My patient doesn't want to work with me at all and it's hurtful

[dsaprog, BSN, RN]

I'm working NOC shifts at a facility I have been at for over a year. I was only recently transferred to NOC shift at a new station and new patients. One of the new patients asked me for a norco pill and I saw his order for norco was discontinued on PCC. I told him and he argued 1 of the orders was discontinued and there was another still active. I didn't see the active order when I looked and I had only a few minutes in my shift. I just left it at that and gave report to AM shift. After I had left, he told management he does not want me to be his nurse at all. He said I was a "****" to him and "couldn't even check a ******* computer". It was really hurtful to hear that because I didn't even think it was a big deal or that he would respond this way. When I tried to give him meds the next day, he was extremely rude and made me start crying, then called DON to stress how he doesn't want me to be his nurse AT ALL. I'm still his nurse because he is in my unit, but a nurse from the other unit has to give him medicine or he won't take it. I know I'm not perfect, and maybe I did make a mistake when I was checking his orders, but I believe that I'm not the worst nurse at the place where I work either. I sort of hate him because he makes me feel so ashamed and embarrassed.

[Been there,done that, ASN, RN]

Do not end your shift until your patient  is medicated.

[Wuzzie]

"I didn't see the active order when I looked and I had only a few minutes in my shift. I just left it at that and gave report to AM shift."

 

This is where you went wrong. The fact that you only had a few minutes left in your shift was irrelevant. The fact that he was new to you as a patient was irrelevant.  You should have re-checked the chart for an active order. It literally would have taken a minute. If you truly could not find it you should have let the patient know that you looked but couldn't find it but you would let the on-coming nurse know of the issue and the two of you would figure it out and he would get his pain medication ASAP. Instead, you blew him off.  From what you posted it does not sound like the situation was even passed on to the day shift nurse. If I was that patient I'd be angry too and rightfully so. What concerns me most, though, is your reaction to all of this. Your feelings are your responsibility. You feel ashamed and embarrassed because you screwed up not because the patient is making you feel that way. Blaming him and hating  him for this is waaaayyyy out of line.  You need to humble yourself and apologize to the patient without making excuses for your lapse in care. 

I'm sorry if this sounds harsh but there is no way to candy coat it.  Personal  growth sometimes hurts yet we always benefit from it. Move forward and do better. That's all we can expect of each other. 

[Cricket183, BSN, RN]

Wuzzie said:

"I didn't see the active order when I looked and I had only a few minutes in my shift. I just left it at that and gave report to AM shift."

 

This is where you went wrong. The fact that you only had a few minutes left in your shift was irrelevant. The fact that he was new to you as a patient was irrelevant.  You should have re-checked the chart for an active order. It literally would have taken a minute. If you truly could not find it you should have let the patient know that you looked but couldn't find it but you would let the on-coming nurse know of the issue and the two of you would figure it out and he would get his pain medication ASAP. Instead, you blew him off.  From what you posted it does not sound like the situation was even passed on to the day shift nurse. If I was that patient I'd be angry too and rightfully so. What concerns me most, though, is your reaction to all of this. Your feelings are your responsibility. You feel ashamed and embarrassed because you screwed up not because the patient is making you feel that way. Blaming him and hating  him for this is waaaayyyy out of line.  You need to humble yourself and apologize to the patient without making excuses for your lapse in care. 

I'm sorry if this sounds harsh but there is no way to candy coat it.  Personal  growth sometimes hurts yet we always benefit from it. Move forward and do better. That's all we can expect of each other. 
 

This!  I agree 100%.
OP, "it wasn't a big deal" to you but it was a big deal to the patient who was in pain.  Waiting for medication when you're in pain can seem like an eternity.  You seem to think the patient overreacted (and possibly he did) but you broke trust with this patient and you seem almost flippant about it by saying I'm not even the worst nurse in the place.  Yes, you made a mistake.  It happens.  We've all failed a patient.  Mine was a quadriplegic patient who needed to be cleaned up.  On my way to get supplies there was a chemo spill in another room.  The spill obviously took priority but when I was finished cleaning it up (which took awhile) I went and filled out an incident report, completely forgetting about my patient who needed cleaning up.  It was right at change of shift (it always happens at change of shift!) and I gave report to the incoming shift and went home.  When the oncoming shift made rounds, the patient was very upset.  Rightfully so.  It was the next morning when I received report back that I was reminded by the outgoing shift that I had forgotten the patient and he did not want me as his nurse that day or ever. I was mortified.  I immediately went to the patient and apologized.  I explained what happened but that it was no excuse for me not coming back and I was very sorry.  He was very gracious and forgiving and he did allow me to be his nurse again but I never forgot that feeling of failing him.  I had a responsibility to him.  Our patients rely on us.  You made a mistake.  Own it, apologize and then move on.  Harboring resentment & hate toward the patient will only further escalate the issue for both you and him.

[mmc51264, BSN, MSN, RN]

Agree with others. Pain is a big deal and its difficult when you are not in control of things. At shift change, it may take an hour or so for the next shift to get caught up to give him his meds. 

You are lucky you don't work inpt as we get pts "firing" us all the time. You might need to develop a little bit thicker skin. 

Hang in there!  Learn from all experiences 🙂 

[JKL33]

Did you make a second look for the active order after he told you he thought there was one, or not? And did you report to the oncoming RN that this was a pending issue? Those details aren't entirely clear from what you wrote.

*If you did those things and communicated them, then I think he sounds like he tried hard to be extra insulting. It is demoralizing when that happens, since we all make mistakes and are not perfect and patients know this.

Just the same, this is/was indeed your responsibility as others have already mentioned.

If this were me I would go to him and apologize as follows (just my style, as an example, you come up with your own words): "I know there are arrangements in place for you to receive care from others but I still feel that you are owed an apology from me. My handling of that situation was not good and I'm sorry you had to wait for your pain medication. I know you don't know anything about me as a nurse, but I do strive to do better than that. I hope you will accept my apology. If you think we can work together in the future I would be happy to provide good care to you."

Then....review what you need to review, learn what you need to learn, and move forward. If he does not respond favorably to an honest and well-intentioned apology, that is on HIM.

And I agree with the others that one of the very important lessons in all of this is learning to separate your own feelings from patients and their words and behaviors.

Take care ~

 

[Emergent, RN]

You are going to have occasional faux pas that angers a patient. The best thing to do is to apologize as soon as possible. He might be a cranky old man, but as detailed above, you didn't read the orders correctly. If a patient questions an order, always go back and investigate. Sometimes they know more than we do and can clue us in.

Always feel free to call the doctor to clarify if a patient questions an order. The patient likely discussed with the doctor the pain control plan. Remember that doctors can forget things too. The doctor can get distracted with something after leaving the patient's room, and forget to put in the order. We're all human. Just remember that patients often pay attention and know a lot about the plan of care. Listen to them. Treat them how you would want to be treated if you were in their shoes.

[FolksBtrippin, BSN, RN]

I think emergent said it best so far.

I would add that it's important to reframe this from "he made me cry" to "I was so upset I cried". 

 

 

[Nurse...123]

This is a teachable moment. Niursing presents them all the time. 

1. Apologize to the patent. Lierally, tell him "I would like to apologize. You are right being upset with me for missing the active order for Norco. This is will never hpen again. I would like to continue being your nurse and work with you." The patient will probably respond angrily but you are their to support him anyway. It is my sense that eventually he will respond positively to your mature behavior. 

2. Expressing strong emotions such as anger or crying in front of the patient is wrong. Compassion is what people want to feel from their nurse. 

3. Work on building relationships with your patients long or short-term stay, it is equally important. 

4. Seek for counseling if needed. Learn, grow, move on. 

5. Love your patients. Yes, love. There is no other feeling in the world that has more healing powers than love. If you feel that love inside, people will respond with warmth and kindness. 

I am wishing you the best. The fact that your are writing here means that you care. This is the first big step. 

[Barriss Offee]

You hate him?

Bro, you knew the patient was in pain, you saw there was no order for pain medication, and then you just bailed. You walked away and dumped it on someone else. Now the next nurse has to send out a page to the doctor as soon as there shift starts. Even if there was no order like you thought, you could have gotten the page sent out and told the patient you are waiting to hear back from the doctor and you are working on a solution. Instead, you just bailed and dumped it on the next person and made it pretty obvious to the patient. Of course this patient doesn't want you as their nurse 😅

I know it sounds harsh but you definitely are not in the right in this scenario. 

[barcode120x, RN, NP]

The only time frame I see in the OP is that she/he had checked at the end of shift. If we assume the OP had the initial pain med interaction during the shift, then I do believe the OP should have done the action of paging the provider for a pain med order.

Now if this initial pain med interaction happened towards the end of his/her shift then I do not see anything wrong with passing along the report to the next shift nurse who should hopefully had completed the request for pain meds.

We all make mistakes, but never feel ashamed and definitely apologize if you were in the wrong. Learn from these experiences and use it to better yourself and your interactions. At the same time, as someone would did tele for 7 years, charge nurse for 2 years, and now working in a the SNF setting, I tend not to let patient's upsetness affect me. Move on and continue your work.