Any advice please?

[bld24]

I'm a new nurse, of less than a few months,scrambling along and having the common time management issues with taking 6 patients, trying to do things by the book, asking lots of questions and thinking things are going pretty good-I'm a little slow, but I think I'm doing well by my patients. I just got knocked back into reality.

At change of shift I had a hypoglycemic episode to deal with on a patient who had just lost her IV site when another patient calls complaining that his pain meds (prn by the way) were an hour late. He had been calling for them every 3 hours, but by this point (his first call) it was around 3-1/2 hours-the orders are q-3-4 prn. I pull them, give them, and let them know the day shift nurse will be taking over-they say thanks.

15 minutes later he and his family (who have been staying in the room 24-7), come to the desk while I'm finishing my charting and say "I think you gave the wrong medication because I don't have any pain relief. I tell him that he's been up walking and to give it a little time. Another 5 minutes go by and he calls for someone to come to the room because he says he wasn't given his medication. I take the oncoming nurse and my supervisor comes along and we go to the room. He says he was tired, but he's sure I only gave him saline, I explain that I mark everything I pull (with a sharpie) and I do the same thing every time-give the med, then flush the line. He swears I only used one flush and gave him saline. I know this is not true.

We all advised him to wait a little while, then I documented everything. And it looks like from now on we'll have to take 2 people into the room for backup. Heck the CNA on my shift asked that I be in the room with her for any care and this was before this all happened.

Now I'm really freaked out and the thought occured to me that patients can actually lie or be wrong about something and it can drop squarely on my shoulders to have to defend. It's the first time I actually thought that I may not be cut out for this job.

The only thing that kept me from getting so down on myself was the fact that another patients family had just asked if I could please take care of their family member again tonight because they thought I gave him some great care.

I'm sitting here unable to sleep knowing I have to go back tonight wondering what they could possibly be saying about me and can this situation cause me any trouble? All I have is my word and my charting and the pyxis that said I pulled the medication. I've cared for this patient for 2 nights now without incident. One thing that bothered me a little was the fact that the family wrote down a lot of things like medications and times and names,etc. and asked a lot of questions and would watch very carefully when I gave any medication to the point of being almost in my face. Howevery, they were very nice up until this episode and seemed very appreciative.

Anyway this is part vent, part freaking out and part question about how to deal with this and is this common?

[snortzmom]

My advice to you would be to just shake it off. When you go to work tonight, request that you not be given this patient. This happens all the time and it won't be the first or the last time this happens to you. If management has any question about you, they will investigate by either taking a look at the meds you have given to many patients, not just this one patient. Furthermore, the facility can always drug test you if there is any suspicion.. I am sorry this happened to you, and people can get nasty and blame the nurse when they want more pain medicine than the doctor prescribes. It sucks but it's just part of the job. Did you fill out an incident report? Have a good night at work and please get some sleep because one nasty patient/family isn't worth it... Chin up :)

[mama_d, BSN, RN]

Don't sweat it. We've all run into situations like you describe; it's why we do so much charting!

I recently had a pt's dtr accuse me of not spending enough time in her dad's room. Never mind the fact that I spent more time in there than in all of my other rooms combined. I ended up charting on him for nearly a half hour just b/c I knew that I wanted to have documented everything that I did for that man to back me up. And I requested to not have that patient again.

Usually these kinds of patients and families have a pattern of behavior where they have these kinds of "issues" consistently, across the spectrum of care. In general, if people are talking about it and they fall into this category, it'll probably be more along the lines of them saying "Did you hear what Jane had to deal with last night with Mr. Smith?" instead of "Did you hear that Jane didn't give Mr. Smith pain meds?"

[LHH1996]

I am sorry you went through that. i agree with other posts, brush it off. you know you did the right thing! And being a new nurse, get used to these "type" patients. When this happens to me, i feel tempted to say, "if you are so skilled in nursing then why are you here???Go HOME!!!!" of course i would NEVER say something like that, but geez, i am sure there are other nurses out their that know what i mean. Obviously if the person needs acute care or SNF they are there for a reason, but man, when these famiies or patients are all over what you are doing and questioning everything, doesn't it just make you mad!!!!

lol

Thanks for the post..now i got to vent too!!!

[gonzo1, ASN, RN]

We have pts like this all the time. They are drug seeking and hoping for a lawsuit to make an easy buck. You will soon learn when you need to take another nurse into the room with you.

Whenever you see a family member charting everything that is done to the pt it is best to get your charge nurse involved so risk management can be notified.

[lindaRN49]

I say go back and kill them with kindness! Challenge yourself to make them want you to be their RN. Tell them each thing you're doing....."I'm giving the medication for pain, it's called Morphine and it should take about ______ minutes for him to feel some relief and it should last _____ "(depending on the route), then explain the flush and reason. Just talking to them allows them to realize you know what you are doing and WHY and that you want to communicate with them. I find those moments save much more time in the long run because you've already told them so they don't have to ask 3 more questions about the topic. Good luck......it's really hard to take on that challenge....I know because I was in a similar boat and took the challenge and it worked (but man, was it hard!)

[bld24]

Thanks to everyone that wrote with advice. I sucked it up and went back in and somehow they had assigned me this patient again. I deferred and switched the assignment, but it all worked out. The family sought me out and actually apologized about the situation. I did learn a big lesson. Charting and documenting seems to take so much time away from patient care, but it's so important to do this part correct and cross all the t's. I take real pride in my patient care and this situation temporarily sunk my confidence, but I'm gonna learn how to deal with situations like this and move on. The good news is that I felt supported by my coworkers and management and that's probably a good thing to know early on.

Again thanks for the support here, I needed it and really appreciate it!