Stopping patient care for another patient

Nurses Relations

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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??

Believe it or not, this nonsense (and I use the word loosely for another that's not acceptable in polite company. . .you get what I mean) goes on in clinic settings, too. Years ago, I was trying desperately to keep the exam rooms full for the physician, but had to handle the after-school allergy injection kids, too. I was doing my level best, honestly, but one or two moms would consistently jump up and ask if their child could have his/her shot NOW. They had not waited an extraordinary period of time at all and knew that the allergy shots were worked in between keeping the exam rooms full. . .after all, they wanted to be seen by the doc in a timely fashion, too, when THEY had a sick child and someone else wanted their AI NOW. Grrrrrr!!

Finally, after two or three rounds of this unreasonable behavior, I spoke to the physician. I don't know what he did/said to these particular mothers, but they never hounded me again. I was always grateful to him for taking MY part and not theirs. SOOOO glad to be out of that setting; don't miss that nonsense AT ALL!!

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I am right there with all of you....Unless there is a code or someone is bleeding out of their eyeballs, I am not interrupting what I am doing and possibly making a mistake....family members that do that are obnoxious at times, stick to your guns and tell your DON exactly that...however playing devil's advocate for a minute, did the tech tell the other patient that you were with someone? I CMA by going to the patient directly because I have had that happen...had a tech answer a light then not tell me what they want and I have caught holy hell until I explain that to them...either way...don't stop what you are doing with one like I said, unless one or both of the above conditions applies.... ;)

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Sorry? BREATHING is my number one nursing priority.

Yes, believe it or not I still remember Maslow's hierarchy. However pain control was number one with family and patient at that time.

I tend to jump on pain control because I watched my father suffer for years from nurse's and doctor's that did not give a rat's patooty.

The bottom line is the patient's family wanted to move the patient from the facility! That is because the very basic need of pain control WAS NOT ADDRESSED. No wonder they wanted him moved.

I am surprised at the number of responses that feel it is an interruption of the NURSE'S routine to administer pain relief . We are not "running back and forth like a servant" when we are trying to comfort someone in pain.

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Specializes in LTC, med/surg, hospice.

So the patient's family was not pleased but we do not know how the patient felt. What was their pain rating? Is is chronic pain? Was their pain relieved? Did they request pain med again and have to wait long time on more occasions?

Pain control is important and I make it a priority to administer requested meds in a very timely fashion. That said every time someone requests pain meds it does not mean they are in excruciating pain and I use my nursing judgment and knowledge of the patient in that area.

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Specializes in Dialysis/Nephrology.

that is what scares me! it's all about the dollar n less about the person n their health! it's bs...jmho!

in response to;

jeweles26

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No, I do not think you were wrong to finish up what you were already in the middle of.

It is well documented that interruptions during medication preparation and administration contribute to a greater incidence of medication errors. Unless the interruption is a real, life threatening emergency, it can wait a few minutes.

What I would have done would have been to instruct the tech to return to Patient B's room and inform the family that the nurse has been made aware of the request, and will be there to address it as soon as she is finished with Patient A. Then, as soon as I finished up with Patient A, I would have gone directly to Patient B's room to do a pain assessment and let the patient and family know that I was addressing the request.

Then, they might not have had to come out into the hallway to find you, and they might have felt like the request was being taken more seriously, and hence, not have felt the need to complain.

Granted, it is much more efficient to just go to the cart and start pulling the meds than it is to go to the room, do the pain assessment, communicate with the family, then go back to the cart to get the meds. But perception is everything. As far as the family is concerned, they are in that room, that room is their universe, and they have no idea what you are doing, with whom, or why. All they know is that you are not in that room, and every minute seems an eternity.

The sooner you come into the room and communicate, the more likely the family's perception that you are actually doing something is to be. The more effectively you are able to communicate, the more likely they are to be satisfied with your care.

One thing I've learned in my brief time as a nurse is that what might be most efficient and make the most sense to you is totally irrelevant to the vast majority of patients and their loved ones. Much of what they perceive is based upon the face to face time with you; not the clock, not your reality, not anything else outside the four walls of that room. Communication really is key.

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Specializes in Med/Surg, Academics.
Can I ask why you wouldn't be allowed to say you were with someone else? Seems to me there is nothing wrong with that! You aren't disclosing personal information, you aren't saying 'I was with Mr. So-and-So.'

I hate what health care is becoming...when did it become more important to kiss everyone's butt than to actually make people better? Just a scary thought for the future of nursing, more about customer service than health care... Ugh...

It's considered "blaming someone else" for the delay. I know...I don't get it either, which is the reason why I've ignored that particular edict.

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Specializes in Oncology.
Yes, believe it or not I still remember Maslow's hierarchy. However pain control was number one with family and patient at that time.

I tend to jump on pain control because I watched my father suffer for years from nurse's and doctor's that did not give a rat's patooty.

The bottom line is the patient's family wanted to move the patient from the facility! That is because the very basic need of pain control WAS NOT ADDRESSED. No wonder they wanted him moved.

I am surprised at the number of responses that feel it is an interruption of the NURSE'S routine to administer pain relief . We are not "running back and forth like a servant" when we are trying to comfort someone in pain.

I stay on top of my prns, so my patients aren't in pain, and yes, going from a room where you're doing a pain med to go do another pain med before you complete the care you've prepared to do on another patient because they are not willing to wait a few minutes and want their pain med NOW is running back and forth, and if they want a private duty nurse to jump at each request and to not have to wait a few minutes, they need to hire one. I am not their servant, I am there to help ALL the patients. And maybe this patient she was turning needed turned badly, and who knows what could have happened had she not turned the patient? Sometimes people request PRNs but I know when I go in there they will have 30 other requests and take up an extreme amount of time, I am not making everyone else wait for them. You don't know the patient, nor the situation, nor how that nurse handles her assignments, so no, she's not expected to jump like a circus monkey and respond to a PRN request at the drop of a hat when she is already doing that. If I had done that at the SNF or the LTC facility, I literally never would have been able to finish dressing changes, treatments, or med pass, and never finished a chart. I am not saying that you should ignore pain and prn requests or make them wait a long time, but you cannot just jump jump jump for everyone about them either. Makes me curious, have you ever actually worked in LTC or SNF or ARF? My guess is no if you think that you should respond to every request for a prn pain med like it's 911 emergency and drop everything else like you don't have other priorities or a heavy workload to manage. And if I had a penny for every time a patient's family wanted to move them from the facility... I'd just be like, listen, you can move them, but no nurse worth her salt who gets her work done and has been in ltc or snf for longer than 5 minutes is gonna jump for everyone's prn requests, sometimes you have to wait a few extra minutes. I encourage my patients to ask for prns before the pain is out of control anyways, that way we can stay on top of it. And a 5-10 minute wait will not kill you if you are already in pain.

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Specializes in Oncology.

And as others have stated, short of a code or someone bleeding or something, med pass does not get interrupted and I don't go back and forth. I am not making an error and I am not making 12 trips down the hall for something that can wait 5 minutes.

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Specializes in ICU.

I make every effort to stay on top of my patient's pain control needs. I have and will stop what I am doing to give pain medication, because I have learned that is one of the things they will complain about the most. What gets me, though, is when you ask the patient if they are hurting, do they need pain medication, and they say "no, I'm fine." Then here comes a family member, takes one look at the patient, and says "he/she needs something for pain!" When the patient has refused pain medication all day, but the family member just assumes you haven't bothered to offer any. Another problem that bothers me is when we get a patient from the emergency room, and the very first words out of their mouth is "I need something for pain." (You have just been in the ER for hours, but suddenly you come to the floor and are writhing in severe pain?) I resent that they complain about not getting pain medication fast enough, when I just got the patient and haven't even got to assess them or their vitals yet. And no, we are not allowed to say we have other patients, either. We are supposed to act like we only have one patient in the entire hospital.

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I stay on top of my prns, so my patients aren't in pain, and yes, going from a room where you're doing a pain med to go do another pain med before you complete the care you've prepared to do on another patient because they are not willing to wait a few minutes and want their pain med NOW is running back and forth, and if they want a private duty nurse to jump at each request and to not have to wait a few minutes, they need to hire one. I am not their servant, I am there to help ALL the patients. And maybe this patient she was turning needed turned badly, and who knows what could have happened had she not turned the patient? Sometimes people request PRNs but I know when I go in there they will have 30 other requests and take up an extreme amount of time, I am not making everyone else wait for them. You don't know the patient, nor the situation, nor how that nurse handles her assignments, so no, she's not expected to jump like a circus monkey and respond to a PRN request at the drop of a hat when she is already doing that. If I had done that at the SNF or the LTC facility, I literally never would have been able to finish dressing changes, treatments, or med pass, and never finished a chart. I am not saying that you should ignore pain and prn requests or make them wait a long time, but you cannot just jump jump jump for everyone about them either. Makes me curious, have you ever actually worked in LTC or SNF or ARF? My guess is no if you think that you should respond to every request for a prn pain med like it's 911 emergency and drop everything else like you don't have other priorities or a heavy workload to manage. And if I had a penny for every time a patient's family wanted to move them from the facility... I'd just be like, listen, you can move them, but no nurse worth her salt who gets her work done and has been in ltc or snf for longer than 5 minutes is gonna jump for everyone's prn requests, sometimes you have to wait a few extra minutes. I encourage my patients to ask for prns before the pain is out of control anyways, that way we can stay on top of it. And a 5-10 minute wait will not kill you if you are already in pain.

You have been a nurse (?) for a whole year now." I'd just be like, listen, you can move them, but no nurse worth her salt who gets her work done and has been in ltc or snf for longer than 5 minutes is gonna jump for everyone's prn requests"

I have worked in all areas . Your attitude of "My work flow is more important than responding to your request for pain control.. simply boggles my mind.

"Like.. ya know." take the bubble gum out of your mouth.. pain is whatever the patient says it is .

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Specializes in Critical Care; Cardiac; Professional Development.

Expecting a nurse to drop what she is doing to make one patient a priority over another without a medical emergency is not reasonable. Pain is a high priority but not a medical emergency. Pulling pain meds for more than one patient at a time is not permissible. Interrupting a med pass is irresponsible.

BTDT, I am so sorry you had trouble with a facility ignoring your father's pain. I can only imagine how awful that was for all of you to go through. Ignoring a patient's pain is heinous and unforgivable.

That being said, a patient having to wait their turn is not the same as ignoring them. Should we all be on top of pain control? Yes, of course. Does that not always happen ideally? Yes, of course. I think your emotions for your father's suffering is affecting your ability to reasonably argue this one, which is understandable. But your situation is not the same as the one outlined above. Ignoring is one thing, putting a patient next in line is totally different. Five to ten minutes is a long time to suffer pain, yes. That doesn't make the reality of it change. Sometimes that is going to happen and all we can do either break safe practice or apologize. I will choose to apologize for being later than the patient would have liked for a pain med any day over having to apologize for a med error to the patient, their family, my manager and/or the BON. That which is more likely to affect my license is going to dictate my care priorities. I won't ever lose my license for being 10 minutes later than a family wanted for pain control. I sure as shinola could, though, for making a med error such as giving the wrong drug to the wrong patient or making errors in patient care due to rushing off to address another patient's pain.

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