The medication is a blood thinner, the patient is a competent adult not in delirium, A&OX4. There are 2 ways to see this:
Manager's and a group of doctor's POV: you are a nurse and it's your job and duty to do that. Plus, we know better than him what's good for him. These people have built their identity around working in healthcare and to them this means I have to stay in the room and make sure the patient takes the medication.
My POV: nursing is not a calling but a job. What my manager and these doctors think is stupid:
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the patient is a competent adult not in delirium, A&OX4. He's old enough to know what happens if he doesn't take the medication because we have told him a number of times already. I'm not his father and I'm not ready to treat a competent adult like a child.
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I have other patients and I'm not going to waste my time watching a patient silently until he decides to take the medication. I'm charting that I left the medication next to him and told him he needs it and why and that I have other patients to take care of.
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It is stupid to watch a person while doing nothing when I should be working with my other patients. It's also invasive as f*ck.
I see it like this: my manager and this group of doctors are not ready to respect a person's autonomy whereas I'm not ready to ignore this same autonomy, even if it means a negative outcome. Respecting a consenting adult's autonomy means respecting his bad choices as well. I feel this group of doctors and my manager are not ready to respect any patient's autonomy.
At this moment, this is a hill I'm willing to die on. AITA?
ETA: I wrote about a group of doctors, because there are other doctors that don't give me hard time if a patient refuses his medication, they simply chart it and move on. I like working with doctors like this because I feel they don’t judge and respect the patient's autonomy as well.
You can put it in nurses notes, or depending on the EHR put an administration "note" in the MAR. But you have to actually put it there and then your manager will yell at you. Point is, you need to be sure they actually took a medication you documented you administered at the time you said you administered it.
This stuff isn't "my bosses" though but "standard nursing care."
On the point of patient's refusing meds, they're allowed to refuse. Nobody's gonna fire you for patients refusing their meds. You just document it as "refused." Now if the patient later says to the doctor that they didn't actually refuse and you just didn't feel like pushing the issue, that's another thing. Put a nurses note as to why they refused in their own words if you want to CYA on that. Doctor has to talk to them a discontinue the medication anyway if they're refusing, so you need a note.
On a particularly difficult patient, like what you're describing, you put in the nurses notes each time you attempted to administer medication and they refused. Those type of red flag notes are always fun to see before you come on shift.
This pt isn't refusing meds though. I've been a nurse a long time, only ER but still, putting in note to the ehr instead of doing one's job is bad practice. They either take it or refuse. In acute care there's no "probably took it later" option. People can refuse whatever. I tell my patients (who can leave) this isn't hospital jail but this guy seems to be talking about dumping a cup of pills and leaving.
We're on the same page. That's what I meant about a patient refusing to take it "right now." That's a refusal and you just document it in the notes and try again after you round on everybody else.
That said, the floor and the ED act a bit different when we're talking about scheduled medications. Things can be a bit more flexible on the floor.
Yeah, this reads like an AITA post and the answer to op is yes lol. I feel like this is 100% not an autonomy issue like op said either. This is hopefully the pt's home meds or something but what if it was something that needs levels? The 5 rights are for pt safety and right time is one of the easiest to remember. I think your reply explains it best.
I wouldn't. They either take them when I'm in there or they don't. You can't chart they took it if you didn't see it. If they are aaox4 why can't you just explain to them they need to take the meds with you present?