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.

[Altra, BSN, RN]

4. When the family member confronted me about not giving the 1 mg, the reasoning she gave was and I quote "it's okay to give 1 mg as long as there's someone who can witness that you wasted the other 1 mg" (our smallest vial of morphine come in 2 mg). Being a new nurse, I thought I didn't even know that's possible. I've never heard of that before.

I have worked where policy allowed this to be an option. There was a place on the EMAR to indicate a change in dose from the order with a few acceptable reasons including "professional judgement". Completing this box triggered notification to the provider who wrote the order.

And I have worked where it was most definitely not an option and would result in a med error.

You can ask your former preceptor, educator or charge nurse, but your most trusted source of info on this may be Pharmacy. This is also one example of why it's good to be familiar with the organization of your actual policies & procedures manual so that you can research things like this as practice issues come up from time to time.

[uRNmyway, ASN, RN]

At my hospital you would have to obtain a doctor's order to give less than the ordered amount. Like, you couldn't just give 1mg instead of the ordered 2mg, without a doctor's order. (It is all about "pain" being one of the vital signs, so they want you to give what is ordered, instead of a lowered amount.) I mentioned this solely for the new nurses who may be reading this. I know that sounds silly, but you wouldn't give a smaller dose of some other ordered medication, without an order, either.[/quote']

THIS! To reiterate, I had colleagues in NS who got KICKED OUT OF THE PROGRAM for doing this. Dose ordered was for x, student felt patient was not in enough pain for full dose and took it upon herself to half the dose. Gone. Didn't even get a second chance at clinical. Now, do I think the decision was too harsh? Absolutely. But now after seeing many nurses take it upon themselves to just play with doctors orders as they feel like, maybe that kind of thing should be done more. I mean, you don't like the order, get it changed. But don't just give what you feel like.

[hope3456, ASN, RN]

I've seen order for IV morphine read 1-2 mg every "x" hours. Seems reasonable

[LadyFree28, BSN, LPN, RN]

THIS! To reiterate, I had colleagues in NS who got KICKED OUT OF THE PROGRAM for doing this. Dose ordered was for x, student felt patient was not in enough pain for full dose and took it upon herself to half the dose. Gone. Didn't even get a second chance at clinical. Now, do I think the decision was too harsh? Absolutely. But now after seeing many nurses take it upon themselves to just play with doctors orders as they feel like, maybe that kind of thing should be done more. I mean, you don't like the order, get it changed. But don't just give what you feel like.

That sounds like your cohort was practicing outside of her scope...

When in doubt, CALL the doctor, AFTER your assessment, just putting it out there for the newbies...

[martymoose, BSN, RN]

if a pt wants only 1/2 , or whatever, we document that they refused bla bla, and accepted whatever. That way its on them. Ive been told thats ok.If I called a doc for that, I'd be reamed out where I am.