Had my first grievance, not very happy...

[mjs2118]

I got a voicemail today from my manager telling me to call her before she left today. This always concerns me right off the bat. I am a fairly new nurse, just about to hit the 6 month mark so I'm still real paranoid about making mistakes or making sure I'm doing things right. I had a patient a few weeks back, and I remember this distinctly because she was so understanding a nice and I never would have though in a million years that she would ever have any complaints. She came in with her first kidney stone and was actually arrived to our floor before I came on. Orders were written at 6:50 pm, right before shift change. This woman was in extremely bad pain. I went in to check on her after getting report on her. She asked when she would be able to get some pain medicine and I told her as soon as the order was in I would bring her some. Being a new nurse I forgot I could override the system and get, BUT considering she IS A NURSE, and AT OUR HOSPITAL for many years, she knew I could so she suggested it. And I apologize and told her that I had never done that before so I forgot I could and that I would go get her some real quick. And I did. I wasn't even done getting report on all my patients yet, but I was happy to do so. I don't remember the specifics but as I'm told by my manager, she had IV fluids ordered and antibiotics that weren't hung until about 11 that night. Yes that's my fault, and sometimes time can get away from you when you have 4 other patients and not to mention, and pharmacy can take a while to get the medication up to the floor sometimes. I'm just in shock I guess. I always try to do right by my patients and this just took me off guard. I would just think that if I were a nurse being treated, I would have a little understanding about how busy my nurse can get sometimes considering I am busy all of the time. Just a little disappointed I guess.

[BuckyBadgerRN, ASN, RN]

OH!!! Thanks for the clarification----I thought she had to wait for the pain med!!!!

[Bec7074]

No, the patient got her morphine at 7 something before I was even done getting report altogether because I had to override the system. She got her pain meds right away... Where I work, a lot of times we don't even get done with report until 8pm, so we don't get things in full swing till then. I always see all of my patients right after getting report, and I usually do my assessment first thing and pass meds at that time as well. As for the new admit that got there at shift change, I should have at least started the fluids, I'm not sure how that didn't happen, it's been a while. As for the anitibiotic... I first have to wait for pharmacy to send it, which takes a while sometimes at my facility... And I don't think I mentioned this earlier, but before I could start the antibiotics, the patients IV went bad even though I had flushed it when I gave the morphine earlier, which I guess could have contributed to getting the anitibiotic going a little later... So yes, from 8pm to 11pm in the world of nursing is hardly any time at all.

Yeah I think your manager should understand given all these obstacles. You can't win over all your patients unfortunately. I also believe in karma-maybe when she's feeling better she'll encounter a similar situation herself and it will show her how unreasonable she was with you.

[Anna Flaxis, BSN, RN]

Fluids should have been hung on admission, and the abx given as soon as they arrived from pharmacy, unless they had already been given in the ED and were Q6 or Q8, then you'd go off the time they were given in the ED. It doesn't sound like she received any abx in the ED, though, so this should have been done STAT.

Yes, it does take time for the pharmacy to fill the order and get it to the floor, and that's a reasonable excuse for not hanging them right away, but does it routinely take pharmacy 4 hours to fill such an order? If so, there is a big problem that needs to be addressed.

I know how busy you can get and how 4 hours can go by in a flash. With 4 other patients to care for, you're being pulled in many different directions. I totally get that. But, fluids and abx were a priority for this particular patient, and I agree with your manager, should have been done sooner.

If it took 4 hours for the med to get to the floor, then you should have filled out an incident report. If it's routinely taking that long for meds to be delivered from pharmacy, then incident reports need to be filled out every single time, so that process can be addressed.

[Pat2012]

As a person who sustained 3 ankle fractures and had poorly managed pain, I think the patient is justified to complain (nurse or no nurse), if her pain was not being treated quickly. How much more would she have suffered if she wasn't a nurse and didn't know about overriding orders? As someone who's endured poor pain management, pain medication that is either not given on time or close to it, is very mentally and physically draining. I'm sure you probably already know this, but sometimes I wish nurses would experience 3 ankle fractures and put up with what I did, so that they would do whatever is in their power to not only get the pain medication but to give it on time.

[ProgressiveActivist, BSN, RN]

This is an excellent example of why patients should NOT be brought to the floor between 6:30 and 7:30 and why nursing supervisors don't always use the best judgement.

What the hell were they thinking transporting a patient in severe pain anyway?

It is just impossible to provide safe care to a new patient while you are changing shifts.

[anotherone, BSN, RN]

No, the patient got her morphine at 7 something before I was even done getting report altogether because I had to override the system. She got her pain meds right away... Where I work, a lot of times we don't even get done with report until 8pm, so we don't get things in full swing till then. I always see all of my patients right after getting report, and I usually do my assessment first thing and pass meds at that time as well. As for the new admit that got there at shift change, I should have at least started the fluids, I'm not sure how that didn't happen, it's been a while. As for the anitibiotic... I first have to wait for pharmacy to send it, which takes a while sometimes at my facility... And I don't think I mentioned this earlier, but before I could start the antibiotics, the patients IV went bad even though I had flushed it when I gave the morphine earlier, which I guess could have contributed to getting the anitibiotic going a little later... So yes, from 8pm to 11pm in the world of nursing is hardly any time at all.

yea, those 3 hours are a daze many times. many times. take one to ct scan, go get pt from ct scan, change another whose family is in the room and wants mom changed NOW, one with bs of 54, ivs go bad, one can't breath now . etc. things do not get done as soon as they are ordered. what type of department is she a nurse in? it will happen many many times. no matter how experienced or fast you get. even if you can prioritize everything correctly.

[anotherone, BSN, RN]

If she got her pain med on time (and yes, she did have to remind you that you could over-ride for it, although it is not encouraged to do so in some facilites, but perhaps she is peeved you didn't know this, but bottom line, she got pain meds) and she also is most likely aware that you have to wait for the pharmacy to send you the antibiotic, I am not sure what her issue is.

It is not as if you chose not to mix her med on time, you have to wait for it to be filled. Lesson from this is to make sure you review your orders, and make sure they where they need to be (pharmacy) so that you are informed before going in to see the patient. And if the patient is in pain, rate it, tell patient you will bring pain meds, and even if you have to call pharmacy to have them put pain med in the system STAT, if say there is no other nurse to witness your over-ride, I would not get into the habit of saying "well, I have to wait to have the med put in the system". People in pain are sometimes more defensive than one would think, and it can come off as an "excuse".

Frankly, I will hope i DO NOT get in the habit o f overrideing any med before it is checked by pharmacy. comming off as an excuse or not I do not care. I have overriden in the past for emergencies and when I was about 99% sure that pharmacy would verify it. ( pt has gotten dialudid in past and md just wrote sta 0.5mg iv push before a dressing chage etc). Pts do not get to dictate how I practice or what best practice is. I have called pharmacy for them to override it but our pharmacy also serves the OR, ICU, ER etc with their tons of stat orders. sometimes a prn morphine is not acknowledged stat even if you call.

[minnymi]

i would hate to be the nurse for another nurse who worked in the same facility.

i wonder if she had a choice to be a patient elsewhere. i definitely wouldn't want to be a patient where i work either.

[Altra, BSN, RN]

This is an excellent example of why patients should NOT be brought to the floor between 6:30 and 7:30 and why nursing supervisors don't always use the best judgement.

What the hell were they thinking transporting a patient in severe pain anyway?

It is just impossible to provide safe care to a new patient while you are changing shifts.

If I waited until some of my patients were pain-free to transport them to the floor, they would be discharged or dead.

And no, I will not tell my patients, "there is an inpatient unit bed assigned and ready for you, but you can't go up there for another hour."

[morte, LPN, LVN]

If not, then you might as well be honest and tell'em the care is likely to stink....

If I waited until some of my patients were pain-free to transport them to the floor, they would be discharged or dead.

And no, I will not tell my patients, "there is an inpatient unit bed assigned and ready for you, but you can't go up there for another hour."

[Anna Flaxis, BSN, RN]

LOL, well, I haven't used exactly those words, but I have warned my patients that it takes time to get the ball rolling, and not to expect things to happen right away.