Question for nurses or hospital staff

[Suprtek]

Say you've been admitted to the hospital. You're waiting on paperwork, test results, or you're recovering from a procedure but you're OK to walk around. You decide you'd like to take a walk outside. Could be to just have a smoke or maybe you're just tired of being stuck inside. Your nurse tells you that you are "not allowed" to leave the ward. What if you just do it anyway? Your not discharging yourself AMA, just taking a walk and coming back within 15 minutes or so. Can the hospital really do anything about it? Can they delay your official discharge until you "comply" with their restrictions for as long as they see fit? Could they possibly cause any problems with your insurance company?

 

[hornadylnl]

Not a nurse but I bet it's a liability thing. My aunt was a nurse and she said the only patient allowed to walk out at discharge was a young gilliane barre patient who had spent months in the hospital. Everyone else had to be wheeled out in a wheelchair.

 

[THard6]

my question to you is.. how are they going to know or find out?! if you're in a hospital there are tons of people there. i' sure they wouldn't even catch on or realize it. and i personally don't think there is anything they can do. they didn't get you specific directions about not leaving the facility.. so take it as you see fit. if you're worried about it. i'm sure it wouldn't hurt to ask your nurse. most of them will either walk with you or give you permission.. and as long as you don't do anything DUMB or getting HURT i think you're clear on the insurance part.

 

[Suprtek]

my question to you is.. how are they going to know or find out?! if you're in a hospital there are tons of people there. i' sure they wouldn't even catch on or realize it. and i personally don't think there is anything they can do. they didn't get you specific directions about not leaving the facility.. so take it as you see fit. if you're worried about it. i'm sure it wouldn't hurt to ask your nurse. most of them will either walk with you or give you permission.. and as long as you don't do anything DUMB or getting HURT i think you're clear on the insurance part.

Most wards are set up to where you can't get to the exit without going past the nurses station. Anyway, I have no interest in hiding from them. As a matter of fact I think the responsible thing to do would be to let them know you'll be back in a few minutes so they don't think you disappeared.

Last time I was in, I did mention something to the nurse about going outside and you'd have thought I made a bomb threat or something. They were very quick to inform me that I did not have permission to leave the floor. I wasn't going to be there much longer so I complied that time but I did tell her that I didn't NEED their permission.

 

[Vince49]

How deep are your pockets.

The last time I tried this I was informed by the floor charge Nurse that he would chart me as discharged against Doctor's orders and that most likely my insurance would refuse to pay for the entire stay(10 days). I waited until I had the discharge from the Doctor. Don't know whether it was true or not, but not wealthy enough to put it to the test.

 

[jd4320t]

I agree it has to be about liability. This is gonna sound funny but don't they have the power to strap a patient to a bed if need be?

 

[Suprtek]

The last time I tried this I was informed by the floor charge Nurse that he would chart me as discharged against Doctor's orders and that most likely my insurance would refuse to pay for the entire stay(10 days). I waited until I had the discharge from the Doctor. Don't know whether it was true or not, but not wealthy enough to put it to the test.

That sounds like an empty threat to me. The key words in that statement to me are "most likely". As far as I know, they can't prove you discharged yourself AMA without your signature on a document stating so or if you don't return in a reasonable amount of time. I would like to hear from someone that knows for sure though.

 

[SEIndSAM]

The last time I was at a hospital was Good Sam in Dayton, OH in June. As I was walking in and out several times, I saw people in wheelchairs & hospital gowns sitting outside the emergency room smoking.

We have some members who are married to nurses here and at least a couple of Doc's, maybe one of those will weigh in?

 

[Suprtek]

I agree it has to be about liability. This is gonna sound funny but don't they have the power to strap a patient to a bed if need be?

Maybe if they can prove a person is an immediate danger to themself or others. That's pretty far from the situation I'm describing. I'll say this though, I don't care what power they think they have. If someone tries to strap me to a hospital bed they are going to have one heluva fight on their hands.

 

[Suprtek]

We have some members who are married to nurses here and at least a couple of Doc's, maybe one of those will weigh in?

This is exactly what I was hoping for. If anyone knows such a member, maybe they could point them in this direction?

 

[jd4320t]

Everything I googled said a waiver must be signed

 

[Suprtek]

Everything I googled said a waiver must be signed

Waiver for what? To show you left AMA, or to absolve the hospital from liability because you choose to walk outside?

In either case, how can they force you to sign such a document?

 

[HandK]

On a side note you can get them to give you a nicotine patch, or better yet buy them your self and take them with you, when I had my knee replaced I asked them for one the nurse said that my Dr would have to authorize one! I told to call him then! she came back in about ten min with one! made it allot easer to be stuck in the bed!

 

[Suprtek]

On a side note you can get them to give you a nicotine patch, or better yet buy them your self and take them with you, when I had my knee replaced I asked them for one the nurse said that my Dr would have to authorize one! I told to call him then! she came back in about ten min with one! made it allot easer to be stuck in the bed!

I was offered the same thing the last 2 times I was in the hospital. In your case it makes perfect sense because walking was certainly a problem for you at the time. I admit getting a nicotine fix would be a primary reason for me to want to leave the ward but that's not the whole point. What if you just want to take a walk and you're perfectly capable of doing so? Besides, I've never been able to keep one of those things lit.

 

[Cam]

Not a nurse, but I am a paramedic and work in a hospital. Most of the time the nurses are pretty cool about the patients walking when they want so long as it makes sense with the treatment plan and reason for visit. As long as it isn't detrimental to your medical reason for being admitted, they'll normally be fine with you grabbing some air. There are, as some have mentioned, liability concerns that come with this allowance and if their recommendation is to not walk outside of the unit, there is likely a good reason for it. As far as the AMA thing goes, a lot of factors can go into the decision. If you aren't being a compliant patient they can't do much to help you and no signature is necessary. People refuse treatment ALL the time in the ED and refuse to sign anything. It's simply documented that the patient refused treatment and is submitted. My understanding is that the insurance company can refuse to pay for your visit if a lack of compliance is noted. But I'm no expert in that area.

The big problem can be that the insurance companies want you out of the hospital as soon as possible and will pay only for the bare minimum of days they have to. For this reason, and others, the hospital does its best to get you well enough to go home as soon as possible. If it is recommended that you not leave the unit to go outside (or wherever), and you do it anyway causing a required increase in length of stay for your condition, you may be stuck paying for it yourself.

Bottom line, they aren't going to hold you down and tie you to the bed. They (the nurses) will advise you accordingly, then simply sick the physician on you to explain the importance of whatever it is they would like for you to do. If you remain non-compliant, they can just discharge you and document accordingly. Hospitals revenue is driven heavily on satisfaction scores (thanks to Obamacare) and if the customers, YOU, are unhappy, the revenue drops for the hospital. They will work with you as far as they can to keep you happy. Or at least they SHOULD. Just ask what the boundaries are up front and do your best to stick to them.

Not sure if this helps, but there you go.

 

[Suprtek]

Thanks Cam. In light of what you have said, I guess it comes down to what is considered being non-compliant. In my case, the last time it came up I was simply waiting to be discharged. The decision had already been made that I was to be discharged and I was simply waiting on paperwork. Yet the nurse still insisted that I was not permitted to leave the floor. Like I said earlier, I did comply this time because it wasn't going to be too long.

I may be going back to the hospital soon and I anticipate a lot time spent waiting for various things. Unless they can tell me something is likely to happen in the next 15 minutes or I am not in any condition to be walking around, I see no reason not to walk outside as I see fit.

 

[Suprtek]

I found something interesting on the web site of the hospital in question under the heading of "Your Rights as a Patient". I'm not sure if this falls into the category of hospital policy or if it is a matter of law, but it reads as follows:

As our patient you have the right…

To be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.

Interesting...

 

[Cam]

Thanks Cam. In light of what you have said, I guess it comes down to what is considered being non-compliant. In my case, the last time it came up I was simply waiting to be discharged. The decision had already been made that I was to be discharged and I was simply waiting on paperwork. Yet the nurse still insisted that I was not permitted to leave the floor. Like I said earlier, I did comply this time because it wasn't going to be too long.

I may be going back to the hospital soon and I anticipate a lot time spent waiting for various things. Unless they can tell me something is likely to happen in the next 15 minutes or I am not in any condition to be walking around, I see no reason not to walk outside as I see fit.

Your thinking sounds reasonable to me. Here's the trick to all of this, talk to your physician. If he or she is fine with you walking ad lib, have them write an order for it. Then the nursing staff won't question it at that point.

Whatever it is you are going back the hospital for, I hope all goes well and you are better quick!

 

[Cam]

I found something interesting on the web site of the hospital in question under the heading of "Your Rights as a Patient". I'm not sure if this falls into the category of hospital policy or if it is a matter of law, but it reads as follows:



Interesting...

Those are definitely matter of law.

 

[Suprtek]

Your thinking sounds reasonable to me. Here's the trick to all of this, talk to your physician. If he or she is fine with you walking ad lib, have them write an order for it. Then the nursing staff won't question it at that point.

Whatever it is you are going back the hospital for, I hope all goes well and you are better quick!

Just playing devil's advocate here...that sounds like something that could backfire on me. If I specifically force the doctor to address the issue, he just might decide to issue an order to the contrary.

As far as my issue goes, they found some kind of obstruction in my small intestine and its been causing some severe pain occasionally. They're trying to figure out what it is and deal with it. I'm sure it'll work out eventually.