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

[Naturally Brilliant]

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.

[KelRN215, BSN, RN]

The RN likely has some knowledge or inside information that you, as the CNA, do not. The child was alone so possibly scared which could have made his pain worse but by relaying the information to the RN, she can then assess what needs to be done. Does the child need more pain medication or possibly different pain medication ordered? Is he maybe not really in pain but lonely and calling Dad would help? Based on the information provided in the OP, I do not view this as "cover-up-y" at all. What are they trying to cover up? Who says that when the Dad is called, he will not be told that the child has been experiencing pain?

[AM326]

I would follow the RN. If I am under them, I do as told. They are the one that gets in trouble if the patient gets upset. :/

[akulahawkRN, ADN, RN, EMT-P]

I'd follow the RN's order. Why? Some patients deliberately attempt to "split" the team just to cause some fireworks, purely for their own enjoyment. That includes splitting parents vs. hospital staff. You, as a PCA/PCT likely aren't privy to certain details like that from previous shifts, or may not be aware of the fact that perhaps the patient was attempting to manipulate staff. Also, if the phone is in the room and the patient could get it themselves, I'd consider that a red flag, as a potential split attempt...

[MommaTy]

If the patient want's to use the phone, the patient can use the phone, unless they aren't allowed to because they will hurt themselves. You should not talk to the parents, but the patient can talk to the parents. You can dial the phone for them too, just you aren't allowed to make any conversations about the patient unless told to do so by the nurse. You aren't trained to deal with medical questions.

[calivianya, BSN, RN]

Other people's responses are really interesting. I don't think the RN has any say over whether a patient is allowed to talk to family members, period. If this had been about a healthcare task I would agree that the RN has the final say, but seriously? Stopping a personal phone call? IMO, that's not in the RN's scope of practice, or anyone's scope of practice for that matter. Unless you are law enforcement, I don't think you have a leg to stand of if you try to take away a person's ability to converse with family.

[duskyjewel]

I can tell you right now that if my child tried to call me and anyone stopped him, I'd have all your asses in slings before you could say "lickety split!" Just who the ***** do you people think you are, to prevent my child communicating with me when he wants or needs to?! This kind of BS is why I would never, in a million years, leave anyone I love alone in a hospital. Not for five seconds.

Aren't you parents? How do you not get this?

[Esme12, ASN, BSN, RN]

I can tell you right now that if my child tried to call me and anyone stopped him, I'd have all your asses in slings before you could say "lickety split!" Just who the ***** do you people think you are, to prevent my child communicating with me when he wants or needs to?! This kind of BS is why I would never, in a million years, leave anyone I love alone in a hospital. Not for five seconds.

Aren't you parents? How do you not get this?

These are subjects that get people passionate about their answers. I agree that if my child was in the hospital and wanted to call home and was prevented.....there would be some heads on a platter served to me with a smile.

However....this is about the CNA asking what to do when presented with this situation.

OP ...... I would calm the child if they are upset and reassure them that you will help them....go directly to the supervisor or charge nurse and tell them of you feelings/concerns. I would even go and get the nurse in charge of this patient for if this happened to one of my patients while I'm at lunch there would be hell to pay.

[Bruce_Wayne, ASN, RN]

Some of the responses here are responding as if this is a pediatric patient and I can't find in the post where the OP said the age of the patient. If the patient was an adult AAOx3 then denying him his phone is a violation of his rights plain and simple.

If the patient was a peds pt then I don't know the rules on that since I've never worked on a peds unit. I thought that the parents were required to stay at the bedside for peds patients usually, that's what I've heard about my hospital. If the parent isn't there and the child is alone does that make the RN the "de jure" guardian? I'm only familiar with this term because I have friends that are teachers and when they're in the classroom they're considered the guardian of the children in my state. I'd be interested to see if that applies to unattended pediatric patients and nurses.

[Rose_Queen, BSN, MSN, RN]

Some of the responses here are responding as if this is a pediatric patient and I can't find in the post where the OP said the age of the patient. If the patient was an adult AAOx3 then denying him his phone is a violation of his rights plain and simple.

Seeing as the OP referred to the replacement as watching the "kids", that implies a pediatric floor. I can see both sides of the issue: perhaps the nurse wants to be available to answer the parents' questions, but the kid should be allowed to call home. If there is a short delay where the nurse does an assessment, performs indicated actions, and then calls the parents, I see nothing wrong with that. I view assessing 10/10 pain as a priority over a phone call.

[ComeTogether, LPN]

That is a bunch of crap. If the kid wanted to talk to his parents he should have been allowed to. You weren't calling them you were helping him call them. I would have told her i wasn't comfortable denying this child the right to speak to his mother who can comfort him.

[green34]

It sounds like the phone is in the room. Why couldn't the patient dial the number himself? I don't know if I would necessarily agree with not dialing the number for the patient to talk to his parents. I wouldn't talk to them myself. How old is the patient? If the patient is like 4 I could understand not wanting them to talk to the parents first without the nurse talking to them. If the patient is like 12, that's a different case.

[benegesserit]

I know not all nurses are going to think this way, but you might try asking why before assuming the worst and going above her head and complaining. I'm generally happy to explain things if my aides (nicely) question something, assuming it isn't violating privacy to do so. The answer may be "just do it and I'll explain later" if I'm particularly busy or it's an emergency or "I can't discuss that with you for privacy reasons" if that's the case. But generally I'll explain.