Patient going to complain against me?

Updated | Posted
by Bella345 (New) New Nurse

Specializes in Med-Surg. Has 3 years experience.

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I am a RN with 2 years experience in Med-Surg and this is the first time this has happened to me. I was precepting a nurse new to our facility and we were taking care of this young patient for a kidney stone. She had came back from surgery and was sleeping. When she woke up I noticed she had tremors and was stuttering a lot.  (Interesting) Family said it was new to this admission but was doing that before surgery as well. 

A few hours later she started crying and reported 10/10 pain. So I had my orientee start by giving her 15mg of toradol IV. No relief, so then 2 tabs of 5/325 norco. Waited an hour or less, patient still crying, so we gave her 2mg of IV morphine.

Patient is now stating she can’t breathe, we check her vitals, everything is normal except heart rate is 105 (I’m assuming from pain and crying). We put her on 2L of oxygen. The family tells me that she was receiving dilaudid at another hospital and that’s all that works for her. (This patient is an adult but her parents were speaking for her).

I say OK I’ll try calling the doctor and see if I can get an order for dilaudid. We called the doctor and he said no, give a one time dose of another 2mg of morphine, we wait a bit because we had just given morphine and then give the one time dose. Patient is asleep, family complain hand is swollen so I have my orientee stop the fluids for a bit and put ice on her hand.

It’s now shift change, patient awake crying in pain again and family in room is yelling at my orientee that we are terrible and not helping her daughter. I’m hearing it from other family member on the phone as well. I explained to them that the doctor said no, and they told me to call a different doctor for the dilaudid.

Night shift nurse says “go home we’ll handle it from here”. I’m back to work again in 2 days (don’t have the patient of course) but I’m hearing from the nurse who has the patient that they are going to write a complaint about my orientee and myself.

I am worried and lost some sleep over this because this is the first time this has happened to me and I’m nervous. Am I in the wrong and was there more I could have done? I feel guilty. 

morelostthanfound, BSN

Specializes in CVOR/General/Transplant Surgery, and cat herding. Has 30 years experience. 268 Posts

     Wow!  So sorry for this experience but you sound as if you are a very competent, attentive nurse and handled the situation brilliantly!!  My take; in terms of pain control, whenever I hear "it's the only thing that works"-HUGE, HUGE red flag for me!  I'm not suggesting that the patient is 'drug seeking', but with this comment it now becomes a definite bleep on my radar.  Personally, I wouldn't waste a minute of my time worrying about it.  The unfortunate fact is that people sometimes just suck and this is the end result of entitled, narcissistic people and hospital administrators expectation of a bed and breakfast treatment for patients.  If your documentation is supportive of your objective observations and interventions, let them complain!

Edited by morelostthanfound

chare

3,225 Posts

1 hour ago, Bella345 said:

... I’m back to work again in 2 days (don’t have the patient of course) but I’m hearing from the nurse who has the patient that they are going to write a complaint about my orientee and myself. I am worried and lost some sleep over this because this is the first time this has happened to me and I’m nervous. Am I in the wrong and was there more I could have done? I feel guilty [emphasis added]. 

Completely agree @morelostthanfound that some people aren't miserable at base line, and aren't happy until they drag everyone around them down as well.  Don't do this to yourself, don't worry about this, and most importantly don't lose any sleep over this or otherwise let it impact your health.  From what you wrote neither you, nor your orientee did anything wrong.  

JKL33

6,080 Posts

3 hours ago, Bella345 said:

I’m hearing it from other family member on the phone as well.

Remember that you don't have to entertain multiple lines of attack. Even if the patient has designated two or more people who are authorized to receive information you certainly can ask one of them to act as a point person to relay messages to you and to relay your info to the others as appropriate.

3 hours ago, Bella345 said:

I feel guilty. 

You should not. If you blew off the patient's pain perceptions and declined to attempt an intervention you would have something to feel guilty about. I  feel like using a "stern" voice on this matter because your guilt reaction is very unhealthy. You can't assume that you should feel guilty (and that shouldn't be your automatic emotion) just because someone is displeased about something. Instead, practice staying in a neutral/professional problem-solving mode. Just hear what is being said without taking it personally (even if they are using personally-aimed language) and then attempt to intervene as appropriate (this latter part you did do). 

Remember also to not fall into what I call spinning mode where you are just reacting to every comment/complaint. As an example (no harsh critique intended here 🙂) - they started at one point mentioning the IV site. Well, is it working properly or not? If it isn't, start another one. If it is, demonstrate that you have carefully assessed it and then declare that it is working properly. The end. Not: Okay well let's do some kind of something because they have complained. That can be a trap because if nothing is wrong to begin with then your intervention can also be faulted, KWIM?

Bottom line, everything's okay here. Don't lose sleep over this. 👍🏽

Bella345

Specializes in Med-Surg. Has 3 years experience. 2 Posts

Thank you for replying. Yes we were trying to help the patient but the family felt like we weren’t and made my orientee and I feel guilty and angry. You are right, I need to just let this go but it is something I still struggle with.  Nursing gives me anxiety sometimes. 

morelostthanfound, BSN

Specializes in CVOR/General/Transplant Surgery, and cat herding. Has 30 years experience. 268 Posts

     One additional comment; if an otherwise healthy, young patient is having this much pain and requiring this much analgesia for renal colic then; A) They may have another, more serious etiology for their pain and need to be further evaluated by the MD  B) They have zero pain tolerance or are a hypochondriac or C) They are opioid tolerant and are likely drug seeking.  Not to be judgy here, but I'm jaded and having seen this before, my money is on the latter!

JKL33

6,080 Posts

2 minutes ago, Bella345 said:

family felt like we weren’t and made my orientee and I feel guilty and angry.

Let's break this down a little. 😬

If the family felt that you weren't trying to help the patient despite the fact that you tried several different interventions in fairly short order, that is their problem. In reality, they likely do not know every in and out of this patient's life and even what they do know they do not have a medical context in which to put it. If they were there clamoring about dilaudid and how it's the only thing that works for her pain then they are some small part of the problem to boot.

I've had similar situations, and when I reviewed them after the fact I did think of things that I would do differently - but they were most often changes in the way I would handle (or react to) the situation and not as much interventions that should have been done that I didn't attempt. Managing the interpersonal portion of situations like this is important--it's often where things are either put back on track or go farther in the wrong direction.

I really, really do know that patient and family behavior can be provocative, but we can all do very well for ourselves by taking ownership of our feelings and how we react to things. Therefore, we should try to decrease the amount of times that we say (to ourselves) that someone "made me feel _________" [negative emotion]. We should try to decrease that thinking. It is difficult but possible to learn to control or limit negative-emotion internal responses. This is coming from someone who had to learn exactly what I am relaying here. And it wasn't easy. But I can now say with 99.9% certainty that these folks would not have made me feel guilty in the least and probably not angry/upset, either.  Because others' perceptions are their own...and especially if they defy reality well then that really is their own problem. It's difficult to understand unless you have been through the process, but it is one of the more freeing things in life to realize that others don't actually dictate your emotions. Very empowering and freeing.

amoLucia

Specializes in retired LTC. 7,495 Posts

Am agreeing 110% with other respondents. Only thing I would consider doing would have been to alert the nsg super. Give Admin the heads up first BEFORE they hear it from the disgruntled family who will have FURTHUR blown things out of proportion.

Man, all those narcs and I'd be ready with a narcan!

Emergent, RN

Specializes in ER. Has 29 years experience. 2 Articles; 3,860 Posts

So glad I'm out of nursing!

vintagegal, BSN, RN

Specializes in Geriatrics. Has 3 years experience. 212 Posts

I normally tell pts ahead of time what I think the doc is going to say, provided I know the physician well and am used to the orders.

I had a pt with CHF and history of MI asking for testosterone. Hard pass! Bahahahaha 

I told the patient that I would ask the physician but likely he would not oblige because of the heart hx. I called up the doc and what do you know? He said hard pass!

Makes it easier to let my pts know, look we talked about this earlier, the physician is not going to provide that order because X,Y, and Z.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 10 years experience. 3,048 Posts

try not to worry, you did everything right. You can't MAKE the provider change orders. We have residents on call, or an APP available to explain stuff that is out of our scope. 

I got fussed at about a pt complaint and I said-that is the one that threatened me that she was "going to kick my a**" and I had security walk me to my car. I couldn't file a complaint because the girl wouldn't give her name. 

You are fine!

jobellestarr

289 Posts

On 11/29/2021 at 9:26 PM, Emergent said:

So glad I'm out of nursing!

Me too. I had anxiety just reading this and it set of all kinds of feels for me. I kind of only like animals now.