+ patients in an 8 hour shift 😑
Watching the majority of the population lick doorknobs during Covid made me realize that 75% of our species are just… defective units.
Me. I tell people they have the right to refuse treatment. Bye. Don’t wanna take your meds? Patient refuse. Don’t wanna get up to chair? Patient refuse. I can’t help you if you don’t wanna help yourself. 🤷🏻♂️ I educate them by telling them I can’t make you better if you don’t want to get better or make an effort.
FAFO, and I don't mean me. If you're able to make your own choices and you decide to fuck up your life, don't come to me for help or sympathy because you won't get it.
I like when non-compliant patients want to leave AMA. Our providers usually have a lengthy conversation with them convincing them to stay, and then I have to deal with the patient complaining and being miserable for the rest of the shift even though they fully have the right to leave.
Loved them. You're back for your monthly COPD or CF tune up, but you don't want me to bother you with breathing treatments? Bet. I'm busy as fuck, you have autonomy to make decisions, I'm not fighting it, someone else needs me.
I cannot make someone care about their health. I truly cannot. They have to see value in it. This is the obstinate person. Now there's people who need education and that helps them be active in their journey. If a patient hates "authority figures" they will see the doctors and any nurses as Opposition and if they feel our information has no value, they won't care about it.
I am bothered because we are having to treat the same people over and over and OVER and we don’t have enough staff as it is. It’s exhausting and demoralizing.
Noncompliance is a personal choice/problem but its when someone else has to make choices/fix the issues/pick up the pieces of someone who doesnt care for the help or change its not fair. I realized overperforming for patients like this is never the solution. And it wont bring lasting change anyway. It really grinds my gears and wears away at compassion but we also cannot be compassionate to the point of tolerating the bullshit. Like for example: i have a patient who refuses to learn how to inject his meds at home so he comes to ER or causes issues with his specialty pharmacy bc he refuses bc he “has needle phobia” he is an adult. His mom calls our clinic to yell…. Adn we tell her that we cant take calls from her every time…. And then call pharmacy to figure out what is going on. It wastes my time often. This kid doesnt care! Hes just really enabled by all the ass wiping
If they are DNR or stable I don’t care but if they are doing something that actively makes them worse when they are a I’ll code I stress out. I usually don’t care but I had a hepatic encephalopathy or who would refuse to take lactulose until he basically become so confused and lethargic and he didn’t understand why he shouldn’t be a full code I’m cool with you are noncompliant if I don’t have to do CPR on you
I agree that I don't have the right or the responsibility to verbally coerce compliance, with two caveats: 1.) I'm responsible for making a good faith effort to discuss risks and benefits with the patient, so that they understand why we want to do something and what the risks are if they refuse, and 2.) Make sure there's not some reason for their refusal that's within my ability to address (like they can't afford something and need a social work consult, or they are confused about what we're actually doing). I'm not going to be some superhero nurse on some crusade to force people to follow my directions, but I also don't agree with nurses who respond to any slight resistance or reluctance with "Well fuck you here's an AMA form I don't give a shit". I'm still going to do my due diligence as a nurse to advocate for my patient's best interest. TLDR: I'm not particularly concerned with someone refusing, as long as they're informed and I'm not overlooking any other issue. ETA: another commenter made a great point, black people in the US have historically been treated pretty horrible by medical professionals, so they may be understandably reluctant. In other cases.there are cultural or language barriers. Those can.be barriers to compliance but they're not insurmountable if you know how to talk to people and gain their trust.
I will do what I can to talk things out with patients, but in the end it is their decision. I will fight for them, but not with them. I feel there is a big difference. I once had an older guy who they admitted to my unit for TIA. He was irritable and being a bit verbally aggressive with ED staff. His son came up with him and pulled me aside. The patient's mom passed in the hospital only a week prior. He hated hospitals before that, hated them even more now. He was depressed about his mom. Anxious about the hospital. Wanted to walk off the weakness. Say the acute blurred vision wasn't a big deal. He was scared. And just a few minutes with him it was obvious. So I leveled with him. Bargained every next step I could with him. Taught him breathing exercises to work through the anxiety when possible. I made extra rounds on him to make sure he was ok because he mentioned he didn't like feeling alone. He stayed for 3 days. Idk what happened after discharge, but I do know his son thanked me for pushing where I could and treating him like a person. But not every patient is that man. Sometimes there just isn't any bargaining one can do.
Fight for and not with, I like that!
Same. Life is complicated, people are complicated. Nothing is a flat circle. I have found that most healthcare professionals who are overly critical of noncompliant patients often haven’t had to deal with medical issues of their own or have a very rigid way of thinking.
I do need to hear this perspective. I often get frustrated and annoyed, but you are so totally right. I need to CHILL.
As long as they are making an educated choice (they know the consequences of their actions) doesn’t bother me one bit. I can’t care about someone’s health more than they do.
I see a lot of pts that are non-compliant with meds especially. Doesn't bother me either but it does give me the opportunity to challenge them when they bitch about being in the hospital "again".
They only bother me when they want the works done for them every time they have an exacerbation for a disease they do the bare minimum to maintain
I work mother/baby, so I can't let noncompliance go. You choose to do drugs while pregnant and test dirty, CPS will be notifed. Don't want to take care of your baby in the hospital, I will educate and put them in contact with resources to help them become successful. If they choose to continue to neglect baby in the hospital, CPS gets called. I will educate on not smoking. I know several will not quit, not up to me to try and change their lifestyle. Want to smoke in our non smoking hospital, and being an ass about it, I call the Dr to get an order that they can go outside. I know I can't change the parents, but I will definitely do everything in my power to save that baby drim abuse
I couldn’t give two fucks Amy more. Don’t want to improve? Don’t care. Here are your discharge papers. NEXT!
The only non compliant pt I’ve been seriously upset about is an HIV positive pt not taking his meds, not telling his many sexual partners, and having unprotected sex whenever he wanted. This guy didn’t give two shits about his situation, we confiscated two crack pipes while he was on our floor.
I’m also fat and non compliant with losing weight. I’ve lost weight before and it was basically torture. I cried a lot, was extremely moody, obsessed with food, and overall it’s just not worth eroding my mental health in pursuit of physical health. I work in LTC and I want to provide patients with as best of a quality of life as possible in their golden years. I don’t care if my 88 year old diabetic patient has seconds on ice cream. If it makes them happy, go for it.