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Keywords:

  • nurse–patient relations;
  • patient compliance;
  • patient participation;
  • patient satisfaction;
  • physician–patient relations;
  • physician's practice patterns;
  • professional autonomy;
  • treatment refusal

Discharging a client from a practice is a choice clinicians may need to make when conflicts arise that cannot be resolved. The legal and ethical considerations before discharging a client are presented. This preliminary survey of 111 certified nurse-midwives was conducted to determine their practices and beliefs about discharging clients. Most (83.7%) participants had discharged five or fewer clients from their practice throughout their careers, including 36.9% who had never discharged a client from their practice. In contrast, 77.5% of participants said that midwives should definitely discharge clients from their practice under some circumstances. Antepartum care was the most frequent period during which clients were discharged, and 59% of those discharged were for noncompliance with the therapeutic regimen, obnoxious or abusive behavior as subjectively identified by the midwife and her colleagues, or failure to keep appointments. When asked why they might not discharge a client from their practice, 60% identified empathy or sympathy for the client as the reason. When asked why they did not discharge clients in the past, 23 (21%) respondents selected “colleagues disagreed” as the reason.