"I don't want him as my nurse"

Nurses LPN/LVN

Published

While this is not exclusively LPN related, I feel that as an LPN I should still discuss my nursing dilemmas here with nurses such as myself.

I go to triage a pt and he says in a lively and over the top voice, "I'm not doing so well."

I look at the pt. I smile at him and say, "I'd imagine you're not doing so well if you needed to come to the ER." His wife laughs and he glares at me and I slightly shrink back- oops. I begin the triage and ask him questions pertinent to the triage. He cuts me off at every question and begins to rant. He goes on and on...... and on... and on.... he belittles the physicians and nursing staff who made him this way. He's yelping and yowling about his problems. The pt is so over the top with his complaints... I get to the question, "On a scale of 0-10, how would you rank your discomfort right now?"

"Uh. A 20!" he states like it is the most blatant thing in the world.

My manager once told me, "I knew I had to leave the bedside in the ER when I sat and listened to a father yelp and howl about how he ran over his daughter and all I could think about was how he couldn't cut tot he chase and tell me the pertinent triage information. I knew it was time for me to go after that."

I look at the patient and say, "Well, anything after 10 on the 0-10 scale is reset back to 0, so if you really think your pain is a 20, then I thin I have send you back. Do you still want to call it a 20?"

The patient hesitantly looked at me, then glanced to his wife behind me, then back at me with confirmation of his indignation, "Yes! Its a 20!"

"Okay. Just so we're clear on that..." I respond.

From that point on, it was smooth sailing. The triage was easily completed. About 15 minutes later, the Primary RN comes to me and says, "No offense, the patient requests you not come back to their room"

.... sigh..... more than happy to oblige.

gah.

Seeing as my 15/10 comment has drawn so much humour, I'd just like to ask how many of you have suffered severe pain?...

You should start a new thread with that question as the title...

Specializes in ER, Addictions, Geriatrics.
I think it's completely reasonable to tell the patient that's telling me their pain is >10 that 10 is the highest it can be, so I will document 10. No need to get into an argument about it at all or have an attitude about it. The fact of the matter is that the pain scale is 0-10 with the highest possible number being 10. Most people can understand that logic.

You can say just about anything to just about anyone if you say it right.

That's usuay what I do. I'll say something like "so by what you're describing this is clearly the worst pain you've ever experienced, and by definition of the pain scale, that would be a 10/10, so we'll put you at ten." Then administer the medication and ask them later if their pain is subsiding. Most patients seem to agree with it.

yep. the "halves terms" are confusing sometimes. you may ask the patient to convert it to percentage instead hehe

I don't get into a lengthy dissertation about how 10 is the highest number the patient is allowed to choose so I'm going to change your answer to 10 if you go higher than 10.

I know that when they say 15 or 20 . . all it means is they are hurting really badly and I need to help them. They are saying "please help me". I couldn't care less if they abide by THE HOLY PAIN SCALE.

As to being fired by a patient . . . yes, that happens. And yes, I've fired myself as well. But that only happened once.

I haven't been in pain that I would rate 15/10 or 10.5/10, but I'm due to deliver any day now so we'll see how that goes :)

I haven't been in pain that I would rate 15/10 or 10.5/10, but I'm due to deliver any day now so we'll see how that goes :)

Good luck and congratulations!

I haven't been in pain that I would rate 15/10 or 10.5/10, but I'm due to deliver any day now so we'll see how that goes :)

That's funny - I rate my pain NOW based on this pain scale: If it doesn't hurt like my labor pains hurt, then it doesn't hurt. ;) In fact I said that last week when my doc was about to inject a wound on my knee with lidocaine and warned me that it might initially hurt. I said the comment above and he smiled. It was easy peasy.

Best wishes on the delivery of a healthy baby! So exciting. :yes:

Specializes in Public Health, L&D, NICU.
Seeing as my 15/10 comment has drawn so much humour, I'd just like to ask how many of you have suffered severe pain?

Ever been diaphoretic, chilled, unable to sit/stand/lie in any position, unable to eat/drink or void all as a result of medical condition that came out of nowhere? Ever had your BP drop suddenly while having your pulse hit 180? Faced the sudden and unexpected prospect of dying?

Too many of you seem to find humour in it that I wonder about the compassion of my fellow nurses.

Oh, and if it's any consolation, I do know who fathered my children.

While I've never had the pulse to 180 with a drop in BP, I can say yes, yes, and yes to the other things. And? The point is that it's a simple question. "How would you rate your pain if 0 meant no pain and 10 was the worst pain you can imagine?" So, if it's the absolute worst, it's a 10. There's no need to be a drama queen and say "15." It's not going to impress anyone, it's just going to make them want to roll their eyes. No nurse is going to hear that and run screaming to the doctor because they have a new record-setter and perhaps general anesthesia is needed to combat the heretofore unheard of pain.

Tell me 10 if you can't imagine it being any worse. I take that seriously, I medicate according to MD order. Tell me 15, I write 15 in quotes, think 10, medicate according to MD order, and wonder if there's a little attention-seeking going on, maybe for the benefit of family.

And I have a medical condition that gives me lots of grief and pain. I've fainted, hit my own head against the wall to make it feel better, paced, rocked, and done all the other weird things pain patients can do. But I've never said "15" because that's just dumb.

I also labored for 12 hours on Pitocin without an epidural and with cephalopelvic disproportion (supposedly that bone-on-bone pain is supposed to be in a league of its own, and I would have to agree) followed by a cesarean under general with no pain orders when I woke up in recovery, and I still never called it 15.

Specializes in Public Health, L&D, NICU.
I haven't been in pain that I would rate 15/10 or 10.5/10, but I'm due to deliver any day now so we'll see how that goes :)

Good luck, hope you have a quick and easy delivery!:dummy1:

I still don't think everyone who says 15 is a drama queen/king.

I'm still not going to make a big deal out it.

Specializes in LTC, Memory loss, PDN.

the op did what i secretly want to do so many times -

be my smart pants self

the pt.'s responses are a vital part of the assessment and should not be altered

as they can answer a lot of questions such as

is the pt. a reliable historian?

is the pt. able to follow directions?

is the pt.'s c/o the primary concern or are there other problems?

etc., etc.

the wife laughing really bothers me and i would have liked to

interview this pt. in private

as far as the pain scale goes, until you ask f/u questions

it's purely subjective anyway

i believe validation can be a good way to start digging deeper

but man is it hard some times

i'm reminded of a young man who cut himself at work

he was carrying on how he was bleeding out

he ended up with two stitches

It's not our job to question a pt's pain level, just acknowledge and follow the orders to treat it. If someone tells me they're 20/10, then I document 20/10 pain scale. To me it says they're in pretty major pain and need relief.

I've been "fired" by a pt because I mispronounced their name. It started with an odd letter and contained more letters than the alphabet, and the last syllable had a short "a" sound instead of the long "a" sound. Pt would roll eyes if they saw me and demand a different nurse and would sit and wait until someone else was available.

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