The Job Description Doesn’t Say You Get to Choose Your Patients

He was a pedophile, just released from jail after 20 years. His diabetes required two different types of insulin. He had acute renal failure and a recent ileostomy.

“They didn’t know what to do with him,” the previous nurse said, “so they dumped him on our doorstep.”

The Reflections essay in the March issue of AJN tells one nurse’s story of holding fast to her responsibility to provide compassionate and quality care to all patients, whatever they may have done in the past, whoever they might be. We hope you’ll click the link above, read it, and let us know your thoughts (the best version to read is reached by clicking through to the PDF version).

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2016-11-21T13:19:11+00:00 February 24th, 2010|career|8 Comments
Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Laura March 16, 2010 at 7:31 am

    It is not our job to judge, that will be done by someone else.

  2. jm March 2, 2010 at 3:02 pm

    What a profound distinction you point out. Thanks for weighing in, Doug. The implications of this difference are many.
    -Jacob Molyneux, blog editor

  3. Douglas Olsen March 2, 2010 at 2:59 pm

    Given the title of the blog entry, “The Job Description Doesn’t Say You Get to Choose Your Patients’ it is interesting to note the American Medical Association code of ethics still supports the idea that physicians do get to choose their patients (Principle VI “A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve. . .” I believe it is a critical conceptual distinction between medicine and nursing. In nursing our goal is to care for all in need and we struggle with how to care for difficult patients, the paradigm of physician practice is still contractual – the physician can accept you as a patient or reject you if you don’t cooperate.

  4. northwoods baby February 27, 2010 at 3:24 pm

    My point about HIV status was that I think it’s more relevant to tx than his criminal hx. What he did does not have any relation to his health. In *this particular case* it doesn’t sound like having him on a mixed ward is of any concern. If there were some concern, there are ways of passing that on without giving his entire criminal history.

    ITA, the author did a stellar job of pt care and she should be proud of herself, as we certainly are.

  5. Big Daddy February 27, 2010 at 2:34 pm

    I must say I also find this all facinating. As nurses we do our best to provide professional and compassionate care to our patients. Despite their background. That is our duty. But a pedophile just sets off a certain nerve with people. After all we are people too; we have families and children and heinous acts against innocent children are just unexcusable. There is even a hierachy among the incarcerated.
    The comment about needing to know a patients HIV status, why? Do we not have Universal/Standard Precautions we are to follow. So why would we need to know an individuals HIV status?
    I believe some rural town hospitals do not have a dedicated pediatric floor. Would it behoove us to have this information for placement purposes? Would we bring an alcoholic to a bar and set a drink in front of him? Does knowing the background of a patient also help the patient and keep others in our care safe as well?
    I commend the author for bringing forward a such a controversal subjct…one I think many of us agree with but are just unwilling to expose ourselves to the backlash. Kudos to her!

  6. Alice Facente February 26, 2010 at 9:28 pm

    As a clinician, I find the examination of the psychiatric causes of pedophilia very interesting. But there is no possible explanation that can be of comfort to me if one of my precious children was the victim of a pedophile. I commend the author for her courage in revealing her honest feelings in this public forum, and appreciate that she nonetheless delivered professional and compassionate care to the patient.

  7. ninjanurse February 26, 2010 at 6:12 pm

    It’s our job to take care of our patients. We do it well.
    As far as HIPPA, I wouldn’t be surprised if it was the patient himself who disclosed his history.

  8. Northwoods Baby February 25, 2010 at 8:02 am

    I wonder how and why his crime was related to the nursing staff. It was not relevant to his care in any way, as far as I can see. If he had served his time, was there a reason for revealing it? Is there no equivalent of HIPAA for ex-cons? I have small children; I am very much aware of the potential dangers to my kids. I also can’t see a wheelchair-bound, toothless, ostomy, diabetic as much of a threat.

    I guess I don’t think that the crimes committed generally relate in any way to the care a pt should receive. If one has a history of attacking nurses, then yes, absolutely it’s critical to be aware of it and take necessary actions to be safe.

    People do horrible things, but generally there is a background that at least partially explains why they did what they did. It DOES NOT excuse it, but sometimes it can help to understand how things ended up the way they did. IF it is deemed necessary to reveal a pt’s crimes, then I think it is also incumbent on the administration to share any pertinent history. But on the whole, I don’t think it is the business of the medical staff to know why someone was in prison.

    So I guess I waffle a bit, but mostly I stand behind my need to not know. Don’t tell me why someone was incarcerated unless it’s something that affects their medical care. I don’t need to know that you robbed a bank; I need to know that you have HIV. It’s a horrible thing that you drove drunk and killed a child, but it does not have anything to do with your colon cancer.

Comments are moderated before approval, but always welcome.

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