Patient complaint - Did I mishandle this situation?

[lily8424]

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.

[kmRN33, MSN, RN]

I think that you did a great job! It would be silly to wake a patient up for their next morphine dose if they are asleep (if you’re in that much pain, then you wouldn’t be able to sleep). You did all you can by offering an alternative, he refused and you even spoke with the on-call physician about his request for Percocet. I can only deduce that he is angry because he was not able to manipulate you into giving him more pain medication. If it’s “PRN”, then you’re not obligated to wake him up if he is asleep and didn’t ask for pain medication.

Let him write his letter, you did all you can to care and advocate for him. Don’t second guess  yourself.  Don’t be afraid of this kinds of tactics because you know you did all you can. In my current practice, I have patients who put the timer on their phone for every 2-4 hours to get their PRN narcotics...it’s an addiction. 

 

[T-Bird78]

Some people complain just to complain. You did nothing wrong. I brought a breakfast tray into a pt room and was getting the pt bed situated for feeding assistance. Pt asked for foot of bed to be lowered, so I lowered it, pt cussed me for moving his legs. I reminded pt they asked for the foot of the bed to be lowered. Pt nodded and asked me to put it back, so as I was adjusting it back pt yelled “stop it, you b*$%H!”  They complain just to hear their own voices. 

[VaniCCRN, BSN, RN]

Don’t lose any sleep over this anymore. This patient isn’t worth it and you did nothing wrong.

Say it with B Y E! Only good things will come from this and you will no longer have to entertain this manipulative patient.

 

 

[mmc51264, BSN, MSN, RN]

you did what you should have but whoever is writing the orders doesn't know much about pain management. 

[amoLucia]

 

10 hours ago, KmRNrodriguez said:

.... In my current practice, I have patients who put the timer on their phone for every 2-4 hours to get their PRN narcotics...it’s an addiction. 

 

An addiction to meds or as a manipulative GAME to them that is just as psycho-socially behaviorally addictive.

[JBMmom, MSN, NP]

On 3/7/2021 at 12:05 AM, lily8424 said:

I apologized and assured him that he would be getting a different nurse tonight.

The only thing I think you might have changed is what you wrote here. You had nothing to apologize for. You did what was best for your patient, changes to the medical plan made by other members of the team are not your fault, nor should you outright apologize for them because then the patient may see a potential error. As others have mentioned, I don't know why you would have a morphine order but not a percocet order, but that's not your fault.  The *only* sort of apology I give in these situations is something like "I'm sorry if you're unhappy with the care you are receiving, I am following the plan of care as it is ordered. I will have the patient care advocate/floor manager reach out to you so you can discuss it with them".

This patient was probably going to complain no matter what, I'd gladly be "fired" by him. Also, never promise you won't be someone's nurse again, sometimes staffing constraints mean they can't dictate who will provide their care. Of course, it would be better for you not to have to deal with getting the patient back as well, but sometimes these things happen. You did your best, I hope you didn't lose any other precious sleep time over it.

[amoLucia]

to newbie members, Km & Lydia - Welcome to AN. Please be careful about your screen names here. Anonymity is your friend on social media. Everybody & anybody reads these posts here, so just to be safe ...

[kmRN33, MSN, RN]

27 minutes ago, amoLucia said:

to newbie members, Km & Lydia - Welcome to AN. Please be careful about your screen names here. Anonymity is your friend on social media. Everybody & anybody reads these posts here, so just to be safe ...

Good call on that! I didn’t even think of it! Thank you! 

[CapeCodMermaid, RN]

I’ve been a nurse for almost 40 years. Unless the patient specifically asks to be woken up for medication, I wouldn’t wake them up for pain meds. I’ve also been a patient more times than I’d like. I have wicked insomnia. I always ask the nurses to leave me alone if I’m sleeping. They don’t always listen but some of them respect my wishes.

From what you’ve told us, you did nothing wrong and certainly didn’t fail your patient 

[amoLucia]

CCM - nice to see you posting again.

[CommunityRNBSN, BSN, RN]

Sleep is an incredibly important tool for healing. Soooo many studies have shown that patients suffer when they are constantly being awoken during a hospital stay. Do not let this experience make you jumpy to where you start constantly waking up patients!  To wake him up and tell him that he still couldn’t have the pain med he was asking for would not have solved anything. 

[CheesePotato, BSN, RN]

On 3/6/2021 at 10:46 PM, lily8424 said:

I feel like I maybe should have woken him up to administer the morphine? I read on here that sleeping is often a coping mechanism for pain. I'm a newer nurse and didn't realize this at the time... I assumed he was comfortable and didn't want to wake him up if I didn't know for sure that he would accept the morphine.

Good day, Lily8424, 

I wanted to build on this to help you as you are a newer nurse and I know the struggle can be real.  

So let's talk about pain and sleep.  As we know, and you can readily find the literature to support, sleep is a critical part of healing.  Also true of sleep, it can act as an escape mechanism-be it from physical or psychological pain--and can yet be disturbed by pain, even if the patient is sleeping.    I'm not going to belabor you with points about the phases of sleep, but there are studies that talk about the effects of pain on the progression of sleep phases.  To summarize: the phase movement is disturbed.  In other words, the patient is sleeping....but they're not sleeping.

Moving on, pain is complex.  And although we may rail against the use of opioids and have stigma attached to them, they are still useful adjuncts in the battle against pain.  I could ramble for hours about it--but let's not.  Not on this day.  What I wish to bring to you is the dialogue to have with your patient that will save you some headache.

"So as I wish for you to get some good rest tonight, as sleep helps you heal, I want to talk to you about your pain medications.  Would you like me to wake you for your pain medications if I come in and find you sleeping?  Or would you like me to leave you sleep?"  <--This three second dialogue does several things: Establish a clear plan of care for the patient, give them input into their care, and tell you want they would like in the realm of sleep.  

Most (conversational) patients will expand on this by talking about their sleep tendencies--if they are insomniacs or wake up easy, etc.  

Otherwise, I think you were fighting an uphill battle with this particular patient.  I'm not going to nit-pick their behavior.  People are people and we all have a story.  But I more wanted to tell you that you did not fail this patient.  Let it roll.  

I also wanted help you build your practice from this experience, because it has been my observation that stated plans and giving patients opportunities to participate in their plan and choices helps mitigate difficulty.  Not all the time.  But you know....people are people.  

Take care of yourself!

~~CP~~