Family Complaint... Why am I so bothered by this?

[Alex87]

I'm sorry if this is long. I don't know how to start my story. But I will try my best to give a good summary of what happened.

I've been a nurse for only 7 months. I'm working on a Tele Floor, and in this particular night I received an admission, patient has multiple fractures (hip and hand) due to a fall. The patient was put on NPO for a surgery the following day. That night, a family member (who is a nurse and works at the same hospital, different floor) came to visit. Everything went well, she went home after a few hours since she had to work the following day.

That night I kept asking the patient if he's doing okay, and if he is having any pain. I must have done this more than 10 times. His response was "I have pain, but I'm okay right now. It's not really bad as long as I don't move a lot." I told him I can give him pain medicine but he keeps refusing them. So what I did was to reposition and tried to keep him as comfortable as possible. This particular patient needed a few units of blood, and I had to hang them that night. So I had to sit with him multiple times, and most of my time must have been spent with him. And in those times I kept assessing his comfort and offering pain medicine and he kept refusing. And I told him that if he ever changes his mind, to just let me know. The charge nurse knows all about these since she had to witness the blood and she knows the patient was refusing the pain medicine.

Around 0645 in the morning before shift change, he told me he was having a really bad headache. I told him I can give him the pain medicine to take care of the headache. And he finally said yes. He was on NPO so I can only given him Morphine since that was the only pain medicine IV ordered, and it was for 2 mg. As I was drawing this, my charge nurse told me "Oh by the way, the family told me to just give him 1 mg he is afraid it will make him loopy". I said "the order was only for 2 mg, do you wanna call the doctor so we can have it changed?" And she said "That's fine, just give him 2 mg." So I did, and he was fine. Nothing "loopiness" happened. I gave report, and I thought my day was done. I was preparing to go home when the family came and wanted to talk to me. I told her he was doing okay, and he got his blood, and finally said yes to the pain medicine this morning. She got really upset because I let the patient go without pain medicine for 12 hours. She said the reason why he didn't want it because it makes him loopy and she said she told the charge nurse before she left to give him 1 mg to at least help with the pain. So I told her he kept refusing it, the charge nurse told me to give him 2 mg. She then asked for the day shift nurse.

I got a call from my nurse manager. This call came right after I got off work and I was literally running to the airport trying to catch a flight. I missed the flight and was so frustrated (the next flight leaves at 6pm, which meant I will miss an important family event). The phone rang, and my nurse manager told me she wanted to talk to me about a complaint by a nurse from another floor about her family member not getting pain medicine. She told me the nurse came to her and was very upset. She just wanted to know my side of the story. I was already pumped with adrenalin from running, plus the frustrations of missing the flight, and now this! I don't know if I told the story in a very calm way. But I tried to as much as possible. She told me she understand my side but she doesn't want the other floors to have this impression about our floor, that we don't take care of our patient's pain. She said I should have investigated more on why the patient doesn't want pain medicine. It's not a valid reason that I just accept when a patient says he's okay as long as he doesn't move a lot. And I explained to her that I repositioned him to make him comfortable and that I can't force pain medicine to someone who doesn't want it. I also told her that the charge nurse never informed about the family member's request until I was already drawing the morphine that morning. I should take this as a learning experience, and not to ignore someone's pain next time. She told me again that the family member was quite upset and she doesn't want this reputation on our floor.

So here's the part that really bothers me. I feel like I've stained my floor's reputation, and other nurses must think very negatively of me now. I can't stop thinking about it. I've had many other horrible families before but I've always tried to be the best nurse to their family and satisfy their expectations. I just couldn't get over the fact that a complaint was filed against me directly to the nurse manager. I'm very anxious to go back to work. It's already stressful as it is, but this one is adding to my stress big time.

[SionainnRN]

It's hard when you're dealing with a family member that is also a nurse in your hospital. You did the right things, you asked the pt repeatedly if he was having pain, offered pain meds, and repositioned. Unless you were supposed to drug him without his okay, I really don't know what else you could do. And if you sat there and questioned why he didn't want the pain meds, you could be accused of trying to push drugs on a pt who didn't want it. Sometimes you just can't win. Just know that you did everything you could and try to explain that to your manager. Good luck.

[loriangel14, RN]

You didn't do anything wrong in my view. The patient was within his rights to refuse the pain meds. What did the family member expect you to do? Give it by force? If he said no there wasn't much else you could do.

[CodeteamB]

Ok, deep breaths.

You did the right thing, you were a good nurse. The family member's opinion on the matter is beyond irrelevant.

The patient's physician ordered an appropriate dose of analgesia, the patient's nurse (you) offered that dose in an appropriate way, at appropriate times and the patient refused it appropriately as he felt he didn't need it. There is no one else who belongs in this equation, especially not Suzy Busybody, RN.

Your manager made a bad call even contacting you on this, an informal question or two next time she saw you should have sufficed, and you certainly should not have been made to feel like you shamed your unit. The only person who should have been ashamed is the family member nurse for sticking her nose where it doesn't belong and being an all around pain in the butt.

Ok, now *I* need to take deep breaths, but you get my point. You did nothing wrong and this too shall pass.

[RNewbie]

You did nothing wrong. Same exact thing happened to me. Pt was in some pain, offered pain med several times, kept reassessing pain, pt kept refusing. Family member who was a nurse showed up and went off on me for not medicating pt. I explained the situation and pulled up the pain assessment flow sheet and went over each time I offered med and pt refused. Also explained that pt had right to refuse and I would not automatically give prn pain med unless pt is confused or unable to verbalize pain. Family member shut up and let me do my job.

Anywho, there is really nothing else you could have done.

[VANurse2010]

Your NM approached this is a very unprofessional way and seems more concerned with her own reputation than supporting her staff. Bad sign.

[jadelpn, LPN, EMT-B]

Your floors perceived "reputation" is not your concern. Neither is the details of the family members condition. Unless the patient specifically signs to have the family member know the medical information, then you should not ever discuss details with family. It is a privacy issue.

That the nurse who works on another floor is then thought to be discussing on such floor the family members medical condition and treatment is a HUGE red flag, and conflict of interest. And could get a HIPAA violation involved as well.

If the patient refuses pain meds, they refuse pain meds. Could you perhaps see if some other non-narcotic pain med is warranted? Perhaps. However, that would be something that as a charge nurse I would have handled while you were monitoring the blood.

No family member, nurse or not, can randomly decide how much (if any) pain medicine someone receives. CYA and DOCUMENT that you got consistent refusals, that when patient assessed and patient agreed to pain med, you were asked to give only 1mg by your CN, and when requesting order for same, CN states "Give him the 2 mg".

It was entirely inappropriate that any nurse manager calls you to discuss what this will "do" to the floor's reputation. It is also inappropriate for the nurse family member to use her occupation at this facility to have access to family medical information who is a patient. Sounds to me as if the NM is afraid that the nurse family member is going to go to her floor and spread rumors--and that is on that nurse, and not on you.

Bottom line, be really, really careful who you discuss details with. Unless you have signed consent to discuss. If you do not, I would be frank with "I really am unable to discuss that with you". This person is also a nurse, and really, should be aware of patient privacy issues! Don't ever take that responsibility on yourself.

This could also open a line of thinking of standing pain orders with pre-surgery patients--with some non-narcotic choices as well. IF the NM is really concerned about pain control, then perhaps this is a unit project. If she is blaming you for the reputation of the unit, it is something to bring to HR, your union rep, your DON.

[chrisrn24]

To me you are in the right.

Also another tip - learn NOT to answer your phone! You have no obligation to answer or respond unless signed in your employment contract.

[Alex87]

Thank you so much for all your responses. It definitely made me feel so much better. I know it was something I definitely need to learn from. After that conversation with the nurse manager, the feeling I got was "I let the unit down" and that "I should have been better". These two sentences just keep playing in my head, making me very anxious about work. I guess what I was looking for was a little bit of support and approval, that I did what I could and that I didn't do anything wrong. And I got that from everyone's responses. So thank you for saving my sanity.

Chrisrn24, thank you for that tip. I've thought about that right after the call, that I shouldn't have answered it, and I should have just let the NM leave a message. And next time I won't answer my phone again.

[hope3456, ASN, RN]

There are definately some red flags here 1) The NM calling you on your personal time. Yes you can just not answer but I think issues such as this need to he addressed in person with a witness present. 2) she doesn't sound very objective - you cannot medicate someone if they refuse - it doesn't matter who the family member is. 3) she sounds overly concerned about "reputation of the unit" which, if this family member does talk about the situation at work, that possibly could be a HIPAA violation. 4) NM has no right to make you feel that you "let the unit down."

It sounds like your NM doesn't handle conflict very well. I have been in situations like this as well and even if it does seem minor, sometimes it is not possible to clear your name with the NM.

You may want to update your resume and start thinking about "plan B" just in case.

[klone, MSN, RN]

First of all, I'm very sorry, sweetie. Your NM handled this poorly. I assume she knew you were going out of town? This could have waited until you returned. She should have known that this would have weighed heavily on your mind and ruined your trip. PLEASE try not to let it ruin your trip.

Secondly, did she actually say something to the effect of it affecting the reputation of the department? If so, holy inappropriate! The reputation of the department is NOT on your shoulders. YOu are a NEW GRAD. You are meant to make mistakes. That's how you learn!

Now, onto the actual situation. It could have been handled differently, sure. While what you did was totally okay, there are always different ways one can approach the situation to get different results, and you learn as you go along. You learned from this situation, and you move on. That's what you do as a new grad. You did not do anything wrong, sweetie. Your NM is the one in the wrong. It was handled poorly by her, I'm sorry.

Once in a while you're going to have families who are unhappy with care, it's just a fact of life. It sucks, and when it's happened to me, it always weighs super heavily on my mind, even though I know logically I didn't do anything wrong. It's a sign of a good nurse who cares.

Take care and enjoy your trip. Hug.

[BacktoBasics]

As someone in management, you did everything you were supposed to do. He was having pain, you offered, he said no. Often family members want us to "do something" and they forget the patient has rights in guiding their care. If I were that NM I would have backed up your Choi e and spoke with the family regarding his rights.

Don't worry about that rep. If the NM is concerned over a RN doing what's appropriate, then she has issues.

Don't worry about it and have a great trip.