If a patient wants something but an RN says don't do it, whom do you follow?

[Naturally Brilliant, BSN, RN]

There was this mini-issue (not even an incident, really) that happened at work, and I feel a bit troubled by it.

OK, so I was caring for my unit's patients as the only nursing assistant one day and there was this one total care patient on our unit who'd been complaining of pain after his physical therapy exercises and was obviously quite unhappy about it. I let the nurse know and she got him some pain meds.

Easy enough, right?

But then the nurse went out to lunch and she had another nurse on the unit (I'll call her 'Replacement') look after her kids. So later on I went back into the patient's room, and the patient said that he was in '10 out of 10 pain' and he wanted to call his dad. So I pick up the phone and start dialing the number for him.

And then right outside the door, Replacement is there and she says ''No, I'll call the nurse and I'll call his parents first!'' I felt a bit angry, because the patient wanted to complain about his situation to his parents, but the Replacement was focused on pre-emptive damage control, She told me out of the room that his parents "freak out" and she'd talk to them first so they wouldn't. It seemed very dishonest, and I started arguing with her, but she abruptly said that she wasn't arguing with me any more.

I don't particularly care about that RN anyway but I felt so bad for the patient. Should I have disobeyed that nurse and called the patient's parents for him? Obviously I left the patient alone and let the Replacement take care of it, but I felt it was all so unethical and 'cover-up'-y. I'm not sure what I should have done. Any guidance would be appreciated.

[vamedic4, EMT-P]

When in doubt, make the charge nurse aware of your concerns...always. What you describe isn't uncommon, moreso when children are in pain because you can bet your bottom dollar as a parent I'd be deep inside someone else's nether region if I find my child's pain isn't adequately controlled. Keep in mind, too, though, that this nurse might know this patient better than you do, and have a bit more insight into his entire history so she is better able to communicate both with the patient and his family with regard to his needs and pain issues. Sometimes children can exaggerate their pain. Even when they don't, a parent on the other end of the line only hears "my baby is in pain", and they go into "I'm going to chew someone up and spit them out" mode. Don't put yourself in the middle. Just notify the nurse and the charge nurse of the situation and let them deal with it.

When you're the help on the floor, leave it up to the ones with the responsibility and the accountability to handle this situation. All you can really do is notify them of what you see, and hope that they do the right thing. Patient advocacy is really what we're all about, and it sounds as if you wanted to do what was right...I'm sure you did.

[FlorenceNtheMachine]

I feel that you should have let the relief RN know about the child's complaint of pain. In your situation, it seemed that the RN would be walking in a no win situation if you had already called the patients dad.

I was a tech, and if I was to think what would I have done? I think I would have reassured the patient I was getting the RN ASAP for some pain meds and tell the RN that he wanted to call his parents.

I wanted to add it seems like your heart is in the right place, but we have to go through the proper channels of authority.

[newnurseoldman]

I feel that you should have let the relief RN know about the child's complaint of pain. In your situation, it seemed that the RN would be walking in a no win situation if you had already called the patients dad.

I was a tech, and if I was to think what would I have done? I think I would have reassured the patient I was getting the RN ASAP for some pain meds and tell the RN that he wanted to call his parents.

I wanted to add it seems like your heart is in the right place, but we have to go through the proper channels of authority.

I wonder why a Cna could not help a minor pt call his parents, phone is in room available to pt seems like the person outside of sop is RN stopping minor child from contacting parent at will. Not CNA helping him.

[P_RN, ADN, RN]

I agree with Florence... your heart is with the child, but you have to go up the chain of command. Replacement *MAY* have info one the kid you don't have. My opinion is to let the RN/Replacement handle it.

[ChristineN, BSN, RN]

It sounds like whatever the nurses are doing for his pain control is not working, so hopefully they have been in communication with the doctor about adjusting his pain plan. If this has not happened, then I understand why the pt would be so frustrated and perhaps he does need to inform his folks so they can advocate on his behalf

[funtimes]

The RN calls the shots. It's their license on the line and their patient. Thats just the way it works. That doesnt mean you cant be a patient advocate. But at the end of the day if you disagree with the Nurse, you go to the charge nurse or supervisor first, not to a Patient's parents or family.

Had you called the patient's parents after the RN explicitly told you not to and that they would do it themselves, it possibly would have resulted in permanently branding you with the RNs you work with as someone whos judgement and temperment for the job is in doubt, especially if you are a relatively new aide. The RNs have other patients and considerations that you arent privy to, so they dont need an aide going rogue.

You also dont mention anything about how the situation turned out. Did the patients pain situation improve, did the RN in fact call their parents? If the answer to both is no, then it could have been time to go to a supervisor and voice your concerns, but you dont even mention these extremely relevant facts.

[kaydensmom01]

I agree that it's not your place to go behind the RN's back to call the parents. This was the RN's patient, and they may have had other information that you as the CNA did not have, such as calling the physician to get the pain control changed.

[Hygiene Queen]

If you call the parents before the nurse can be informed of the situation, then nurse would not have been given an opportunity to possibly address it.

If you call the parents first, then all the parents will know is that their child is having pain and the nurse didn't give anything for it.

But, if you let the nurse address it with the doctor and get a pain med and give it... then the nurse can call the parents and let them know that, not only is the child having pain, but that it was acknowledged, the doctor is aware, a med was given and Junior is starting to feel better.

What scenario do you think is for the best?

If you were the parent, would you want your child calling you and crying with unaddressed pain...

Or would you want the nurse to call you to let you know what's up and that it's addressed and the child is feeling better?

[loriangel14, RN]

If the RN says don't do it then you don't do it.

[Hygiene Queen]

If the RN says don't do it then you don't do it.

Now, that's getting to the point!

[Corpsman514]

Now, that's getting to the point!

Exactly!