I had the misfortune of taking care of a patient last weekend. This patient was a friend of mine that I have not associated with in years. This acquaintance is the type of person who called the cops on a restaurant due to they added the tip into her bill and she didn't want to pay. One of the reasons I stopped hanging out with her was due to she would ALWAYS complain about poor service when we went out to eat; the most memorable experience my birthday was ruined due to her complaining about the service at a restaurant that was fabulous. I met her at a salon and she had started doing my hair and we became acquaintances/friends. She brought me Thanksgiving dinner when I had to work a few years ago. So, she's my patient last weekend. She had her arm bent showing me pictures of the gas station where she fell and broke her arm meanwhile telling me she has a lawyer. I asked her to straighten her arm because the IV was in her AC so she did and I administered 1mg dilaudid. The MD that same day increased the dilaudid dosage from 1mg to 1.5mg but the day shift rn told me in bedside handover report that the patient did not want 1.5 md she only used/wanted 1mg. I asked her if she wanted 1mg or 1.5mg and she said she only wanted 1mg. I gave 1mg dilaudid and then flushed her. She continued telling me her story and the flush syringe fell off bed; patient's husband pointed that out. I found out after the fact that this patient put up a big stink the last time she was admitted for hip surgery posting two nurses names on Facebook saying they were not compassionate etc one of the nurses I was working with that night is one that the patient posted about on FB; she told me she would not ever take care of said patient and because of said patient she switched from full to part time she also told me that another nurse who is a day shift charge quit over that same patient but later came back. I said to myself I wish I had known this before I took this patient. Well back to my point, this patient stated after I gave her the 1mg dilaudid that she didn't feel it. I offered the extra 0.5 mg (which would be 1/2 of the 1mg syringe) and she agreed to take it; I gave it to her. After all this the patient calls my charge nurse to tell her she can't believe I did this to her accusing me of not giving it to her I guess. After I left the room I wasted the 0.5 mg left in the syringe. My question is, how do I prevent someone from accusing me of not giving them their medicine. My thought is that I tell them when I give it to them that I am giving them the 1mg of dilaudid right now. Do I always bring a witness? I wish we could wear cameras. Make a point of verbalizing what I'm doing. Any suggestions? This has bothered me. the patient posted on FB negative things about the hospital and my cohorts about her last stay and the hospital apologized to her. This experience is making me question my career choice. To this day I have thoroughly enjoyed nursing. I LOVE nursing. I love teaching nursing. I love my coworkers and the clients I serve. How do I not allow this experience to taint my satisfaction and love of the field? Can someone's claim be substantiated even if it's false and I lose my license?
Thank you.
P.s. It is my goal to further my education (current BSN want MSN in clinical nurse education) because I love nursing and education so much. I intend on always having hands on nursing care but want to teach too. Just and FYI.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
If you have not had a patient/and/or family complain you have not been a nurse long enough.You will have to provide nursing care to all types and you can not control the angry,bitter,manipulative,ignorant and just plain crazy patients and and their families.All you can do is control your response to them and that includes to not let them rattle you. I would never lessen my hours over a nutty patient because it's their problem,not mine.It's just part of the job and while it's annoying as hell to deal with it , anyone who has dealt with patients understands!
I've had one patient say to me he didn't feel the medicine I gave him and that's it. I think I take it too personally when they do this and am completely offended because I am an honest person. I just get pissed. When this particular person/client/PIA did this to me this is the only time I have ever had a patient call the charge nurse to tell them I didn't give the medication.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
I had a lady like that. She would lie on staff about not getting her Roxanol (Morphine) and so first time I met her I took a witness and every time after that. When she was in a rush to get it, I'd tell her that I am waiting for a witness. I was not taking any chances with her. She even said, you are the only one who does it like that. But thats how you treat liars. Thought to self: " you don't trust me, I don't trust you".
I love this response. Thank you. I'm going to use it in the future.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
Like others have said, forget about it. This certainly won't be the last patient like this if you stay in the field.
I distinctly remember one patient a few years back that did this sort of thing, and would say things like, "I know how you nurses are" and what not so it got to the point that we would take the unopened vial into the room and draw it up and talk him through the process. It was annoying, but life went on.
There's a good chance too that if you diluted the med maybe one of your coworkers had not, so she didn't feel the rush of the pure drug going in and so thought she didn't get any.
Just make sure you're documenting everything, including her accusations. Then forget about it.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
When I give iv pain meds I draw it up in front of the patient and say more than once I'm giving you your whatever pain med it is. Then I tell them again after I administered it and tell them it!ll start working shortly.
I do too but she was busy trying to show me the picture her daughter took of the gas station pavement where she fell and the fact we had a history just made a huge difference. I will NEVER again take care of someone with whom I even had a remote history with.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
Rule #4 of nursing: if at all possible, never take care of a patient that you've had a pre-existing relationship with. This includes family members, friends, coworkers, romantic interests, etc. There's too much potential for drama...it's not unheard of these patients expecting "special" treatment from you because they know you from the outside. It's also a conflict of interest on your part.
Explain to your charge/NM that you have a conflict of interest related to an existing relationship with this patient and request another patient assignment. It may not happen that same shift, but they'll address it. They're aware that it could be a potential problem and they don't want to deal with that problem any more than you do.
More than once, I've asked to be assigned to a different unit because I knew a patient or patient's family member. My request has never been turned down.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
I realize that you ended up giving 1.5 mg. But, question for the group--if the order is for 1.5 mg PRN, can you just give 1 mg because the pt requests it? Just curious.
Yes, I most certainly can. I work on a unit where one hall is med/surg and the other is orthopedic. The patient never has to take anything they don't want to. Of course if it's critical to their wellbeing I get them to sign a refusal form.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
Exactly. This was my first thought when I read "This patient was a friend of mine...." That was before I even read the rest of the situation. It does not matter if they are a chronically complaining PITA or if they are sweet as pie. Go to the charge nurse, tell him/her that you know the person, and you are not able to be her caregiver.
When you are nurse, people are going to file ridiculous complaints against you--it is just a sad truth about being a nurse. However, IMHO, the real issue is in having a (former) friend as a patient. Unfortunately, you were set up for something not-so-good to happen.
Thank you. I have learned a lesson. This will NEVER happen again.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
Ditto - the patient refusal being the key part. "1 mg given d/t pt declining remainder of dose." I have begun documenting all CS wastes in the medical record as well as the dispensing machine's waste process, as suggested on AN by pharmacy person several months ago. I would also get a different order as appropriate if the pt. decided sometime later that they wanted the remainder/didn't receive adequate relief, since the original order didn't say, "give pt-specified doses according to pt. request up to 1.5 mg total in [time frame]."
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
I only have ED experience with this behavior--not floor, so it's kinda different. But yes, this woman seems to have a baseline for how she "feels" when she receives narcotics--and you did this a different way.
yep.
Documenting the living hell out of this type of thing is essential. I never say the words "seeker"--but I sure as **** make my implications point to nothing other than....this patient wants to be high. "slow push as per policy", "diluted as per policy".
Thank you. I am doing this in the future.
There is a post here somewhere that someone made a brilliant leap--and I wish now I had a few ED shifts on which to practice it---
She said, that if the patient continually asks for narcotics, because after 2-3 full doses they still have "10/10 pain", she then converts to---we need to try something non narcotic because OBVIOUSLY narcotics are not easing your pain. THAT gets their attention---and you document accordingly...that you feel that the patient is not being helped by this medication and that escalation is futile because of it.
I LOVE this and will use it and document document document.
As others have said. Don't treat friends, colleagues, neighbors, relatives, or even loose associations. I made the mistake of visiting my own ED for cp. The poor RN who had to put in the IV/draw blood was actually shaking. She was so nervous she would miss and what would I think/do? I won't do it again. Open season for the mentally unstable or the perpetual litigator to catch you off guard.
I will NEVER do this again.
As for administering dilaudid--it came in 2mg vials most places I worked. I could give as much or as little as the patient "wanted"---but again....DOCUMENTATION of said refusal as well as witness on waste...every single time.
Same here.
EPIC also has a very handy dandy little whistle, that I am not sure every place has installed---but you can waste at bedside...and document it in Pyxis via EPIC. You don't have to be in the med room to do it anymore. Check to see if your employer has it, if they have EPIC. It was a life saver at one of my ED jobs---because I would bring the meds to the bedside, draw everything up in front of said problem patient (usually a seeker), and then waste right there if the patient was trying to be cute and refusing parts of it.
I wish I had EPIC. I couldn't find a witness after I pulled out of pyxis (I work night shift on a busy orthopedic) floor and I didn't know if patient/PIA wanted 1 or 1.5mg.
Oh. I also am a beyotch where I don't just dilute in a 10mL flush. If I suspect the pt is a seeker or a problem? I'll put it in a 50mL bag if they are on fluids (which they usually were in the ED. again, different for the floor). Didn't put it on a pump (which was tempting), but I sure as hell am not participating in this "buzz seeking".
OMG I LOVE this.
I also don't ever, EVER inject narcotics at the angiocath site if they are on fluids. I go all the way up to the first port of the fluid bag and inject over the full 2 minutes. Want to see an RN get fired from a pt's care within 10 min of meeting? Do this. Seekers know.
LOVE LOVE LOVE
As long as you documented every single thing you did that would possibly get you or your hospital into trouble? She can report anything she likes. If you are one of those RNs that is always getting these complaints, I would worry, but I am assuming you are not.
No, I am not always getting these types of complaints and my manager never said a word to me. The patient even complained to legal that my manager (not floor nurse) didn't come into her room enough. No-one has ever complained about my manager to my knowledge (of course I'm a night shifter).
A friend quit nursing after 30 years because of litigious patients and their families. Some told her to her face that they were watching everything she did so that they could find something to sue the hospital over.
I felt this way but have since gotten over it and realize that I am an amazing nurse and I covered my ass with documentation. The Mss on her case will never care for her again too.
Do your job. Document everything. If you feel uneasy, ask a Charge to come and witness any procedures/med admin that you may feel could end up in contention. When admin has to be pulled in time and again, particularly if you do things like I did---walk into the MD box and bring them into the situation. These types of litigious patients can't control many of us at the same time--if a witness and/or MD are in the room, there is no opportunity for bending the truth.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
When/where I worked on the floor, Dilaudid came in 2 mg/mL syringe. So wasting was pretty much ALWAYS required (sigh). And wasting required a witness, whose credentials were typed into the Pyxis along with my own.
Same here and this is what I and the other nurse did.
OP, did anyone SEE you waste that last bit of Dilaudid? I'm not suggesting you didn't but this whole thing may be a crazy uphill battle without a witness.
Yes, always
And...you've learned a lesson here about caring for folks that you know. Don't! You never know what strange dynamics will emerge in that situation.
Right.
Good luck, OP!
Thank you. Lesson well learned. I will not repeat this again(taking care of someone I know).
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
People make stuff up. It's irritating.
Once had a patient freak out in the middle of the night claiming that I ate her sandwich.
Please forgive my response but my immediate response was a giggle because this is ludicrous
She made the charge nurse call my manager at home to report me because she SAW me eat it. I've been a charge nurse, I would not call my manager about this. I would notify her though
I left at 11pm so I wasn't there for the show, but did get a lovely wakeup call asking if I had seen this damn sandwich. Management apologized up and down to the patient and ordered out for a sandwich because our kitchen was closed. Irritated the s*** out of me. Of course I didn't touch a patient's nasty sandwich. She didn't even have one. My manager never doubted me but gave in for patient satisfaction.
The last time this patient was at our facility she posted on FB the names of nurses she did not like. Our organization apologized and of course the poor abused nurses were never reprimanded or anything.
My point is this: people will always lie and complain to get free stuff or special accommodations. It's obnoxious but isn't going to end any time soon. Do your job well and document fully and your overall performance will speak for itself.
KMULL002, BSN
64 Posts
Thank you so much. :)