Scenario: You are team leader on a medicalunit of a small community hospital. Your shift is 3 to 11 PM. Whenleaving the report room, John, the day-shift team leader, tells youthat Mrs. Jackson, a patient who is terminally ill with cancer, hasdecided to check herself out of the hospital “against medicaladvice.” John states that he has already contacted Mrs. Jackson’sdoctor, who expressed his concern that the patient would haveinadequate pain control at home and undependable family support. Hebelieves that she will die within a few days if she leaves thehospital. He did, however, leave orders for home prescriptions anda follow-up appointment.
You immediately go into Mrs. Jackson’s room to assess thesituation. She tells you that the doctor has told her she willprobably die within 6 weeks and that she wants to spend what timeshe has left at home with her little dog who has been her constantcompanion for many years. In addition, she has many things “to putin order.” She states that she is fully aware of her doctor’sconcerns and that she was already informed by the day-shift nursethat leaving “against medical advice” may result in the insurancecompany refusing to pay for her current hospitalization. She statesthat she will be leaving in 15 minutes when her ride homearrives.
When you go to the nurse’s station to get a copy of the homeprescriptions and follow-up doctor’s appointment for the patient,the unit clerk states, “The hospital policy says that patients wholeave against medical advice have to contact the physician directlyfor prescriptions and an appointment because they are not legallydischarged. The hospital has no obligation to provide this service.She made the choice—now let her live with it.” She refuses to givea copy of the orders to you and places the patient’s chart in herlap. Short of physically removing the chart from the clerk’s lap,you clearly have no immediate access to the orders.
You confront the charge nurse, who is unsure what to do andwho states that the hospital policy does give that responsibilityto the patient. The unit director, who has been paged, appears tobe out of the hospital temporarily.
You are outraged. You believe that the patient has the“right” to her prescriptions because the doctor ordered them,assuming she would receive them before she left. You also know thatif the medications are not dispensed by the hospital, there islittle likelihood that Mrs. Jackson will have the resources to havethe prescriptions filled. Five minutes later, Mrs. Jackson appearsat the nurse’s station, accompanied by her friend. She states thatshe is leaving and would like her discharge prescriptions.
The power struggle in this scenario involves you, the unitclerk, the charge nurse, and organizational politics.
- Does the unit clerk in this scenario have informal or formalpower?
- What alternatives for action do you have?
- What are the costs or consequences of each possiblealternative?
- What action would you take?
