Patient complaint - Did I mishandle this situation?

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So I got my first patient complaint. Without going into much detail, I had a patient who was on IV Morphine q 4 hours. Patient was reporting pain in middle of night. I administer medication to said pt. I check up on patient half an hour later and he is sleeping. 2 hours later, patient is reporting pain again. Patient has order for Tramadol q6 and I offer it to him. Patient states medication doesn't work for him but states they've been giving him Percocet q6h. I check the MAR again and the attending DC'd the order. I explain that to him that order was DC'd. Patient is upset about this but I tell him that I will reach out to Dr. I explain to Dr that patient states tramadol doesn't work for him and had been on Percocet q 6h. On call Dr states they are trying to wean him off the Percocet and told me to have him wait for the morphine. I check on patient again to explain the situation but patient is asleep again. I rounded on patient again when morphine dose was due but pt was still asleep and I didn't even know if he'd want it instead of Percocet so I decide to let him sleep. When patient woke up in morning, I offered morphine again to him but he refused, stating he didn't have pain and didn't want it. I apologized and told him they were trying to wean him off the Percocet, but he told me he was going to write a complaint about me and wants another nurse and refused care from me. I had to get oncoming nurse to administer his morning med and vitals since he refused to allow me to do it. I documented my interaction with the Dr and pt but can't stop feeling like I failed this pt.

Specializes in ER.

One thing that will help you in your nursing career is to develop an attitude of detachment. It will protect you in many ways, and shield you from being emotionally manipulated or coerced. 

You did your best in this situation, and I think your best was good enough. The only thing I probably would have done differently would be to just simply state the fact that you had talked to the on call doctor, who did not want to reinstate the Percocet order. As you found out, sharing the fact that the doctor wanted to wean him from Percocet probably made him angry, and he made you his scapegoat. He probably sensed your insecurities as a new nurse. He lashed out at you, but that doesn't mean you did anything wrong.

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He was being manipulative and "punishing" you because he didn't get what he wanted. If he didn't sense that you were easy to affect, he would not have bothered. I doubt this guy will mouth off any more than he already has, and he doesn't have a case anyway.

I will share one strategy that's been useful to me. When I'm waiting to hear back about something, I will frequently ask the patient if they want to be woken up when I have news. Then I don't have to decide whether or not to wake them up.

 

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Specializes in Mental health, substance abuse, geriatrics, PCU.
4 hours ago, Sour Lemon said:

He was being manipulative and "punishing" you because he didn't get what he wanted. If he didn't sense that you were easy to affect, he would not have bothered. I doubt this guy will mouth off any more than he already has, and he doesn't have a case anyway.

I will share one strategy that's been useful to me. When I'm waiting to hear back about something, I will frequently ask the patient if they want to be woken up when I have news. Then I don't have to decide whether or not to wake them up.

 

That is an excellent tactic. Some people you just can't please no matter what you do so don't even waste an iota of energy worrying if you could have changed the outcome, for some patients short of letting them snort the percocet off the bedside table you're not gonna make them happy. 

When patients have demands or desires that are not met it is not uncommon at all for them to start refusing care as a form of "that'll show them" kind of attitude. But hey it is their body, their health so if he wants to refuse his morphine, thats on him, not you.

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Honestly, I’d be happy to not have him back.  Let him write a complaint.  They can easily see you have pain medication, call the physician who said no.  You did your part.  If the patient wants to be mad at someone, be mad at the physician. 
 

it seems weird they’d rather give IV morphine over the percocets.  And the morphine q4 probably was not an adequate dose.  It depends on a lot of things though, like the reason for the visit, what’s the history of the patient.  But none of that Is your call.  You can’t order meds.  
 

Give yourself a break and be thankful you don’t have to deal with him again.

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7 hours ago, lily8424 said:

Last night made me feel like a terrible nurse and have been unable to sleep at all tonight over this... 

I hope this will be a good learning experience for you. I think that you logically know that you didn't do anything wrong, so the question is why you emotionally went this route with it. I think that bears some pondering.

What @Emergent said is important but sometimes nurses misunderstand:  It isn't a callous or uncaring sort of detachment but rather a mental attitude where logic informs your emotions, not the other way around. The detachment part is detaching your own emotions from your professional services in a way that is healthy. It is understanding that not everything is about you (or me) as a nurse and what we do or don't do.

It isn't logical to think that because someone has a problem and will not be able to address it with their preferred solution and refused other assistance then you must have done something wrong. It makes me want to say "Come on now, you know better than that." ?

Learn from this. You will thank yourself many, many times over. You are there to professionally care for people; to look at their situation neutrally and employ your professional knowledge and skills to assist them in therapeutic ways. You treat them with respect and dignity and the rest pretty much consists of things you don't control and that have nothing to do with you.

??

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Specializes in Psych, Addictions, SOL (Student of Life).
9 hours ago, SilverBells said:

.......... I might have kept quiet about the Percocet and only have addressed  it or let someone else address it if he spoke of it again. ...........

"Really"

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Specializes in OB.

How do you wean someone off Percocet by providing IV morphine instead?  ?

You did nothing wrong.  The patient wanted what he wanted and when he didn't get what he wanted, he blamed you.  I have a hard time shaking things off too, but it's gotten much better with time in my career.  Try not to be so hard on yourself ❤️

 

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Specializes in ER, Pre-Op, PACU.
13 hours ago, Wuzzie said:

Please elaborate on how you think you failed this patient because I’m not seeing it.

I have the same thoughts. You advocated for your patient - you contacted the physician for an order but didn’t receive one. It sounds like the patient is mad at not receiving a med he wanted and projected his anger on whoever he chose to - which was you. 

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Specializes in ER.

Detachment is a spiritual ideal in most religions. Those who follow deeply spiritual and contemplative lives, such as Monks and Nuns, Yogis, Sufis, work to nurture the virtue of service with an attitude of detachment. 

Nurses need to develop this attribute. It protects us from emotional involvement, and it allows us to help our patients more fully.

If you remain detached, it can keep you from being triggered by patients. It protects you from burnout. It helps you avoid impropriety. 

You should not be needing the approval of patients. Your ego has to stay out of this as much as possible. You are dedicated to a higher set of ideals and standards. You are a professional, this is your livelihood and maybe rises to the level of a vocation for you. If a disordered patient has a tantrum such as this one did, honestly reflect, but do not assign yourself blame or let it affect your peace of mind. 

There has been some awesome advice given on this thread!

 

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Specializes in Elementary School Nurse.
On 3/6/2021 at 11:38 PM, Wuzzie said:

Please elaborate on how you think you failed this patient because I’m not seeing it.

I think you did the right thing, why would you wake someone up to give them pain meds!

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Specializes in retired LTC.

And what do you think would have happened if you woke the pt up, but still couldn't give the percoset??? A complaint again, regardless ...

Be cool!

1 hour ago, linderl said:

I think you did the right thing, why would you wake someone up to give them pain meds!

Like waking up a pt 'to give a sleeping pill'... Used to happen all the time.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

You did nothing wrong; let him complain. He is manipulative. Everyone else said it best. I just wanted to reassure you.

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