Patient going to complain against me?

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by Bella345 Bella345 (New) New Nurse

Specializes in Med-Surg. Has 3 years experience.

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payitforward

payitforward

Specializes in Med/surg,orthopedics,emergency room,. 98 Posts

I pretty much agree with everything everyone else said. IF you have done EVERYTHING that you possibly can NEVER let family members make you feel guilty for ANYTHING! 

mnj7351

mnj7351

15 Posts

On 11/29/2021 at 8:55 AM, Bella345 said:

nurse-family-complaining.jpg.8912986124da45e5928c8bb9c61392fb.jpg

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. 

Listen, things like this are going to come up your entire career. You literally just have to brush things like this off and not second guess yourself. You can not do anything that you don't have a Drs order for. Are some people going to give you a hard time when they don't get what they think in their minds they need? Absolutely. You can't do anything about that. All you can do is follow your Drs orders and do everything that you already stated that you did and explain to the patient everything you're doing and why. You can't pull an order out of your a$$ every time a pt (OR FAMILY) doesn't like something. This is going to happen a lot. It sounds like you're doing a good though. To be honest, if I were that Dr, there's no way in hell I would of just said, "aww...she's got tremors and she's stuttering?? Yea, sure I'll just go straight to IV Dilaudid since that's what the family requested and make her stutter turn into a slur. " That's just ridiculous. (Side note, toradol normally works very well for kidney stones even though it's non narcotic. Maybe she needed 30mg??) Family members are just scared. Sometimes family members make the whole hospital stay so much worse than it needed to be. It's hard for people to handle seeing their loved ones in pain or in anything that isn't their norm. Some people Just don't know how to handle things well. They don't appreciate the care that you are actually giving to their loved one bc they don't see past the patient who is crying and shaking. You are not God. You can't fix everything that your patients and their family members are concerned about. All you can do is monitor them and maintain their stability and call the Dr when things come up...and follow your orders. And show care and compassion obviously. Anything else is outside your scope of practice. You're doing a good job. Keep that up. 

mnj7351

mnj7351

15 Posts

On 11/29/2021 at 10:43 AM, chare said:

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.  

"Miserable at baseline." Brilliant.

cgw5364

cgw5364, ADN

Specializes in Maternal Newborn and Denials Management. Has 38 years experience. 25 Posts

I am a nurse with 30 years of experience. In that 30 years I have taken care of many patients with intractable pain due to cancer, chronic pain due to pinched nerves, Sickle Cell Crisis, intractable migraine, acute post-surgical pain and many more. I learned that every patient is different when it comes to what works for pain. People with chronic pain do know what medications work best. I always asked my patient's admitted with chronic conditions what medications work best for their pain.  I also learned that a patient can be asleep and still be in pain. This happened to me during childbirth. I was given Stadol during labor. This made me woozy/sleepy and did nothing for the pain. In the situation you were in I would have called the physician again after the Morphine did not work. If the physician refused to change the pain medication or come examine the patient I would have gotten the charge nurse and nursing supervisor involved. 

JKL33

6,319 Posts

On 12/7/2021 at 5:53 PM, Susie2310 said:

A general comment about kidney stone pain apart from the situation described in the OP:  Kidney stone pain is known to be severe.  Frankly, if my family member was a patient and they were medicated for severe kidney stone pain with Morphine in a dosage that wouldn't be appropriate for their severe pain and their pain was unrelieved, and they still continued to complain of severe pain, I would be absolutely furious, and I would be complaining.  And I would take this situation further formally.  As nurses we are the patient's advocate.

I've debated making this comment...but, in the interest of clarity: The kidney stone situation that is most associated with significant, intolerable acute pain is a kidney stone in transit out of the kidney, ureter, etc. Not just "I have a kidney stone [in my kidney]" or "I just passed a kidney stone" or even "they just took a kidney stone out of me."

While none of us can know the degree of perceived post-op pain for this patient, the stories of "this is outrageous because I had a kidney stone and morphine didn't touch it!" are not really appropriate or necessarily even applicable.

I actually think that plenty of people don't make any distinctions at all when discussing kidney stones and mostly are only ever referring to the legitimate "I-can't-sit-still-this-is-worse-than-unmedicated-childbirth" situation of an acutely-in-transit kidney stone. Meanwhile they clearly wouldn't believe that pregnant people need an epidural to tolerate pregnancy and post-partum just because the pain of childbirth is so severe.

This is a post-op patient. While there's no question that the kidney stone experience can be exceedingly painful and surgeries can involve acute pain, it's very possible that this scenario is something like post-partum women being offered ibuprofen--no one expects that the strongest pain interventions we have available are going to be routinely needed after the fact. This isn't "she had a kidney stone and the nurse and doctor are blowing off the pain of kidney stones."

Even patients are confused about it all. That's why they come to the ED for "kidney stone pain" bringing their scans/reports showing their stone in their kidney. Some of them have figured out they should at least prick their finger and put some blood in their urine sample. Not saying the majority of patients are like this AT ALL. I'm just reminding people that "I had X so this is ridiculous patient treatment" is not a very wide assessment of the possibilities.

FTR, the answer here is not to choose either A or B (demand stronger medications or blow off the patient's reports). The answer is to assess the patient, have conversations/report to the physician, try interventions, reassess, etc. Which is what the OP did.

nursej22, MSN, RN

Specializes in Public Health, TB. Has 37 years experience. 2,596 Posts

20 hours ago, cgw5364 said:

  I also learned that a patient can be asleep and still be in pain. This happened to me during childbirth. I was given Stadol during labor. This made me woozy/sleepy and did nothing for the pain. 

I can attest to this. When I had a hysterectomy I had a Demerol PCA. It really didn't touch the pain, but it made me too goofy to express what I was feeling or complain. I later saw that nurses had charted that I rated my pain at 3/10, and frankly, I don't even think I was asked. 

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 30 years experience. 31,842 Posts

The issue isn't that the nurse judged the patient's pain. The nurse listened to the patient.  The nurse gave the ordered pain medication, when that didn't work and understood that dilaudid worked the nurse informed the doctor.  

If at the end of the day if you know you've done your due diligence then let them complain.  I'm sure it's hard on them seeing their daughter cry and there's probably some dynamics there.  

There's probably very few of us that have pleased our patients or family 100% of the time and didn't get a complaint.  

 

Susie2310

Susie2310

2,083 Posts

11 hours ago, JKL33 said:

I've debated making this comment...but, in the interest of clarity: The kidney stone situation that is most associated with significant, intolerable acute pain is a kidney stone in transit out of the kidney, ureter, etc. Not just "I have a kidney stone [in my kidney]" or "I just passed a kidney stone" or even "they just took a kidney stone out of me."

While none of us can know the degree of perceived post-op pain for this patient, the stories of "this is outrageous because I had a kidney stone and morphine didn't touch it!" are not really appropriate or necessarily even applicable.

 

Did you read that I started my comment with the words:  "A GENERAL COMMENT about kidney stone pain APART from the situation described in the OP?"  In the interest of clarity, of course.  

I think this rather invalidates your comment above.

Edited by Susie2310

kbrn2002, ADN, RN

Specializes in Geriatrics, Dialysis. Has 20 years experience. 3,660 Posts

You did nothing wrong. You assessed the patient appropriately and reported your findings and concerns to the MD who declined to order the med the patient's family requested.  The decision on what medications and what dose to use for pain control is not your to make.  The only thing I can think of that you might have been able to do differently is ask the MD to physically come and assess the patient for pain himself [or herself] when it appeared that the ordered regimen wasn't effective. 

On 11/30/2021 at 1:21 PM, mmc51264 said:

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!

She was a patient and you didn't know her name, but what about her room number?

Why was she threatening you?

JKL33

6,319 Posts

On 12/10/2021 at 10:09 PM, Susie2310 said:

Did you read that I started my comment with the words:  "A GENERAL COMMENT about kidney stone pain APART from the situation described in the OP?"  In the interest of clarity, of course.  

I think this rather invalidates your comment above.

EDIT:

"Noted."

Edited by JKL33

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 10 years experience. 3,098 Posts

On 12/11/2021 at 1:41 PM, Kooky Korky said:

She was a patient and you didn't know her name, but what about her room number?

Why was she threatening you?

I didn't know the visitor's name. She was upset because I was trying to enforce our visitor policy and she didn't like it. She complained about me, and I got called into the office, she kind of left out the fact that she threatened me. 

Thanks for blaming me for being assaulted.