Stopping patient care for another patient

[sAssy_NurSe]

Ok I have a question....

Here's the scenario ... I was in the middle of patient care with one patient who was requesting pain medication. It was time for her scheduled meds so I was doing the whole nine. Checking her vitals, re-positioning, etc.

When I stepped out to grab something off my cart one of the techs on my other hall told me that a patient's family said that she wanted something for pain. I said I will come as soon as I finish.

When I finish I went to my other cart to prepare her meds when her family came up the hall and stated she needed more water so I said I will get it. I got some water then finished pulling her meds and walked with the family down to her room. Administered her meds and made sure she was comfy before I headed back down the hall.

2 days later my DON calls me and asked me to explain what happened because the family said she waited 45 mins(bogus) and they wanted to move her to a new facility. Now was I wrong for not interrupting my current patient care to go to another?

If I was then I will accept that for future reference. But I look at it as unfair to patients to put them on hold for another unless absolutely necessary. I took all of 10 mins at the most. I feel bad. Do you cut patient care short when someone requests something i.e. pain med, tx, water, snacks??

[Been there,done that, ASN, RN]

I would not worry about it. You can't be in 6 places at once sometimes people just had to wait. I might though, if you know you are busy, see about asking a coworker for a little help if you know you'll be a while with a patient or task (maybe get the charge to pass a pain pill for you?). I also usually ask my assistant to tell my patient and family that I'm in another room and will be with them very shortly.

I usually sweetly say to patients or families "I am sorry it took me so long to get here. I was told your request but was already in the middle of something with another patient. I had to finish that up and got here as soon a I could. I understand you wanted (whatever they wanted). Is there anything else you need or would like?"

How much "sweetness"does it take after you've been laying in pain?

You might "worry about it" if it was YOUR loved one in pain. Pain control is NUMBER ONE of all nursing priorities. In this case, she only needed to be in 2 places at once. And that is addressing the patients PAIN.

I can give pain meds to 2 patients , at the same time, show my concern and follow up on the cause as needed. This is NOT rocket science.

[bewilly]

some people would complain if ya hung em with a gold rope,I moved to homehealth due to the effects of 25+years of what,cvicu,icu,and er does to ones back and actually get to teach pts and see them improve and become knowledgable about their disease,i also dont have to deal with all the idiot administrators who value money more than the pt.

[LouisVRN, RN]

Yes, you were wrong.

Patient A requested pain meds. You then delivered the RX.. and went on to complete the med pass and complete the bedside needs.

That was YOUR agenda.

Patient B (and now we have family concerns) requests pain medication.

Waiting for pain relief is a VERY long time in the patient's and family agenda. Ten minutes is a very long time when requesting pain relief.

You needed to address patient B's pain before you completed your tasks on patient A.

You were NOT cutting patient A short. You just didn't juggle the situation correctly.

I agree with this. Pt A wanted pain medication. Once they received that they probably would not have minded if you reassessed their vitals, repositioned them, etc when you went back to reassess your pain after medicating patient B.

I have had one patient complaint in 4 years of nursing - which I think is pretty good. It was a lap appy pt that requested two Tylenol for pain and he had to wait 20 minutes. However I was with a pt who had aspirated her dentures.

[FurBabyMom, MSN, RN]

How much "sweetness"does it take after you've been laying in pain?

You might "worry about it" if it was YOUR loved one in pain. Pain control is NUMBER ONE of all nursing priorities. In this case, she only needed to be in 2 places at once. And that is addressing the patients PAIN.

I can give pain meds to 2 patients , at the same time, show my concern and follow up on the cause as needed. This is NOT rocket science.

Well...seeing as not only have I had relatives lying in pain but very recently (April) I was the patient having emergency surgery - I guess I don't know anything then. For most people good customer service will help de-escalate a situation. Apologizing and working harder are not bad options. And I did offer valid alternatives for actions... My point was not to not worry about a patients pain but was to point out that yes it was a complaint there's a lot more serious things one could get in trouble over.

Perhaps I didn't comprehend the situation correctly. Perhaps I'm stuck on how things work at my job and what my work situation is like...that is, after all, my persoective. Perhaps I read too much into it. Where I work we are not allowed to pull narcs or meds (anything in the accudose/pyxis) on multiple patients at a time. That kinda rules out pulling two peoples pain meds at the same time... The situation read to me like a customer service issue and would be a he said / she said thing but to disregard policy is much more concrete and would definitely get me in trouble when pharmacy and my manager look at the report of what was pulled and when. Where I work, often, our charge has no patients on day and evenings so it's reasonable to ask the charge to handle a pain pill of you're busy (which is addressing your patients pain too).

Pain control is important. But the type of unit and patients I work with? When three of my five patients are high risk for aspiration, I'm not hurry through something I've already started and do something halfway as well as it should be with any of them to scamper over to give someone elses pain med. Keeping my other patients from aspirating is a bigger issue than someones pain pill being given the second they ask for it. Do I agree that starting a new task instead of dealing with pain would be a not so great choice? Yes. Finishing what you've started? Maybe not. For what it's worth - if I had a clear stopping point between tasks or had not begun a task with meds I would go deal with the pain pill first. A lot of my patients - I have to crush meds. I can't just put my patients crushed meds on top of my computer cart and go pull someone else's pain medication... I'm not gonna bathe and change a patient but if my patient A has a med I've already crushed I'm gonna give that and then move on. If all I had were walkie talkie patients it would probably be easier to get things done faster.

Furthermore, pain control is something I have limited control over. I am forever asking about pain and giving pain meds as often as PRN orders allow or when patients ask for them. I'm stuck between a patient's demands and a physician's orders. I monitor the effect of pain meds and try to ask for better pain meds for my patient that isn't responding well to the PRNs ordered but I can't fix the orders myself.

Since you argue that pain control is the number one end all be all of nursing priorities, I guess I'm a horrible nurse for not giving my patient with a blood pressure of something like 88/44 their IV Demerol then huh? If I'd given it they wouldn't hurt...but their pressure would surely drop even more and there is a point at which pressures are too low for adequate perfusion. Did that patient complain? They sure did. Patient asked to see the on call physician coverage who had my back on the situation - I asked him to see the patient, he went to see the patient and he explained why I was right. Patient complained to our manager and VP for patient relations (some fluffy title like that). Guess what? My manager and the person in administration agreed with me.

[martymoose, BSN, RN]

In customer service- the squeaky wheel gets the oil.That's why this profession sux. We have to please the squeaky wheel, even if someone else is coding. They don't care- they want what they want. And mgmt will always kiss their behind.And everyone else loses.

[Penelope_Pitstop, BSN, RN]

Pain control is NUMBER ONE of all nursing priorities.

When was this decided?

[katnurseswims]

Your DON was wrong in approaching you like this. I would not have attended to the other patient until the other patient's scheduled meds were passed. The family has unrealistic expectations of how one nurse cannot be in two places at once and the DON should have explained policy. If they want instant service and are willing to pay to go somewhere that has a smaller nurse to patient ratio, that is their choice.....but that is not your fault and your DON should know that. She/he obviously does not have much experience in patient care.

[katnurseswims]

And to "been there done that" (not willing to view every post to copy the quote again).....how are you able to give two patient's pain meds at once? There are strict policies when it comes to med passes, and it NEVER includes giving two patient's meds at one time. If you are, that is a huge safety violation. Plain and simple.

[JZ_RN]

You were right, I know pain is important, but I am sorry, with the heavy patient load we have, there's not time to make trips back and forth into rooms. I would not have dropped the patient care I was already doing, left the room I was already in, to go spend 10 minutes doing prn meds and the assessment and the charting and the probably crushing and mixing up pills and all that and dealing with a family member... nope. Not enough time in my day. Sorry. I'd go to patient 2 and give the pain med when I was finished with what I was already doing. Short of a code or bleeding injury or something, I'm not gonna run around back and forth like a servant.

[JZ_RN]

And pain control is not the number 1 nursing priority, it never has been, never will be. Number 1 priority is safety, then respiratory, then cardiac, etc.

[redhead_NURSE98!, ADN, BSN]

How much "sweetness"does it take after you've been laying in pain?

You might "worry about it" if it was YOUR loved one in pain. Pain control is NUMBER ONE of all nursing priorities.

Sorry? BREATHING is my number one nursing priority.

[Nascar nurse, ASN, RN]

one thing that i do that seems to work for reasonable patients, although we aren't allowed by management to do it: i say, "i'm sorry for the 10 minute delay. i was with another patient at the time i was told of your request, but i'm here now! here's your pain pill! anything else you need?"

i would suggest adding in your own time frame at the onset of this - it makes it harder for the family to go back later and claim a 45 minute (bogus) delay.