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??

[uRNmyway, ASN, RN]

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.

look, i realize your response is largely influenced by your personal experience with your father/mother (whoever it was). but as others have said over and over, walking away from someone who you are already doing an evaluation on is just begging for errors, medication and otherwise. its not like she said anything about finishing all of her morning rounds or anything like that. she said she would finish what she was doing with that patient. geez, if i dropped everything and ran anytime a patient complained of pain, no matter what department or setting its on, i would never get anything done! and with me not getting anything done, its not about "my work flow being more important". its about "my patients are not getting care that they need and was ordered for them in a timely manner".

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

wow, get off your soap box and quit being judgmental. you have no idea who she is or anything about her. she uses a few words and you assume she is a bubble-gum chewing air-head? unless i missed something, this pain is not what the patient said it is. it is what the family members said it was. and check out other threads, that is another controversial issue in itself. personally, if a family member tells me their mother/father/child/whatever is in pain, i want to assess said pain for myself, not just take their word for it and rush with pain meds. and to be able to focus on them and assess this pain properly, i cant be thinking about the patient i just left behind with unfinished care.

[nrsang97, BSN, RN]

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. 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 to your father's suffering is affecting your ability to reasonably argue this one. 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 rules 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.

I totally agree with this.

[Butterfly E. Phect]

I have a feeling that this family is going to be moving this patient from one health care facility to another one A LOT. They are going to be just as unhappy in their next hospital. About the 4th or 5th hospital, they'll probably adjust their expectations to realistic ones.

[Do-over, 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 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?"

Most seem to respond positively to that. If the family or patient is impossible to please, nothing you could say or do would make it better.

I do this pretty much anytime I can't answer a call right away... "Sorry it took me so long to get here, I was with another patient/on the phone with a doctor, etc". Or, I might stick my head in the door to acknowledge that the CNA passed on the request and that they are next on my list. Seems to work well for me.

I've heard before about how some places don't want staff to say that they were busy with someone else, etc. My employer has not stated that, but I am sure I would ignore it (as I do with most scripting). My patients are perfectly aware that I have several people to look after, and every now and again they ask how many I have. I tell them.

[JZ_RN]

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 .

I don't care if you've been a nurse for 5 minutes, if you run back and forth between rooms just so someone will be "pleased" they don't have to wait 5 minutes for a pain pill, who's really the naive one? Time management is important. And unless the patient's call light is paging me and i know they pushed it, their family can get over having to wait a short period of time for me to come and do the PRN pain assessment, talk to the patient, and perhaps get a pain med. Maybe you have worked in all areas, but I'm here to let you know that moving from room to room in a systematic fashion is what has to be done so every patient gets equal, necessary, and fair care. If you let a demanding family monopolize your time then all your other patients will suffer. So I guess that makes you a good nurse (?) though because you're awesome at customer service? I don't care what you think or what your opinion of me is, because I know that all of my patients receive the care they need and I am fair and honest about it, I don't run like a chicken with my head cut off and apologize for being busy, because I am, and unfortunately once in a while a person will have to wait a minute for me to come. I'm not saying I'd make them wait forever, but I am NOT dropping what I am doing for a non-emergency need, and a family member requesting pain meds is not an emergency. . Pain is whatever the patient says it is, and I will address it in a moment when I go see that patient, not just respond to every screaming family member that hunts me down in the hall or harasses my CNAs. I am not "prioritizing" my needs over the patient's, I am prioritizing the needs of the patient I am already with over the needs of a patient whose family just requested something, which I will do promptly as soon as I finish what I am already doing. So, in short, get over yourself.

[Been there,done that, ASN, RN]

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.

Let me explain in more specific terms. I am currently a float nurse, that can go to most units..in multiple facilities in the largest health care system in a large city.

I have no problem pulling any narcotic I need from the pyxis , at the same time..even if it is for two different patients. I am a professional. I am expected to give narcotic A to patient A and narcotic B to patient B.

I can administer the correct medication to the first patient... walk down the hall and medicate the other patient PDQ. I fail to see how that would be a safety violation.

I have also started a blood transfusion on two patients at the same time. I can read.

30 years of experience will do that for ya.

[JZ_RN]

Let me explain in more specific terms. I am currently a float nurse, that can go to most units..in multiple facilities in the largest health care system in a large city.

I have no problem pulling any narcotic I need from the pyxis , at the same time..even if it is for two different patients. I am a professional. I am expected to give narcotic A to patient A and narcotic B to patient B.

I can administer the correct medication to the first patient... walk down the hall and medicate the other patient PDQ. I fail to see how that would be a safety violation.

I have also started a blood transfusion on two patients at the same time. I can read.

30 years of experience will do that for ya.

Considering that this is LTC I believe she is talking about and the meds for narcs come usually in packs or cards, so if you get them out, 2 pills can look similar or even the same, and be different, so to give 2 people pain meds at once or even have 2 pulled and not administered is BAD practice and CAN lead to errors. And lord knows she'll probably get interrupted during that and have to get another med, then another call, and it'll just be a mess, and leaving a narc sitting around is not gonna work either.

[redhead_NURSE98!, ADN, BSN]

wow, get off your soap box and quit being judgmental. you have no idea who she is or anything about her. she uses a few words and you assume she is a bubble-gum chewing air-head? unless i missed something, this pain is not what the patient said it is. it is what the family members said it was. and check out other threads, that is another controversial issue in itself. personally, if a family member tells me their mother/father/child/whatever is in pain, i want to assess said pain for myself, not just take their word for it and rush with pain meds. and to be able to focus on them and assess this pain properly, i cant be thinking about the patient i just left behind with unfinished care.

agreed...her personal experience is coloring everything in the universe, exhibit x y and z are that she thinks pain is a nurse's "number one priority."

[redhead_NURSE98!, ADN, BSN]

I have also started a blood transfusion on two patients at the same time.

Fascinating. Were they patients in the same room?

[Piglet08]

from do-over: " i've heard before about how some places don't want staff to say that they were busy with someone else, etc. my employer has not stated that, but i am sure i would ignore it (as i do with most scripting). my patients are perfectly aware that i have several people to look after, and every now and again they ask how many i have. i tell them."

i do that, too. and sometimes i explain, when it seems helpful, that another patient, even if it's not mine, is so critical that we're all helping in that room, so i might not always be where my patient can see me, but here's the monitoring system, so we know about your vss and heart rhythm, and you have your call bell right here, and here's all the reasons you're safe. that often helps, but not always. one time, i had to (diplomatically) tell a patient who was low acuity, young, walkie-talkie, overnight observe and not really meeting icu criteria even for that, but anxious and needy and ... okay, kinda whiny, i have to say it to paint the picture - that my other patient was extremely ill, intubated, sedated and totally helpless, unable even to breathe without our help, and that each of the honks and beeps she was complaining were keeping her awake were signs that the other patient needed something, like maybe air, and therefore, no, we could not turn off the alarms. i told her i could shut her door, but she didn't want that. and she said something about how now she felt guilty for complaining. and deep inside i said "yessssss!".

administration might frown upon inducing guilt in a paying customer. i considered it an appropriate nursing intervention, along the spiritual lines. or neuro, as in, adjusting her orientation to place (not at the ritz) or self (not someone at death's door).

op, it stinks that admin threw you under the bus like that. you didn't do anything wrong.

[uRNmyway, ASN, RN]

Let me explain in more specific terms. I am currently a float nurse, that can go to most units..in multiple facilities in the largest health care system in a large city.

I have no problem pulling any narcotic I need from the pyxis , at the same time..even if it is for two different patients. I am a professional. I am expected to give narcotic A to patient A and narcotic B to patient B.

I can administer the correct medication to the first patient... walk down the hall and medicate the other patient PDQ. I fail to see how that would be a safety violation.

I have also started a blood transfusion on two patients at the same time. I can read.

30 years of experience will do that for ya.

Ok, so after coming across several of your posts, generally I agree with you on opinions you have. This however, is honestly driving me nuts.

I really feel like your personal experience with your family member is irreparably tainting your opinions on this. I wish I could just ask you to put that aside, and to be completely objective about this.

In any setting, but especially in LTC, where the nurse to patient ratio is so ridiculous, it is completely unreasonable to expect nurses to drop everything they are doing with someone to go give narcotics on the word of a family member. Especially if you are CURRENTLY in the act of giving narcotics to someone else. Especially if said patient still requires further evaluations for the narcotics being administered. ESPECIALLY if you are a fairly new nurse who really needs to focus on what they are doing to avoid errors (Pardon me OP if Im off on this assumption).

If you are willing to put your licence on the line, if you are willing to risk making mistakes with your patients, just because your opinion is tainted by the negative experience of having nurses ignore your family member (which I am very sorry you had to experience), that is your thing. This is not what the OP was doing here though. She was not ignoring a patient's pain. She was trying to avoid making mistakes, trying to be fair to the patient she was in the middle of assessing. Last I checked, like you mentioned, we are still being tought Maslow's hierarchy in nursing school. And while pain has been added as part of the vital signs, it is still NOT #1 priority as you claimed.

And props to you if you have learned in all your years of nursing how to multitask without making mistakes. Personally, in my 4 years of experience, I have mostly learned to do it as well. I WILL prepare meds for all my patients before doing my rounds. I CAN walk away from someone because someone else urgently needs something. I prefer not to, but can. However there are things I wont do. I wont pull narcotics for more than one person at a time. Medication mistakes are one thing, but narcotic mistakes are a whole other problem. I can also have more than one transfusion running at the same time, but will not have both of them on me at the same time to go begin them. Thats just playing with fire. I dont care HOW MANY years of experience you have, you are still human and thus are still prone to making mistakes.

[nursel56]

The studies are pretty solid on the link between med errors and interruptions of a med pass. Stopping in the middle of what you're doing to avoid having another patient wait for less than 30 minutes for a pain med might be a snap for prodigious nurses. Error rates are statistically higher when this happens, so those who can pull it off will have to settle for admiration rather than emulation.

Excuse me for now, gotta get another piece of Hubba Bubba. Yeah, crusties like gum, too. :)

JAMA Network | Archives of Internal Medicine | Association of Interruptions With an Increased Risk and Severity of Medication Administration ErrorsInterruptions and Medication Administration Errors