I love Norman Rockwell imagery. There’s something about it that not only speaks of a different time, but a different relationship between the healthcare provider and the patient. He understandably focused on the Dr and not the nurse. In fact, I Googled and found no images of a nurse caring for a patient. That’s not to say he didn’t do any, just that I didn’t find any with that search.

Regardless of his possible omission, the role of the nurse is very different than it was in the 40’s and 50’s when he was painting these popular images. As I’ve stated in the past, nurses are not doctors, and shouldn’t be.

Something else has been sticking in my craw recently, and that’s the “rights” of patients to dictate their care. As a new RN I’m still navigating the waters in this area. I’m a firm believer that patients should be involved in their healthcare. They have every right to decide the course of their treatment. But managing that on a practical level can be challenging. People continue to eat too much, too often, and the bad stuff. They smoke. They don’t exercise. And I’m just talking about the nurses I know at this point.

Kidding!

Seriously, if a patient continues to behave in an unhealthy manner despite all evidence and advice to the contrary, when is it okay to stop treating? People with psychological conditions are forcibly treated, making it lawful to step in because the patient cannot distinguish reality, or is unable to care for themselves. The current popularity of blaming everyone else for our own condition is valid in a court of law (”They made the hot coffee too hot and I was burned”, “I can’t stop eating McFood, they must put something in it”, “I never would be this fat if they didn’t make Twinkies”….). Isn’t this a similar type of crazy living in a fantasy world?

Shouldn’t the healthcare providers be able to say “no” to the people unwilling to care for themselves in any meaningful way? Part of me thinks hell yeah! this is a possibility, and the other thinks that first part is sick. As nurses we’re here’s to help. But where is the line? Isn’t enabling exactly what we’re doing at some point?

And how about the professional patients? “No, I can’t tolerate dilauded, I need morphine.” “I’m more comfortable on 5 liters of oxygen, not 2.” “At home, I always crush that pill.”

These are the ones that are typically “frequent flyers” in the ED, the ICU, the substance abuse clinics. I spoke with one patient waiting for another set of lungs because her last pair were giving out. She was going through nicotine withdrawals because we couldn’t let her smoke inside. When do we cut them off? If they know so much about how to manage their health, then why do they keep showing up at the hospital?

Now, I’m not talking about the people who despite their best efforts simply cannot control the course of their condition/disease (cancer, AIDS, etc), but those who choose consciously or not to let go of that control until they get into a hospital. I don’t know the answers, but I’m very curious to hear other opinions.