ER Nurse to Lunch Break Before Medicating Patient for Pain

[wondern]

While out of town on vacation this summer my husband was doing some exercising, sit ups to be specific. One day while doing these sit ups he said he felt as if he pulled something but was able to carry on with normal daily activities except now avoided doing more sit ups as it hurt too badly.

We continued riding bikes and swimming for a couple days after this but as time went on he seemed to get more sore.

Then later on the second night after he'd felt the initial muscle pull he woke up in the early am hours in pretty severe pain with some minor palpable swelling in his left lower quadrant. The pain was much worse than when he had the initial pull. He actually said he hadn't slept much at all which is highly unusual for him.

He has a history of diverticulitis and DVTs and is on coumadin therapy. We both thought maybe it could be a diverticulitis flare but most likely the muscle but just weren't sure. Who really wants to go to the ER at all though especially in the middle of the night?

He went ahead and took some ibuprofen even though he is really not supposed to due to being on coumadin but was hurting enough that he took three 200mg caplets and was able to sleep for a couple hours but woke up still in pain. I then decided to drive my husband to the ER that morning after he had slept a few hours as he was still having pretty severe left lower quadrant pain and now his color looked a little pale.

To try and make a long story short he was diagnosed after a CT scan with a torn abdominis rectus muscle or abdominal sheath with a subsequent 4 cm blood clot within the tear due to his history of being on coumadin therapy.

The ER physician said anyone else would have torn the muscle and be sore for a while but since he was on coumadin there was bleeding along with the tear which created the 4 cm blood clot from which he could see no signs of further active bleeding.

Upon assessment during the ER admission process via triage he told the nurse when asked his pain level was at 7-8 on a scale of 10, and had been in pain throughout the night before coming to the ER.

The ER physician came right in and ordered a pain med and a CT scan. Meanwhile the nurse started his IV, drew some blood and we thought gave him some pain medicine as he did some kind of flush with a clear solution in a syringe before my husband was taken for a CT scan of his abdomen where he was asked to scoot from stretcher to table, and of course back again.

When he arrived back from radiology department my husband said to me, "This pain medicine is not working...I'm still really hurting." I called the nurses station and asked for more pain medicine. I could see the physician at the desk from our room with a look on his face like, Really? He hasn't got his pain med yet? which I understood more clearly shortly thereafter.

I thought it might just be some breakthrough pain from going to radiology and from scooting back and forth from stretcher to table.

When the nurse finally came back in the room he states, " He hasn't had any pain medicine yet. I had to go on lunch break or I wouldn't have got any break at all."

Being a nurse myself I certainly understand the concept of missing a break. No it's not healthy. No it's not fun. No management doesn't like it sometimes regardless of what's going on. Sometimes however it is necessary in order to provide the proper and compassionate care needed for our patients.

At this point we'd been there in the ER patient room for at least over 30 minutes now and as noted above he even went to CT without any pain med. Maybe you could ask another nurse to give it in your absence?

As an ER nurse or any nurse for that matter, don't you think it would be a priority or should be a priority to medicate your patient for pain before going to lunch given the above scenario or any similar such situation?

Just wondering what other nurse's opinions are on this matter. What would you do? Would you make sure your patient got their ordered pain med before they went to radiology in pain or would you go on to lunch and give pain med that has already been ordered after you get back for fear that you'd get no break?

[wondern, ASN]

:wideyed:Yes there is that look too sometimes...

It wasn't that look this time though. This doc was in the room and on it and explained that he'd be getting something for pain.

I guess there's always that possibility but then when the nurse himself explained that his lunch was a priority it sounded as if the order was there he just let him go on to CT first so he could go eat. I wanted to say WT@#%&* but restrained myself instead saying well I understand that which I understand wanting break but not while letting my patient hurt longer. I was trying to be nice.

I may have felt a little guilt myself for not taking him sooner. He wanted to try the ibuprofen during the night and it helped slightly but he was hurting. Maybe being a nurse, y'all know how sometimes we put off getting medical attention for ourselves or family longer than the average bear???

The weird part is we thought he'd given the pain med with the flush then when he came back and my husband was really hurting even worse now was when the nurse said the thing about he had to go to lunch then or he may not get a break so he hadn't had any yet. I thought he gave it with the flush and then inserted the IVF before he left. It was obvious he was in the vein.

Anyhow, maybe his name wasn't unlocked in the computer as mentioned above. It's all good now. Poor hubby made it through. I do appreciate all y'alls' input!

Now if that was one of my babies hurting I would've reverted back to what I wanted to say and ask for the charge nurse, manager, doctor, and whoever else I needed to obtain for pain relief.

[caliotter3]

I was once told I would be given pain medication and the nurse never returned. Nobody came around for several hours. It was night and I tried to sleep and was a patient patient. At some point in time after shift change, a new nurse told me she had no idea why I wasn't given any pain medication, that it was not passed on in report. I was summarily discharged, in pain and with virtually no care (although I got a bill from my PCP's practice when no doctor even spoke to me more than once, much less a doctor from my PCP's practice). (You might call it observation to shunt someone off into a room by themselves and ignore them until discharge, but I don't call that rendering care). I did not care to complain. I went home and took as much OTC medicine as I could stand and dealt with it myself. Weeks later when I got a patient survey request, I refused to return it because I felt compelled to tell the truth and again, did not want to deal with them any further. Now I think more than twice before going to that ER, based upon my own experiences. At least the OP was engaged by the personnel, although she didn't like that the nurse wanted to go to lunch. In my case, I wondered just exactly what transpired at the nurses' station that no one felt the need to engage me any more than they did. Something tells me that it does not pay to be the patient patient.

[wondern, ASN]

That sounds terrible, calilotter3! :bag:Being ignored can actually be very abusive.

The doctor and the transport girl who got him a warm blanket were actually the most engaging as the nurse told us his name but then I had to ask if he was our nurse. I wasn't sure. He never really introduced who he was. I had to ask. Just weird I thought.

Of course a totally different set of names was left on the dry erase board in the room and I asked who so and so was listed under 'nurse' he said I don't know who any of those people are. Hmmmm, okay....

[JKL33]

That sounds terrible, calilotter3! :bag:Being ignored can actually be very abusive.

The doctor and the transport girl who got him a warm blanket were actually the most engaging as the nurse told us his name but then I had to ask if he was our nurse. I wasn't sure. He never really introduced who he was. I had to ask. Just weird I thought.

Of course a totally different set of names was left on the dry erase board in the room and I asked who so and so was listed under 'nurse' he said I don't know who any of those people are. Hmmmm, okay....

I don't like it when people interacting with patients don't introduce themselves and their role. It is inappropriate given the fact that they will be doing something with the patient. The patient deserves to know who they are and what it is that they will be doing.

One thing about the doctor and the radiology transport girl being the most engaging. These two roles are extremely defined compared to "nursing" and the litany of things that fall under the nurse's purview. I don't mean to minimize the physician's role at ALL, but in the ED, if they can make a good first impression in the 1-5 minutes they're at the bedside, they are often "done" with major patient interaction (speaking practically, not literally) until they decide a definite treatment and/or it's time to make a decision about "dispo" (assuming there isn't a major change in the expected course of care, and speaking about non-critical care cases). The nurse runs/oversees/facilitates literally every other thing that happens until there's enough information for the physician to make a dispo decision. So, it's not too hard for the physician to look stellar as long as they aren't boorish during their initial few minutes of interaction.

Transport people have a very defined role. Patients love them, and I appreciate the goodwill they spread around by making conversation and interacting with patients. But again, they bring the patient back to the room and if anything other than a warm blanket is needed - - well - that goes to the nurse. I'm NOT saying it shouldn't be that way or that there's anything at all wrong with that. But if my interaction with a patient was one defined thing, it'd be a lot easier to do that one thing in an overtly pleasant fashion and then exit. Not hard to leave a good impression.

It can be hard to hear that everyone else was more engaging than the nurse. The nurse gets this frequently because (I think) we are trying to do/think about so much at once. It's not at all uncommon to have family visiting amongst themselves and trying to make quips and small talk with the nurse during critical nursing functions (like titrating critical gtts, etc.) - - so not only am I not readily joining in on the banter, I'm not making eye contact, and I'm trying to actually think and be careful and attentive to my task at hand. I've had good luck with making eye contact upon my entry to the room each time and explaining what I'll be doing (and why) and then saying something like, "I need to focus on this for a couple of minutes and then we can chat some more" and then asking if there are needs or questions before I leave the room. But even these efforts at "being engaged" likely don't compare favorably to someone who comes to the room once for a defined purpose (registration clerk, transport, RRT to administer neb tx, etc).

In my version of utopia, we get accolades for the mental work we do and the overall picture of what is accomplished. :)

[wondern, ASN]

You make some very good points JKL33. I do like your version of utopia.

Like caliotter3 (sorry for the typo on your name above) mentioned in her experience of being given no pain med at all she just wanted to not make any waves and get on out of there. That's how we both felt too.

At least he got something eventually after lunch break.

[ComeTogether, LPN]

I think the nurse wasn't clear in that the med was not yet ordered/available to give when he/she went to lunch and became available while he/she was gone. It sounds like this was a great nurse and I find it hard to believe he/she would have opted to not give a needed med in order to eat. I find the first scenario I mentioned much more likely,

[wondern, ASN]

I find it hard to believe too.

[jdub6]

:wideyed:Yes there is that look too sometimes...

It wasn't that look this time though. This doc was in the room and on it and explained that he'd be getting something for pain

Yeah, I've heard doctors tell patientsc a million times "the nurse will be right in with your pain medicine." They then walk away and put the order in an hour later.

Also the ED is very tasky-sometimes you just have to stop and go to break because you'll never be all caught up with no tasks to do. Ideally someone else would have given the med-that they didn't tells me either the order wasn't in/verified or this place is short staffed.

And, if CT wss ready, I would send him too unless i was ready at bedside with meds. Priority is getting diagnosed and the process of giving opiates can take 10 minutes during which your patient loses their place in line for CT.

[RestlessHeart]

Dont byte my head off for asking this. Im seriously curious. Ive been in the hospital so many times thru the years. Ive had 30 some surgeries blah blah blah but Im curious. Would it be plausible to ask the patient if he'd be ok waiting just a little while you grab a bite to eat or a drink? I know I always always always tried to give my Nurses space for that and would wait a little extra if it'd help them out a little.

I suppose now that I see it in "writing" it doesnt sound good does it?

[Meriwhen, ASN, BSN, MSN, RN]

Another thing to consider in addition to everything else: sometimes, we HAVE to take lunch when we do. In California, we are required to take our meal break within a certain number of hours after our shift start (example: I work 2300-0730, so I have to take it before 0400). If we don't take it in time, the CA government penalizes our employer and we get an hour's pay for having to take a late break. As you imagine, facilities don't like having to pay us an extra hour, so most of the places I've worked at will move heaven and earth to get their staff breaked on time. So this means even though your nurse may have been ready and willing to give the medication, she may have been forced to go on break by her charge RN.

However, it's not as though the patient would have been nurse-less during this time. Another nurse would have been covering, and this nurse is as perfectly capable of giving medication as the original nurse is. So there's no reason to wait the 30 minutes until nurse #1 returns--the pain med could have been requested from the covering nurse. Or the offgoing nurse could have asked the covering nurse to medicate the patient if/when the medication became available.

[wondern, ASN]

Thanks Meriwhen. I totally agree. I did not know who the relief nurse was or that he was gone. By the time I asked for what I thought was more pain med he was back to give what we then found out to be the first dose.

As a nurse, I think I would like having a Union to stand up for nurses' work rights in the southeast US. At least the pay appears to be better as evidenced in the thread regarding pay and also maybe a union could make a manger uphold their zero -tolerance towards bullying policies as opposed to letting them slide even in so called 'Magnet' facilities.

https://allnurses.com/general-nursing-discussion/2017-nurse-salary-1083369.html

https://allnurses.com/nurse-colleague-patient/magnet-2017-bullying-1132390.html

[Wuzzie]

Would it be plausible to ask the patient if he'd be ok waiting just a little while you grab a bite to eat or a drink?

This wouldn't be acceptable because we are not allowed to give the impression that our needs are more important than the patients'. Nor are we allowed to communicate to patients that we have needs at all. Actually, we aren't allowed to have needs in the first place as evidenced by having to legislate lunch breaks. I worked for a place once that the lead physician decided nurses shouldn't be allowed to sit when they chart because it gave the impression that we weren't working so he had all the chairs but the ones at the doctors' computers removed.

BTW, we very much appreciate your being a patient patient!