Stressed about a loved patient

Nurses Relations

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I work in LTC and have taken care of one resident for a little over five years. She has become a dear friend in this time. She is soft spoken and not understood by other staff members. She has developed an ulcer and is on comfort care. Her Last living will states she doesn't want a feeding tube(which she has) and wants maximum pain relief. I feel much anxierty leaving work because people just don't pay attention to her. Other nurses state that, "She looks comfortable." And I have communicated with them multiple times she may appear comfortable but when she is turned and repositioned(every 2 hours) She cringes her face and her discomfort is obvious. But because there is lack of communication between the aides and nurses, and the nurses don't take the time to pay attention to her needs or communicate with her. She recieves no PRN pain medication for the 16 hours I'm not there. It's heart breaking to watch a loved one suffer, when she has PRN medication she could be receiving!!

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This is one of the hardest things about working with people long-term. As such, the first thing I want you to correct is your terminology.

This is not your mother, your sister, your relative or even your friend. She is your patient. She is not your "loved one". That is one of the pitfalls of your post--you have allowed her to cross over from being a patient to being something more. That is an extremely dangerous practice and one that you need to take purposeful steps to avoid.

With regards to her medications, she needs to be her own advocate on this matter and the nurses caring for her need to note her wishes, offer medication and do their jobs as they should. I'd talk to your manager if she's really being neglected in this way. No one should have to die in pain.

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If she truly has pain all the time, can you advocate for the meds to be changed from PRN to routine?

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Compassion is a large part of nursing. I don's see how someone with compassion could take care of a patient for 5 years and not develop a relationship with them. Her only of communicating now is through blinking her eyes. If the nurses just glances at her without asking her, or paying attention to her face while she is being repositioned or moved at all, they just leave her be. I have communicated this with my supervisors and MD, who then ordered a few routine medications which help, but the nurses still need to pay attention!

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Of course compassion is part of nursing, but so is setting up boundaries so that you do not overstep the professional relationship--emphasis on professional and relationship simultaneously, because those two things can and do exist together.

I would encourage you to tirelessly advocate for this patient if you feel she is not being adequately cared for. Krisiepoo's suggestion about transition her meds from PRN to routine via physician collaboration is also a great idea. Aside from providing her with the best care you can when you're there, that is all you can do.

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Specializes in LTC,Hospice/palliative care,acute care.

You do have to recognize boundaries-in your life you will face the loss of your grandparents ,parents and possibly a spouse, maybe a child,siblings and friends. Do you really want to feel that type of loss with someone else's mother whom you are paid to care for? That's a good way to burn yourself out.

Be an advocate for ALL of your residents (are you spending extra time with her while on duty? How fair is that to the rest?) Get her a fentanyl patch, get her family involved if she has any.

One of the hardest aspects of nursing is recognizing that you CAN NOT CONTROL OTHERS.If you are suffering from anxiety and worrying about this situation while you are not at work you are already in danger of compassion fatigue and you need to seek counsel at work with your supervisor,unit manager or education dept,

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With regards to her medications, she needs to be her own advocate on this matter and the nurses caring for her need to note her wishes, offer medication and do their jobs as they should. I'd talk to your manager if she's really being neglected in this way. No one should have to die in pain.

How can she be "her own advocate" when she can NOT communicate.The OP might have over stepped her boundaries and made the "mortal sin" of becoming too attached to the lady but at least she is trying to advocate for someone who is unable to. Isn't that what nurses are SUPPOSED to do?

Too bad more nurses weren't like her which is apparent from her post regarding the nurses who work at the LTC.

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Specializes in Pain, critical care, administration, med.

This is the exact reason as a NP I work in a nursing home and subacute facility I order pain medications round the clock. Everything is ordered PRN. Residents are not assessed. The famous response is" he/she doesn't look like they are in pain"! So my answer is so what does pain look like?

Nurses regardless of being attached must advocate and always do the right thing. And as for crossing the line it is not the issue it's about care and concern for a resident.

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Advocate for Hospice or that her PRN meds need to be round the clock following your facilities chain of command-in other words keep squawking until someone listens!

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How can she be "her own advocate" when she can NOT communicate.The OP might have over stepped her boundaries and made the "mortal sin" of becoming too attached to the lady but at least she is trying to advocate for someone who is unable to. Isn't that what nurses are SUPPOSED to do?

Too bad more nurses weren't like her which is apparent from her post regarding the nurses who work at the LTC.

Please refer back to the OP. You will note that the OP did not say that the patient was unable to advocate for herself--she said she was soft spoken. There's a very big difference between communicating with blinks (as the OP mentions in her f/u post) and being shy.

Being soft-spoken could be remedied with education, encouragement and empowerment from a confident, caring nurse--a nurse such as the OP, who does in fact sound like a stellar nurse. She simply allowed herself to get too attached. As a nurse who worked long-term with oncology patient and continues to work long-term in an outpatient setting, I understand the OP's heartbreak more than you realize.

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Nurses regardless of being attached must advocate and always do the right thing. And as for crossing the line it is not the issue it's about care and concern for a resident.

Of course it is. If you cross that line regularly, your chances of burning out are ridiculously high. It's emotionally exhausting when you're that invested in every patient.

So advocate until you're blue in the face, but make sure you know where you stand yourself with your patients. We need good nurses out there. Having people burn out because they were never warned to set boundaries is a sad, needless loss from a very difficult profession. Ironically, it is that nurse who over-invests that is most often a victim of compassion fatigue.

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PT was soft spoken (the NP and other part time day nurse even stated to me they never hear her speak) It's because they don't listen! Funny story: soft spoken pt - meaning she has to know you to answer and putting your ear inches away from her mouth to hear her) once called the part time day nurse a zombie. When I asked her why she stated because he never spoke to her. Now that she is only communicating through blinking(which I have stated to other nurses multiple times she is doing!) Her pain is still be ignored! Her living will states that she doesn't want a feeding tube(That she has had for the past five years d/t son) but also states she wants maximum pain relief. It's killing me to see both aspects ignored. The NP knows how I feel about pt and determined it as a therapeutic relationship. She was kind enough to order a fenty patch and routine 5mg roxanol Q6 hours. When pt has a stage 4 sacral ulcer, bilateral ulcers on ears - attention to patient is key. She appears comfortable while laying in bed but touch anywhere near her ears, watch her face while cares are being done, she is being repositioned(which is every two hours), or changing her dressing where bone and muscle are clearly visible. Better yet ask her!! blink if this hurts; blink 3x if you're in pain. I hate to leave her and yes, I consider her as much of a friend as a patient. She's a person. Her PRN Q1 hour medication is being ignored the 16 hours I'm absent. My bosses and I have both stressed to other shifts the importance of checking her.

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