"I don't want him as my nurse"

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Specializes in Emergency Nursing.

While this is not exclusively LPN related, I feel that as an LPN I should still discuss my nursing dilemmas here with nurses such as myself.

I go to triage a pt and he says in a lively and over the top voice, "I'm not doing so well."

I look at the pt. I smile at him and say, "I'd imagine you're not doing so well if you needed to come to the ER." His wife laughs and he glares at me and I slightly shrink back- oops. I begin the triage and ask him questions pertinent to the triage. He cuts me off at every question and begins to rant. He goes on and on...... and on... and on.... he belittles the physicians and nursing staff who made him this way. He's yelping and yowling about his problems. The pt is so over the top with his complaints... I get to the question, "On a scale of 0-10, how would you rank your discomfort right now?"

"Uh. A 20!" he states like it is the most blatant thing in the world.

My manager once told me, "I knew I had to leave the bedside in the ER when I sat and listened to a father yelp and howl about how he ran over his daughter and all I could think about was how he couldn't cut tot he chase and tell me the pertinent triage information. I knew it was time for me to go after that."

I look at the patient and say, "Well, anything after 10 on the 0-10 scale is reset back to 0, so if you really think your pain is a 20, then I thin I have send you back. Do you still want to call it a 20?"

The patient hesitantly looked at me, then glanced to his wife behind me, then back at me with confirmation of his indignation, "Yes! Its a 20!"

"Okay. Just so we're clear on that..." I respond.

From that point on, it was smooth sailing. The triage was easily completed. About 15 minutes later, the Primary RN comes to me and says, "No offense, the patient requests you not come back to their room"

.... sigh..... more than happy to oblige.

gah.

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I've been "fired" by a patient before. After the charge had a chat with her, the patient wanted me back as her nurse. The charge happily told her that I'd already swapped with another nurse, so instead of having the one nurse on the unit qualified to look after one of her problems she had a new grad that wanted a challenging experience.

Having said that, I recently experienced pain. It had to be at least a 15/10 but I was in agony and the triage nurse took one look at me and I went to the top of the list.

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Specializes in Emergency Nursing.

Sigh... I once saw a pt who could do nothing but scream and cry. Scream and cry. Scream and Cry....

That was a 10/10.

Scream and cry....

The same day, a gentleman refused to throw his Hardee's burger & fries away and his chest pain was a... Sigh... 10/10

If u can verbalize anything, it is at most a 9. If it is a 10 then it cannot be verbalized and nothing more can ever be expressed in words.

Nothing can be more than a 10, for to be expressed in a greater than 10 numerical rating is to diminish the value of a 0-10 pain rating scale.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I've had patients fire me in the past after bending over backwards.....I consider it a reprieve.

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Some people don't want to have a witty conversation about number theory, they just want you to know they're in pain. 15 out of 10 is a good enough answer for me. In fact, I think it's a stupid "question" to start out with. I realize most of us are forced to ask it, though.

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Specializes in Acute Care.

The reason a 0-10 scale is helpful, is because you can reassess after medicating. If the number's gone down, usually... the medication has been effective. So the number scale is valuable. But I do agree that the question can seem ridiculous to patients. I just assure them that it's a valuable tool, and I use it to monitor the effectiveness of the intervention. They usually comply after they realize WHY I'm asking. And I agree with pangea... If I get a 15/10, or a 100/10, I just say... "Okay, we'll get you medicated." I don't question it- not worth my time... haha

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Specializes in Hospice / Psych / RNAC.

If you're going to push it when you know they're in pain well...I would have just marked it a 10 with a note patient says 20 and then configure from there.

You must choose your battles wisely; some are not worth tickering over...after all when the patient says he's a 20, I believe him no matter what number model you want to use.

I would say your resistance to adapt to the patient's numbers puts you at a 10 on the 1 through 10 levels of the stubborn nurse number line. Level 10 being most stubborn :yes:

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I've always medicated to what the patient tells me. Everyone has a different tolerance of pain and medication.

Trust me, my pain threshold is pretty high. When you are panting, writhing, and howling, your pain is well past tolerable.

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Specializes in Med/Surg,Cardiac.

When a patient tells me 10, I confirm by saying "so this is the worst pain you've ever experienced?" Sometimes the patient will be like.. Well maybe it's an 8. Sometimes they continue to say it's a 10.

Maybe they wouldn't use the pain scale out of proportion if they knew I'd still medicate them even if they said "it's probably a 5 but the morphine works best."

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By definition, there is no pain on the scale higher than 10. If they give me a number more than 10, I ignore what they say and simply mark 10.

I find 0-3 to be about as meaningful a resolution as there is for pain. None, a little, a lot, and over the top.

What drives me nuts is when patients insist on using halves.... if I'm on good terms, I'll respond with, "are you sure it's not 9/16 or 15/32?"

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Specializes in Home health.

Whenever a patient tells me the pain is 15/10, all it means is they are extremely uncomfortable and they want my help to alleviate this pain. I'm not going to sit and discuss that there's nothing beyond 10 on this scale. It is wasting my time and delaying the care. When I have to evaluate the effectiveness of the medication, all of my patients are able to give me the real number.

I've been on the other end before, and I can handle my pain pretty well, so my pain can very well be 10/10 and I would not be screaming or crying because that's just not something I do. I just get extremely quiet. Pain is what the patient says it is... And it is true.

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Whenever a patient tells me the pain is 15/10, all it means is they are extremely uncomfortable and they want my help to alleviate this pain. I'm not going to sit and discuss that there's nothing beyond 10 on this scale. It is wasting my time and delaying the care. When I have to evaluate the effectiveness of the medication, all of my patients are able to give me the real number.

I've been on the other end before, and I can handle my pain pretty well, so my pain can very well be 10/10 and I would not be screaming or crying because that's just not something I do. I just get extremely quiet. Pain is what the patient says it is... And it is true.

Thank you.

That is what I was taught in college. Pain is subjective and you have to take your patients word.

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