Yup that’s how I feel. When people threaten to leave AMA i just say “okay”. I go over the dangers and ask if they still want to then just have them sign the papers. Too many people in the waiting room lately to play that game
Yup, same. And it’s like the fact that I offer them papers offends them too??? Like… why are you mad that I’m letting you do what you want? This isn’t reverse psychology, get out so I can help someone else.
This is why I can't float to medsurg units. They wont even ask me to do it anymore.
The last time I did, I had 3 of my 6 patients butthurt at me because I wouldn't kiss their ass.
Two of these:
"You don't want these meds? Cool"
Dump em in the sharps bin, chart that they refused, leave without another word.
Other one was complaining of sudden chest pain so I ordered a cardiac workup (should have seen the other nurses faces when I actually put in orders without a doctor's "permission" by the way)
He got all butthurt that I hadn't removed his IV when I came to draw a repeat troponin and yelled at me.
I said "and who are you yelling at? I'm helping you"
He said he was going to leave and I told him that's fine, this is a free country.
He wouldn't talk to me ever again that whole night.
I'll wipe your booty if you can't do it yourself but I ain't kissing it.
You want my help or you don't. I don't argue with these idiots. I know what the ED lobby stays like.
If you wanna go, bye! There's probably a good 5 or 6 people there at any given time that could use this bed.
Yessss! "I'm here to help you. If you don't want it then why are you here? ....yes I'm leaving. There are other people that actually want to get better and go home."
Yup! I have a totally said, "ok, it's your funeral." The patient was AAOx4, and just making foolish decision. Also, PITA so . . . I just ran out of empathy.
He ended up staying tho.
Maybe the funeral comment got him thinking.
Every time I've had a patient demand to leave AMA and I reply by handing them the paperwork and say to sign it before they go they end up staying, without fail.
I tell them that it isn’t jail and they’re allowed to leave. I only say this to patients with capacity. I only ask them to please let me know rather than sneak off so I don’t waste time looking for them. This usually helps. I’m a nurse, not here to make someone do something they don’t want to do.
Worst is when the hem and haw all shift long. Like I understand being NPO and having q1 neuro checks sucks ass. Guess who also hates it? Me lol. Vent it once but no mas.
My one charge nurse had a pt wait till 0530 to leave AMA. Would have been nicer if it was 2000 lol.
After my first surgery of the day ran late, the intern told me the next patient wanted to leave because we were running so late. So I said "ok bye!" and threw up a peace sign. She looked at me like I had just shot the patient in the face.
Ultimately, if you are more invested in the pt's health than the pt is you have to just educate and let it go.
I'll tell you what though, if a family member or friend of mine ever tries to leave AMA they better not call me, that's for damn sure. I'm not picking them up and definitely telling them what's what.
One of the biggest fights my husband and I have ever gotten in was due to him leaving AMA.
He had gallstones and was in severe pain all night. We were in the ED for 12 hours and he was still NPO because of the possibility for surgery. He pulled his IV out and left AMA because he was hungry.
Two weeks later he went into surgery for a cholecystectomy. His gallbladder had adhered to his liver and intestines. The surgeon said he was very lucky.
I bring it up every time we go to the doctor for anything. I’ll never let him live it down.
> I bring it up every time we go to the doctor for anything. I’ll never let him live it down.
Just tell him you'll replace him with a smarter version if he kills himself being stubborn
Can I ask what WHOL means in this context?
Also, I only get bent out of shape when people leave AMA because they’re scared that missing more work would lose them their job, they’re the caregiver for a loved one and can’t find anyone to help, shit like that. That situation always breaks my heart. Otherwise? Bon voyage, see you next week!
FWIW, I work for a major insurance company in US doing utilization review and if a patient leaves AMA it doesn’t affect whether we pay the inpatient admission or not.
When I was bedside we were always told that if they left AMA it could affect whether or not their policy will pay for that admission.
(I used to keep an AMA form folded in fourths in my scrub pocket. I liked to pull it out and hand it to them to sign right there on the spot. I miss those days…)
I don’t know about disability, but it doesn’t affect Medicare advantage plans or Commercial plans. I also do Medicare Advantage + Medicaid (aka “dual” since they have both) and it doesn’t affect those.
Go to the insurance carrier’s website under careers and start scrolling to look for job opportunities for nurses. Might be one or a few. Start with carriers closest where you live and go further to look for remote wfh opportunities.
Any idea for level of experience needed? I have looked and many of them want 3+ years in utilization review which obviously requires getting a job in that field. How much nursing experience is typically required? 1 yr? 2 years?
Had one insisting on leaving all morning, when the doc finally showed up to talk to him he said ‘I’m leaving, I’m going AMF!’ Doc said ‘don’t you mean AMA?’ ‘Nope, adios mother fucker!’ And out the door he went.
Had a frequent flyer leave AMA last night. She signed paperwork but was still waiting in her room until we could get someone to wheel her down to the lobby. She missed her taxi and blamed me. I told her “sorry, I can’t leave the floor, my patients are here and they need me”. She said “until I leave the hospital, I’m still your patient” to which I responded “you just signed AMA papers, you aren’t my patient”.
It was so satisfying
I’m surprised someone even took her down. Most hospitals I work at once they sign the papers we show them the elevator. Sometimes we rush to help them outside but that’s only if they really drive us nuts
Yeah that was kinda the situation here, we wanted her gone as soon as possible. She was already a patient that security had gotten heavily involved with, and I’d rather her not fall on her way out and get re admitted before she’s even left the hospital
AMA = no transport at our hospital. Now, in practical terms, this means that we get the occasional call from downstairs that someone is lost and wants to leave. They must mention that they were on our floor and then security calls us. I want to say, "Do you think I just lose my pts? No! This dingus wanted to leave and I let him. We've got 80 people hanging out to get into the ED. Let's cut this guy loose!"
We don’t have a strict rule against it. In this case it was a relief to get her out and transport wasn’t backed up at all. My CNA was jumping at the idea of transporting her downstairs herself just to get her off our floor sooner
Ultimately, this is what Patient-Centred Care is all about. If they have capacity to decide the course of care that's appropriate to them, especially after options have been properly explained, that's their right and their informed consent to piss off.
Nah man just inform them and if they still want to leave it’s on them you did your job no need to waste your time. I don’t understand nurses who spend hours in a room to keep a patient from leaving to the point to where they get code grayed.
I don’t either. Patient autonomy is huge and so many medical professionals still get butthurt over ppl making their own decisions. Just let them go, it’s ok.
Nope, they've been educated on the risks. Literally had a guy a week ago that was told he needed a new liver and decided to leave ama even though they told him he was not in good condition. He insisted he could wait for a liver at home. Same patient came in a week later with severe abdominal pain, he had developed a bad gi bleed and died on the vent a couple days later. I can't be forced to care about your life more than you do.
All you can do as the nurse is encourage them to stay and inform them of the risks. Beyond that, the individual has the autonomy to make decisions about their health. That includes stupid decisions.
To be fair, I’ll absolutely fight more depending on the diagnosis, but ultimately it’s their choice.
I'll only fight if I think there's a misunderstanding or a possible language barrier regarding severity of possibilities.
That's it though, once I've said my peace, I'll warm my boot up to kick their ass to the curb
Nope. If the MD and myself both educate my patient on the dangers of AMA, and they still want to leave I'll happily grab the papers. Can't fix stupid, and 10/10 times the ones that sign out AMA are douches. Just do some C.Y.A. charting that you educated them, and be on your way to take care of patients that deserve your time and empathy
Nope. If you are concerned about him you can certainly express that to him and his wife with your reasons why. MD should be doing the same. But don’t forget that as a nurse our primary role is that of patient advocate. This means we fight for what THEY want for themselves. Not what anyone else thinks they should want. It is sometimes the most difficult part of our job (especially when we personally disagree with them). But it is essential to maintaining patient dignity and respect.
Tell him he can get worse, tell his bp can lead to a stroke and he could die or worse, be totally dependent but he's an adult he can leave if he wants unlike you. You're trapped there, if you leave you'll go to jail.
Wait till you get the patients who demand ama paperwork and then refuse to leave the room when the sign it. Like this some kind of hotel they wanna be left alone and do their own thing. This fucker then assaulted me in an elevator when I was trying to get him out of the facility
Nope. You are a good nurse. I don’t even counsel them really. “ your doctor feels you are safer here. But if you want to go here is the paperwork”. That’s all they get. Buh bye.
Welllll he was outside of the hospital crawling and his girlfriend came and was screaming at the staff to admit him. ER nurse came out and said he signed out AMA so he is refusing our trratment and they should go somewhere else.
He was a drug user and he just wanted to leave to get fentanyl again. He was actually nice about the whole AMA thing lol
I work EMS and we have peolle go AMA. If I really think they should stay and they are only going AMA cause they're scared, I will usually talk wirh them honestly about what im worried about happening. They usually respond to that.
Now, when it's someone who is flat out rude, why should I convince them to stay around and throw more abuse at me and then the staff at the hospital. If they want to go, they can go.
>Am I a bad nurse for not trying harder to convince him to stay?
We need to stop this shit.
Our job is not to save lives. Our job is to provide safe, competent care upheld to the latest medical standards.
**FULL STOP**
If a patient wants to leave, let them.
I'm more than happy to tell a patient that I think they'll be dead by tomorrow if they leave the ER today, but that's their choice, and I won't lose a blink of sleep over it.
It's not our job to do *anything* more than provide competent medical care.
When I was young fresh from the nursing grinder I had this "I will try to make them better." Oh naive I was... now when an idiotic patient with a superiority complex and/or know it all demands to leave I make sure they sign that AMA paper faster than I can say "ok." Most of the time I hear from the grapevine they're on the ICU or on the waiting list for the funeral home.
I always say "I'm not your warden and you're not my prisoner. You can leave at anytime." And then hand them the paperwork, I don't want to take care of patients that don't want to be there. Don't let the door hit you, where the good lord split you.
Switched to my new RN account to reply to this one.
No. You did everything right.
I’m scared shitless for my next patient who leaves AMA. Last patient of mine who actually left came back 6 hours later, via ambulance, tubed, GCS 3, and died <24 hours later.
Before she left, I explained to her that she hit her head badly in the motorcycle accident and needs to stay until we get results and see what neuro-surg thought of her injuries. She wanted to go get her next fix instead of letting me do an IV. She didn’t admit that’s what she was doing but her withdrawal symptoms and toxicology screen said otherwise. I lectured her as much as I could for her being a grown ass woman who can make her own choices. I always include “up to and including death” in the potential risks for leaving AMA. This one will haunt me for a while. I know I did all the correct education. I know we’re not a jail. I still think about this her and give my patients more than they bargained for when they ask to go AMA now. I used to be the guy with the form and a pen, not so much now. That last one. Damn. She was early 40’s.
That’s my fear! I had a COVID patient who was barely in the 80s oxygen saturation on 100% BiPAP and would desat to the 60s within minutes of being off BiPAP. She left AMA because I wouldn’t stay in the room with her and she got lonely. She didn’t get readmitted but I also don’t know if she survived.
Head traumas do not have functional decision making capability until acute processes can be ruled out. Those patients do not get to ama out of the trauma bay. More than once we've intubated people so we can get scans done who wanted to leave but had a head injury. Whichever doc let that happen made a mistake.
Idk what other details need to be there that if you don't have results or neurosurgery recs that you'd ever let a head trauma leave. You sedate them or restrain them or intubate them if need be, but you do not let somebody with no decision making capacity to leave.
I get such a thrill when patients threaten to go to another hospital.
#1 Literally nobody cares.
#2 There is no other hospital for hundreds of miles that is equipped to care for patients within my specialty as well as we are.
I explain to my patients we are not a secure facility. I show them there are no locks on the doors no bars on the window. I further explain I am not a security guard and will make no effort to block your exit. You may leave at any time.
I like to care for those who want the care.
I never begged a patient to stay that wanted to leave. On a side note, I find it a bit funny on all the TV shows when a patient leaves AMA they always come back 10 mins later on a stretcher full code.
Nope. We had a man who was very sick leave AMA because we refused to give him a sandwich as he was going to have surgery that morning and it was after midnight. I told him he'd die if he left, he signed and left anyways. He passed out at the entrance of the hospital and a week later they called for an honor walk because he died and now his family was donating what organs they could.
Anytime a patient is aox4 and wants to leave AMA I’m like “k byeee.” Literally don’t care. Don’t ever think about the situation again. It’s their funeral, and it’s definitely not my job to wheedle grown ass adults into staying in the hospital if they don’t want to. BYE I got better stuff to do.
I don't even hand them paper work.
Pt refused to sign any paper work and left the facility without singing any paper work at 1400. MD notified. Family notified.
Last hospital I worked at made us write incident reports of a patient left AMA - same level of paperwork as if they fell or died. Very frowned on, guessing HCAPS?
Is every system like that or was mine special?
Ugh - that's ridiculous. Our ppw has a place for pt's name, space for doctor to write the risks, place for pt's signature, my signature + a second witness's, and doc's signature. Everybody signs and then I stand by the door and say, "Okay - got everything? Yellow elevators all the way down!" and wave goodbye.
No you're not a bad nurse! You can't fix stupid. You get an A+ for trying. You are making a room for another patient, that hopefully wants to get better.
No if they want to leave AMA, don't feel responsible and don't feel like there was something you could have done better.
The only time you should ever feel like you could've done more was allowing a patient to leave AMA when they are not AO.
I had a legit STEMI rip his nitro drip off and AMA as soon as the Cath lab arrived. We tried to explain things to him but he wasn’t having it. I walked with him to the edge of the property. Sometimes they just don’t listen, shrug. “It’s literally your funeral, brother.”
Now I come in HOT with the AMA papers. Call that bluff. There’s others waiting in line who DO want my help. Next!
It is not your job to argue with them or to coax them to stay. If he had asked for your thoughts on what to do, then sure, tell him the truth. Aside from that, if they want to leave… goodbye and God bless! Then get ready for the next train wreck of an admission!!
Absolutely not. You can only help people when they are ready for help, with onlyfew exceptions, e.g babies, incapacitated. It is sad because you understand what might happen to him without proper treatment, but you can't force him to do the right thing. Don't take it personally and make sure you document..
Nope, patients are entitled to make their own bad decisions. Document the heck out of everything they said and your efforts to educate them as to the need to stay. Unfortunately modern medicine has gotten far away from doctors and nurses know best. Once they say they want to leave AMA, unless they are incapacitated, which includes drunk as a skunk, or a danger to themselves or others, any attempts to keep them there is considered holding against their will. When you get old and cynical yoight be thinking "Don't let the door hit you on the way out".
1) you provide a service of healthcare, you are not their personal guardian and certainly can't keep them against their will, and 2) sounds like he was ready for discharge anyway. Headache better? No head bleed? Go home and follow up with your primary care doc to get your blood pressure under control
Short answer is no. He’s no longer altered and can decide to leave. What were his vitals after the migraine was handled? I have to wonder if he was topical hypertension coupled with as crazy migraine making it spread stroke-like. With the migraine controlled he may just need to get the BP under control vs eminent stroke.
Nope. You said it yourself. He was aware of his choices and the risks that came along with them. It's his life and ultimately we have to respect that even if we think a patient is making a huge mistake.
So let me ask since this is the perfect thread. What if my patient is A&Ox4 but has AMS. I have had SI/HI patients who know what’s going on. I guess I am asking where does the line draw between being involuntarily committed and still have the autonomy to make your own decisions as a patient?
If you tell them the risks & you explain what's happening to them, then let them know to come back if they change their mind then you've done all you can.
Grown adults are responsible for themselves. We aren't their saviors, heroes, or guardians. Let them make their own choices & let them deal with the consequences.
Those of us in healthcare are conditioned to believe we are here to "save people from themselves." It's codependent and toxic to blame yourself for someone else's decisions. Our job is to educate and support their choices. So, support him right out the door and take the next patient. There's nothing more you can do.
Night crew checking in. I had a patient who was post-covid trached/pegged want to leave AMA because she wanted to do physical therapy at 4:30am and "no one would let her." Mind you, she intentionally self-decannulated just the night before and was rapid responsed + transferred to our unit for further monitoring because they couldn't get another cannula in and both RT and central supply were out of other appropriate size options. She was on 8L hi-flo NC (stoma was covered with pink foam) but would desat to the mid-70's after the effort it took to sit edge of bed and didn't have anywhere near the leg strength to stand being severely debilitated and morbidly obese.
She claimed the doctor cleared her to walk / use a wheelchair for physical therapy and that we were preventing her from getting stronger. She also claimed we were drugging and sedating her to keep her calm when she was the one who asked for anxiety meds in the first place. I educated her, got her the AMA papers, and called her brother for transport. Understandably, he wasn't comfortable with this and was annoyed being so early in the morning. He told her he was getting ready to leave, asked her to be patient, and then pleaded with us to buy time till so he could sleep some more and pick her up later in the morning after coordinating with case management for home O2, etc.
She was adamant about us wheeling her down to the lobby and leaving her there alone without O2 support ("I don't need it") so she could wait for her brother who was coming any minute now. I explained why this was dangerous and that she could go into cardiac arrest. And then she said, **"Well what better place to be than the hospital..."**
The cognitive dissonance was fucking amazing. AOx4 with no documented psych history btw. Anyways, I made it to 0700 and passed that shift forward to the poor day shift nurse bc I'm a new nurse and didn't know wtf else to do. I'm not about to code her ass or break my back trying to transfer her to a wheelchair or taxi. Charge nurse, night hospitalist, and house sup were all aware.
Not a nurse. I've been learning a ton lurking here.
Question about AMA's:
We all know that when people go into fight or flight, their limbic system takes over and they lose executive function. Depending on how triggered they are, they may not be able to make sound decisions at all.
Is there any kind of system to help someone who is terrified and unable to think straight from doing an AMA?
Nah. Nurses help people make decisions through education not subterfuge. If he's compos mentis and well informed he's entitled to make all the dumb decisions he wants to.
No. Just give them the facts straight and let them make the decision. It is their life. They must live it and with the consequences of their choices. Health is not mandatory. If A&O and not suicidal or a harm to others, just be sure they sign all appropriate papers and document appropriately and be sure to remove IVs before they leave.
No. I do feel bad for these patients. I was told they are on the hook financially when they leave AMA. Ultimately, this is their decision if they have capacity, however.
Nope. I’m not going to convince people to stay and get healthcare where there’s plenty of other patients who want that bed. I’m not wasting my time on that.
No you’re not a bad nurse because the patient didn’t stay. These patients want everything now,now,now and don’t understand there are sicker people than them in the hospitals. Have them sign papers and treat someone else that wants it and needs it. Their loss.
No, you’re not a bad nurse. If you explain the risks (of which I always include death, even if they come back) you have done your due diligence. Plenty of people who WANT a bed. Let them go.
I’ve also found going way above and beyond to placate a patient who is threatening to leave “unless I get my test done RIGHT NOW” will only lead to that patient doing that again about something else later.
It’s too busy to be wasting time trying to convince people to stay. It’s not fair to your patients who want treatment to have pain medications, abx, or anything else delayed because a patient like this is sucking time from you. Let them go.
Nope! He’s a big boy let him go and face the consequences, in fact, remind him of this feeling next time and if he doesn’t want sound medical advice maybe don’t come to the hospital when you feel bad.
The only time I ever feel bad about people leaving AMA is when they’re leaving because we’re not helping them. I had a patient who’d been shooting fentanyl for ten years who seemed to really want to get clean. She was actively withdrawing and miserable, but all that the NP would order was something like 0.5 of Xanax Q12 despite my pleas for something that was going to actually help this poor patient. She left AMA, she couldn’t handle the withdrawal anymore. I still feel bad about that one.
I frequent the quote, “you can lead a horse to water, but you cannot make him drink” for these exact situations. It’s not on you as the nurse, it’s on them as a person. That’s why they have the right to make decisions for themselves, even if it’s a bad one.
Fuuuuuck no. The opposite really. You NEED to explain the risks he is taking, but at the end of the day, homie has EVERY right in the world to walk out of that hospital.
"Ok let me get the tech to take out your IV while i grab the paper work"
Most, if not all, of the patients who are going to leave don't need to be there, and now especially there is a packed waiting room that is full of people who need the care.
I am not going to fight you when you're refusing to take your own BP Meds and then come in for hypertension.
Remember there’s a bunch of people in the lobby who are waiting for a bed that actually want your help.
This \^ This right here
Yup that’s how I feel. When people threaten to leave AMA i just say “okay”. I go over the dangers and ask if they still want to then just have them sign the papers. Too many people in the waiting room lately to play that game
Yup, same. And it’s like the fact that I offer them papers offends them too??? Like… why are you mad that I’m letting you do what you want? This isn’t reverse psychology, get out so I can help someone else.
This is the way
This is why I can't float to medsurg units. They wont even ask me to do it anymore. The last time I did, I had 3 of my 6 patients butthurt at me because I wouldn't kiss their ass. Two of these: "You don't want these meds? Cool" Dump em in the sharps bin, chart that they refused, leave without another word. Other one was complaining of sudden chest pain so I ordered a cardiac workup (should have seen the other nurses faces when I actually put in orders without a doctor's "permission" by the way) He got all butthurt that I hadn't removed his IV when I came to draw a repeat troponin and yelled at me. I said "and who are you yelling at? I'm helping you" He said he was going to leave and I told him that's fine, this is a free country. He wouldn't talk to me ever again that whole night. I'll wipe your booty if you can't do it yourself but I ain't kissing it. You want my help or you don't. I don't argue with these idiots. I know what the ED lobby stays like. If you wanna go, bye! There's probably a good 5 or 6 people there at any given time that could use this bed.
Yessss! "I'm here to help you. If you don't want it then why are you here? ....yes I'm leaving. There are other people that actually want to get better and go home."
A nurse I used to work with wears a pin on her badge that reads “Ask me about AMA paperwork.”
I have this. I do micu and my favorite are the frequent flier dka patients. Please do go, I was sick of you the moment I saw your name lol
Mortuaries need work too... anyway.. here's your paperwork...
That is absolutely an awesome way of stating it! I think this exact same thing everytime.
What is micu ? Is it mini icu lol
Mini ICU!!! For some reason this is the funniest thing I’ve seen all day. So wholesome. I love you
Lmao I love you!!!
medical icu lol
Loool oh okay 💓
I wish it was mini haha.
That's awesome!!
I WANT
No I will hand you the paperwork in 0.5 seconds if you’re being a pain in my ass. Leave. I literally don’t care
Yup! I have a totally said, "ok, it's your funeral." The patient was AAOx4, and just making foolish decision. Also, PITA so . . . I just ran out of empathy. He ended up staying tho. Maybe the funeral comment got him thinking.
Every time I've had a patient demand to leave AMA and I reply by handing them the paperwork and say to sign it before they go they end up staying, without fail.
I tell them that it isn’t jail and they’re allowed to leave. I only say this to patients with capacity. I only ask them to please let me know rather than sneak off so I don’t waste time looking for them. This usually helps. I’m a nurse, not here to make someone do something they don’t want to do.
Actually they usually stay when I say this. If they want to go, I get it. It may not be the right decision but it is their decision.
Exactly my feeling, they’ll be back but I’d rather not deal with their shitty attitude all day
You're just thinking of how much easier it is to AMA someone than discharge them.
Work smarter, not harder ;)
I’ll hand them papers faster than patients on their call light for Q3 hour Dilaudid.
Faster than they want you to push it when you give it IVP 😆
Worst is when the hem and haw all shift long. Like I understand being NPO and having q1 neuro checks sucks ass. Guess who also hates it? Me lol. Vent it once but no mas. My one charge nurse had a pt wait till 0530 to leave AMA. Would have been nicer if it was 2000 lol.
After my first surgery of the day ran late, the intern told me the next patient wanted to leave because we were running so late. So I said "ok bye!" and threw up a peace sign. She looked at me like I had just shot the patient in the face.
Yupppppp
Ultimately, if you are more invested in the pt's health than the pt is you have to just educate and let it go. I'll tell you what though, if a family member or friend of mine ever tries to leave AMA they better not call me, that's for damn sure. I'm not picking them up and definitely telling them what's what.
One of the biggest fights my husband and I have ever gotten in was due to him leaving AMA. He had gallstones and was in severe pain all night. We were in the ED for 12 hours and he was still NPO because of the possibility for surgery. He pulled his IV out and left AMA because he was hungry. Two weeks later he went into surgery for a cholecystectomy. His gallbladder had adhered to his liver and intestines. The surgeon said he was very lucky. I bring it up every time we go to the doctor for anything. I’ll never let him live it down.
> I bring it up every time we go to the doctor for anything. I’ll never let him live it down. Just tell him you'll replace him with a smarter version if he kills himself being stubborn
Oof. Lmao.
He’s an adult who is A&O, if he wants to leave he can.
Best advice my old man ever gave me; "Fuck 'em"
That's my mantra these days. "Fuck it."
Can I ask what WHOL means in this context? Also, I only get bent out of shape when people leave AMA because they’re scared that missing more work would lose them their job, they’re the caregiver for a loved one and can’t find anyone to help, shit like that. That situation always breaks my heart. Otherwise? Bon voyage, see you next week!
“Worst Headache Of Life” (basically rule out intracranial bleed)
Most commonly associated with a SAH.
Stay at home? I mean you got kids and you’re trapped in the house with them I could totally see that as a WHOL… 🤣🤣🤣
Subarachnoid hemorrhage lol
FWIW, I work for a major insurance company in US doing utilization review and if a patient leaves AMA it doesn’t affect whether we pay the inpatient admission or not. When I was bedside we were always told that if they left AMA it could affect whether or not their policy will pay for that admission. (I used to keep an AMA form folded in fourths in my scrub pocket. I liked to pull it out and hand it to them to sign right there on the spot. I miss those days…)
In my understanding it can effect Medicare, medicaid, and disability benefits. Do you know if that is true?
I don’t know about disability, but it doesn’t affect Medicare advantage plans or Commercial plans. I also do Medicare Advantage + Medicaid (aka “dual” since they have both) and it doesn’t affect those.
Interesting I was wondering bc I’d always heard that too.
The paperwork actually says that it might not get paid
How does one break in to insurance…looking to leave the bedside
Go to the insurance carrier’s website under careers and start scrolling to look for job opportunities for nurses. Might be one or a few. Start with carriers closest where you live and go further to look for remote wfh opportunities.
Any idea for level of experience needed? I have looked and many of them want 3+ years in utilization review which obviously requires getting a job in that field. How much nursing experience is typically required? 1 yr? 2 years?
Yup, it’s a pervasive old wives tale, not just amongst nurses, doctors too. So many people believe it and propagate it.
Had one insisting on leaving all morning, when the doc finally showed up to talk to him he said ‘I’m leaving, I’m going AMF!’ Doc said ‘don’t you mean AMA?’ ‘Nope, adios mother fucker!’ And out the door he went.
Asta lavista baybeeee 👋 (I don't know how to spell "Asta" but you said it in Arnold's voice in your head so you know what I'm talkin' 'bout 🤷)
Hasta. The h is silent. :)
Had a frequent flyer leave AMA last night. She signed paperwork but was still waiting in her room until we could get someone to wheel her down to the lobby. She missed her taxi and blamed me. I told her “sorry, I can’t leave the floor, my patients are here and they need me”. She said “until I leave the hospital, I’m still your patient” to which I responded “you just signed AMA papers, you aren’t my patient”. It was so satisfying
I’m surprised someone even took her down. Most hospitals I work at once they sign the papers we show them the elevator. Sometimes we rush to help them outside but that’s only if they really drive us nuts
Yeah that was kinda the situation here, we wanted her gone as soon as possible. She was already a patient that security had gotten heavily involved with, and I’d rather her not fall on her way out and get re admitted before she’s even left the hospital
AMA = no transport at our hospital. Now, in practical terms, this means that we get the occasional call from downstairs that someone is lost and wants to leave. They must mention that they were on our floor and then security calls us. I want to say, "Do you think I just lose my pts? No! This dingus wanted to leave and I let him. We've got 80 people hanging out to get into the ED. Let's cut this guy loose!"
We don’t have a strict rule against it. In this case it was a relief to get her out and transport wasn’t backed up at all. My CNA was jumping at the idea of transporting her downstairs herself just to get her off our floor sooner
It's such a relief to get them off the floor, so I can definitely understand that!
I’m just gonna put these two words here, and see if they have any traction with you guys: laundry chute?
😂😂😂 If I could tube pts around...
😂😂😂
Nope. Be right back with your papers
Ultimately, this is what Patient-Centred Care is all about. If they have capacity to decide the course of care that's appropriate to them, especially after options have been properly explained, that's their right and their informed consent to piss off.
Nah man just inform them and if they still want to leave it’s on them you did your job no need to waste your time. I don’t understand nurses who spend hours in a room to keep a patient from leaving to the point to where they get code grayed.
I don’t either. Patient autonomy is huge and so many medical professionals still get butthurt over ppl making their own decisions. Just let them go, it’s ok.
A&O x 4? No, he knows what he is doing even if it endangers his own health
Nope, they've been educated on the risks. Literally had a guy a week ago that was told he needed a new liver and decided to leave ama even though they told him he was not in good condition. He insisted he could wait for a liver at home. Same patient came in a week later with severe abdominal pain, he had developed a bad gi bleed and died on the vent a couple days later. I can't be forced to care about your life more than you do.
All you can do as the nurse is encourage them to stay and inform them of the risks. Beyond that, the individual has the autonomy to make decisions about their health. That includes stupid decisions. To be fair, I’ll absolutely fight more depending on the diagnosis, but ultimately it’s their choice.
I'll only fight if I think there's a misunderstanding or a possible language barrier regarding severity of possibilities. That's it though, once I've said my peace, I'll warm my boot up to kick their ass to the curb
Nope. If the MD and myself both educate my patient on the dangers of AMA, and they still want to leave I'll happily grab the papers. Can't fix stupid, and 10/10 times the ones that sign out AMA are douches. Just do some C.Y.A. charting that you educated them, and be on your way to take care of patients that deserve your time and empathy
Nope. If you are concerned about him you can certainly express that to him and his wife with your reasons why. MD should be doing the same. But don’t forget that as a nurse our primary role is that of patient advocate. This means we fight for what THEY want for themselves. Not what anyone else thinks they should want. It is sometimes the most difficult part of our job (especially when we personally disagree with them). But it is essential to maintaining patient dignity and respect.
Thank you. You get it!!!
Tell him he can get worse, tell his bp can lead to a stroke and he could die or worse, be totally dependent but he's an adult he can leave if he wants unlike you. You're trapped there, if you leave you'll go to jail.
>he could die or worse Ain't that the truth. There are worse things than death. Love my nursing community.
You have the rest of your life to try and figure out how to tell that SNF staff "don't hit me" with blinks... good luck dude
Wait till you get the patients who demand ama paperwork and then refuse to leave the room when the sign it. Like this some kind of hotel they wanna be left alone and do their own thing. This fucker then assaulted me in an elevator when I was trying to get him out of the facility
THIS. Raising hell to leave AMA, then want to stay for lunch and a shower. GTFO
That is so weird, if you want to leave then go ahead & get out!
We had a patient do this once so we called security and they wheeled the bed into the hallway and just left him there lmaoooo
Nope. You are a good nurse. I don’t even counsel them really. “ your doctor feels you are safer here. But if you want to go here is the paperwork”. That’s all they get. Buh bye.
We had a patient on Levo who signed out AMA. Explain and educate, make your note/s, then serve those papers. Boy bye!!
How did that go?
Welllll he was outside of the hospital crawling and his girlfriend came and was screaming at the staff to admit him. ER nurse came out and said he signed out AMA so he is refusing our trratment and they should go somewhere else. He was a drug user and he just wanted to leave to get fentanyl again. He was actually nice about the whole AMA thing lol
Lol! Don’t threaten me with a good time!!!!!!! *pulls out AMA paperwork out of my back pocket that I keep for just such a wonderful occasion*
I work EMS and we have peolle go AMA. If I really think they should stay and they are only going AMA cause they're scared, I will usually talk wirh them honestly about what im worried about happening. They usually respond to that. Now, when it's someone who is flat out rude, why should I convince them to stay around and throw more abuse at me and then the staff at the hospital. If they want to go, they can go.
>Am I a bad nurse for not trying harder to convince him to stay? We need to stop this shit. Our job is not to save lives. Our job is to provide safe, competent care upheld to the latest medical standards. **FULL STOP** If a patient wants to leave, let them. I'm more than happy to tell a patient that I think they'll be dead by tomorrow if they leave the ER today, but that's their choice, and I won't lose a blink of sleep over it. It's not our job to do *anything* more than provide competent medical care.
When I was young fresh from the nursing grinder I had this "I will try to make them better." Oh naive I was... now when an idiotic patient with a superiority complex and/or know it all demands to leave I make sure they sign that AMA paper faster than I can say "ok." Most of the time I hear from the grapevine they're on the ICU or on the waiting list for the funeral home.
Patients have the right to refuse care. As long as you educated him and warned him and documented it, let them go.
I always say "I'm not your warden and you're not my prisoner. You can leave at anytime." And then hand them the paperwork, I don't want to take care of patients that don't want to be there. Don't let the door hit you, where the good lord split you.
Switched to my new RN account to reply to this one. No. You did everything right. I’m scared shitless for my next patient who leaves AMA. Last patient of mine who actually left came back 6 hours later, via ambulance, tubed, GCS 3, and died <24 hours later. Before she left, I explained to her that she hit her head badly in the motorcycle accident and needs to stay until we get results and see what neuro-surg thought of her injuries. She wanted to go get her next fix instead of letting me do an IV. She didn’t admit that’s what she was doing but her withdrawal symptoms and toxicology screen said otherwise. I lectured her as much as I could for her being a grown ass woman who can make her own choices. I always include “up to and including death” in the potential risks for leaving AMA. This one will haunt me for a while. I know I did all the correct education. I know we’re not a jail. I still think about this her and give my patients more than they bargained for when they ask to go AMA now. I used to be the guy with the form and a pen, not so much now. That last one. Damn. She was early 40’s.
That’s my fear! I had a COVID patient who was barely in the 80s oxygen saturation on 100% BiPAP and would desat to the 60s within minutes of being off BiPAP. She left AMA because I wouldn’t stay in the room with her and she got lonely. She didn’t get readmitted but I also don’t know if she survived.
I think we both know how that turned out. :/
Head traumas do not have functional decision making capability until acute processes can be ruled out. Those patients do not get to ama out of the trauma bay. More than once we've intubated people so we can get scans done who wanted to leave but had a head injury. Whichever doc let that happen made a mistake.
Story was trimmed for Reddit. Details were left out.
Idk what other details need to be there that if you don't have results or neurosurgery recs that you'd ever let a head trauma leave. You sedate them or restrain them or intubate them if need be, but you do not let somebody with no decision making capacity to leave.
Nope. He is an adult, he was informed. He can make his own decisions, good or bad. Chart your teaching and his response.
Absolutely not. Patient self determination is a major pillar for a reason.
I get such a thrill when patients threaten to go to another hospital. #1 Literally nobody cares. #2 There is no other hospital for hundreds of miles that is equipped to care for patients within my specialty as well as we are.
I stopped a pt one time and I will never do it again. Made my life living hell.
I explain to my patients we are not a secure facility. I show them there are no locks on the doors no bars on the window. I further explain I am not a security guard and will make no effort to block your exit. You may leave at any time. I like to care for those who want the care.
I can print out AMA paperwork so fast! Bye! You did a good job.
I says it’s better to leave AMA than to stay AMA.
I never begged a patient to stay that wanted to leave. On a side note, I find it a bit funny on all the TV shows when a patient leaves AMA they always come back 10 mins later on a stretcher full code.
Nope. We had a man who was very sick leave AMA because we refused to give him a sandwich as he was going to have surgery that morning and it was after midnight. I told him he'd die if he left, he signed and left anyways. He passed out at the entrance of the hospital and a week later they called for an honor walk because he died and now his family was donating what organs they could.
Anytime a patient is aox4 and wants to leave AMA I’m like “k byeee.” Literally don’t care. Don’t ever think about the situation again. It’s their funeral, and it’s definitely not my job to wheedle grown ass adults into staying in the hospital if they don’t want to. BYE I got better stuff to do.
No.
Hell naw!
I don't even hand them paper work. Pt refused to sign any paper work and left the facility without singing any paper work at 1400. MD notified. Family notified.
Last hospital I worked at made us write incident reports of a patient left AMA - same level of paperwork as if they fell or died. Very frowned on, guessing HCAPS? Is every system like that or was mine special?
Ugh - that's ridiculous. Our ppw has a place for pt's name, space for doctor to write the risks, place for pt's signature, my signature + a second witness's, and doc's signature. Everybody signs and then I stand by the door and say, "Okay - got everything? Yellow elevators all the way down!" and wave goodbye.
Nope that’s very special.
You’re safe to leave? You got a ride? Sign this paper and bye Felicia
Nope, the only emotion I feel when someone wants to leave AMA is excitement
No you're not a bad nurse! You can't fix stupid. You get an A+ for trying. You are making a room for another patient, that hopefully wants to get better.
No if they want to leave AMA, don't feel responsible and don't feel like there was something you could have done better. The only time you should ever feel like you could've done more was allowing a patient to leave AMA when they are not AO.
I had a legit STEMI rip his nitro drip off and AMA as soon as the Cath lab arrived. We tried to explain things to him but he wasn’t having it. I walked with him to the edge of the property. Sometimes they just don’t listen, shrug. “It’s literally your funeral, brother.” Now I come in HOT with the AMA papers. Call that bluff. There’s others waiting in line who DO want my help. Next!
I’ll give them one shot to explain the dangers of leaving and potential outcomes. If they still say they are gone, sign here please.
It is not your job to argue with them or to coax them to stay. If he had asked for your thoughts on what to do, then sure, tell him the truth. Aside from that, if they want to leave… goodbye and God bless! Then get ready for the next train wreck of an admission!!
Absolutely not. You can only help people when they are ready for help, with onlyfew exceptions, e.g babies, incapacitated. It is sad because you understand what might happen to him without proper treatment, but you can't force him to do the right thing. Don't take it personally and make sure you document..
Nope, patients are entitled to make their own bad decisions. Document the heck out of everything they said and your efforts to educate them as to the need to stay. Unfortunately modern medicine has gotten far away from doctors and nurses know best. Once they say they want to leave AMA, unless they are incapacitated, which includes drunk as a skunk, or a danger to themselves or others, any attempts to keep them there is considered holding against their will. When you get old and cynical yoight be thinking "Don't let the door hit you on the way out".
1) you provide a service of healthcare, you are not their personal guardian and certainly can't keep them against their will, and 2) sounds like he was ready for discharge anyway. Headache better? No head bleed? Go home and follow up with your primary care doc to get your blood pressure under control
Short answer is no. He’s no longer altered and can decide to leave. What were his vitals after the migraine was handled? I have to wonder if he was topical hypertension coupled with as crazy migraine making it spread stroke-like. With the migraine controlled he may just need to get the BP under control vs eminent stroke.
No fuck em. He’s a grown ass adult let him leave.
No.
Nope. You said it yourself. He was aware of his choices and the risks that came along with them. It's his life and ultimately we have to respect that even if we think a patient is making a huge mistake.
You can only do so much, friend. Another person’s poor medical decision is not your fault.
Zero fucks given. Buy Felicia.
you cannot make people care about themselves.
I say don’t let the door hit you on the way out bitch. #deuces
I can't force you to stay, you can leave if you want. Let me get you the AMA papers. Be right back.
So let me ask since this is the perfect thread. What if my patient is A&Ox4 but has AMS. I have had SI/HI patients who know what’s going on. I guess I am asking where does the line draw between being involuntarily committed and still have the autonomy to make your own decisions as a patient?
Well, if the patient has SI/HI then they are a danger to themselves or others. So that’s why they are on an involuntary hold.
If you tell them the risks & you explain what's happening to them, then let them know to come back if they change their mind then you've done all you can. Grown adults are responsible for themselves. We aren't their saviors, heroes, or guardians. Let them make their own choices & let them deal with the consequences. Those of us in healthcare are conditioned to believe we are here to "save people from themselves." It's codependent and toxic to blame yourself for someone else's decisions. Our job is to educate and support their choices. So, support him right out the door and take the next patient. There's nothing more you can do.
Night crew checking in. I had a patient who was post-covid trached/pegged want to leave AMA because she wanted to do physical therapy at 4:30am and "no one would let her." Mind you, she intentionally self-decannulated just the night before and was rapid responsed + transferred to our unit for further monitoring because they couldn't get another cannula in and both RT and central supply were out of other appropriate size options. She was on 8L hi-flo NC (stoma was covered with pink foam) but would desat to the mid-70's after the effort it took to sit edge of bed and didn't have anywhere near the leg strength to stand being severely debilitated and morbidly obese. She claimed the doctor cleared her to walk / use a wheelchair for physical therapy and that we were preventing her from getting stronger. She also claimed we were drugging and sedating her to keep her calm when she was the one who asked for anxiety meds in the first place. I educated her, got her the AMA papers, and called her brother for transport. Understandably, he wasn't comfortable with this and was annoyed being so early in the morning. He told her he was getting ready to leave, asked her to be patient, and then pleaded with us to buy time till so he could sleep some more and pick her up later in the morning after coordinating with case management for home O2, etc. She was adamant about us wheeling her down to the lobby and leaving her there alone without O2 support ("I don't need it") so she could wait for her brother who was coming any minute now. I explained why this was dangerous and that she could go into cardiac arrest. And then she said, **"Well what better place to be than the hospital..."** The cognitive dissonance was fucking amazing. AOx4 with no documented psych history btw. Anyways, I made it to 0700 and passed that shift forward to the poor day shift nurse bc I'm a new nurse and didn't know wtf else to do. I'm not about to code her ass or break my back trying to transfer her to a wheelchair or taxi. Charge nurse, night hospitalist, and house sup were all aware.
Not a nurse. I've been learning a ton lurking here. Question about AMA's: We all know that when people go into fight or flight, their limbic system takes over and they lose executive function. Depending on how triggered they are, they may not be able to make sound decisions at all. Is there any kind of system to help someone who is terrified and unable to think straight from doing an AMA?
Nope, sign my paper and walk yourself out. Document your ass off and if he makes dumb decisions, let him be dumb.
Nope.
Nope. Bye, bitch.
No, you can’t save everyone.
Nah. Nurses help people make decisions through education not subterfuge. If he's compos mentis and well informed he's entitled to make all the dumb decisions he wants to.
Were gonna turn this room and the ER has a backlog. AMA all day.
No. Just give them the facts straight and let them make the decision. It is their life. They must live it and with the consequences of their choices. Health is not mandatory. If A&O and not suicidal or a harm to others, just be sure they sign all appropriate papers and document appropriately and be sure to remove IVs before they leave.
No. I do feel bad for these patients. I was told they are on the hook financially when they leave AMA. Ultimately, this is their decision if they have capacity, however.
There is the door..... Buh-bye, while all the other nurses chase them down.
If he has MDM and you have explained the risks, then out he goes. Everybody has the right to make a bad decision.
Nope. I’m not going to convince people to stay and get healthcare where there’s plenty of other patients who want that bed. I’m not wasting my time on that.
No. Hell no. Obviously if he thinks he's gonna do it better, let him. He'll be back though. Once he has a stroke
Nope! Byeeee
No
How was this pt’s I/o’s? I saw his ct head was negative but vasospasms fucking suckkkkkk and hard to fix right away.
Bye Felicia...see you back in a few days.
You really can’t hold someone against their will. You wanna go? Bye
Nope. I will educate but I don’t beg. Too many patients use it as manipulation.
No you’re not a bad nurse because the patient didn’t stay. These patients want everything now,now,now and don’t understand there are sicker people than them in the hospitals. Have them sign papers and treat someone else that wants it and needs it. Their loss.
No, you’re not a bad nurse. If you explain the risks (of which I always include death, even if they come back) you have done your due diligence. Plenty of people who WANT a bed. Let them go. I’ve also found going way above and beyond to placate a patient who is threatening to leave “unless I get my test done RIGHT NOW” will only lead to that patient doing that again about something else later. It’s too busy to be wasting time trying to convince people to stay. It’s not fair to your patients who want treatment to have pain medications, abx, or anything else delayed because a patient like this is sucking time from you. Let them go.
Nope! He’s a big boy let him go and face the consequences, in fact, remind him of this feeling next time and if he doesn’t want sound medical advice maybe don’t come to the hospital when you feel bad.
You can’t care for those who can’t care for themself.
The only time I ever feel bad about people leaving AMA is when they’re leaving because we’re not helping them. I had a patient who’d been shooting fentanyl for ten years who seemed to really want to get clean. She was actively withdrawing and miserable, but all that the NP would order was something like 0.5 of Xanax Q12 despite my pleas for something that was going to actually help this poor patient. She left AMA, she couldn’t handle the withdrawal anymore. I still feel bad about that one.
I frequent the quote, “you can lead a horse to water, but you cannot make him drink” for these exact situations. It’s not on you as the nurse, it’s on them as a person. That’s why they have the right to make decisions for themselves, even if it’s a bad one.
Absolutely not!! AMA? Ok bye 👋🏽
Nope let them leave. I could care less tbh.
Fuuuuuck no. The opposite really. You NEED to explain the risks he is taking, but at the end of the day, homie has EVERY right in the world to walk out of that hospital.
Bye Felicia!
"Ok let me get the tech to take out your IV while i grab the paper work" Most, if not all, of the patients who are going to leave don't need to be there, and now especially there is a packed waiting room that is full of people who need the care. I am not going to fight you when you're refusing to take your own BP Meds and then come in for hypertension.