Patient going to complain against me?

Specializes in Med-Surg.
Patient going to complain against me?

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. 

55 Answers

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. ??

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!

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.  

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.

Specializes in Geriatrics.

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.

Specializes in orthopedic/trauma, Informatics, diabetes.

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!

Specializes in SRNA.

Patients complain all the time (it gets easier the more it happens LOL). You did nothing wrong - you acted within your scope given by the parameters that were prescribed. Once you clock out, leave it at work and don't bring it home with you. 

Specializes in ER.
4 minutes ago, Orion81RN said:

Dilauded is, in fact, the ONLY thing that worked for my 10/10 kidney stone pain. Morphine is laughable. I think it’s awful that your “radar” goes up bc a kidney stone pt KNOWS what works for them and what doesn’t. Toradol was the miracle drug post surgery for me for the inflammation, no need for narcotics. Nice to know you’re the nurse who doesn’t advocate for your patients bc OMG what if they are addicted even though their pain still needs to be treated regardless. Awful. 

You seem to be taking this personally. You are extrapolating a whole lot from one statement about drug-seekers,  whose manipulative behaviors and entitled attitudes are perfectly illustrated in the opening post.

I know what severe pain is as well. I had a traumatic injury that damaged/severed nerves and tendons. I also had 6 homebirths. That never blinded me to the fact that some patients are looking for a fix. Our system has enabled them and it takes its toll on nursing. 

The request for Dilaudid was denied by the MD. You gave her what the MD would give her. They asked you to go over the MDs head and find someone who would order it. That definitely would not have gone well later....

This one is sounding drug seeking. Let her complain. Once they drop that they didn't get their request for dilaudid and an MD had been called and denied it admin will likely catch on. 

Specializes in ER.
1 hour ago, londonflo said:

Very good advice from an OR nurse who doesn't have to deal with this as his patients are under anesthesia.

I'm an ER nurse and totally agree with @morelostthanfound

I've also worked post-surgical, which is what this patient was, along with the enabling family. The patient was NOT  an acute kidney stone patient! Duh...

Specializes in ICU.

The doctor refused diluadid, so you did what you could do. I’d disagree with the doctor, personally because we’re talking narcs here, give some of one, give another one, whatever works, not every med works for every person and I’ve seen that. However, I definitely don’t blame the posters bringing up drug seeking. It is a real problem and something we’ve seen a lot of in the ICU. It’s tough. The patient is sick enough to be there and is likely uncomfortable or in pain, but they still may simultaneously have a drug problem. It’s a complex issue, and yes nurses have to deal with it face to face the most as these patients come to the hospital and they and their families often become aggressive when attempting to medicate to their needs. 

In my experience of people I've known who have had a kidney stone, the pain as experienced by them was excruciating and completely incapacitating.  These are stoic adults, who usually tolerate pain quite well, and they don't take narcotics normally in their daily lives.  

One person received two IV doses of Morphine along with Phenergan and Zofran at an outpatient facility; I think the Morphine doses were 5 mg each but I'm sure they weren't any smaller.  Then, after they were discharged home with a prescription for Norco 5/325 (which they took), they had to go to the ER for more pain control and received an IM injection of Morphine, and were discharged with a prescription for Norco 10/325, which they took a few hours later.  

I was shocked at the extreme pain these people experienced.  I can't think what we would have done if the staff had insisted on giving very small doses of narcotics; they simply would have been in excruciating pain.  I also can't imagine what we would have done if the staff had behaved as though the patient was drug-seeking; it would have been a horrendous situation.

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