"Your patient in 520 is in pain!"

Altra, BSN, RN · May 2, 2009

I hear ya ... oh, boy, do I hear ya! :selfbonk:

SunnyAndrsn · May 2, 2009

Yup, bugs me too. I have a CNA who has been labeled a "saint". She is NOT and I wish my NM would work the floor with her for a week. Heck, one day and she drive them nuts.

I work with her on our subacute wing:

CNA: 220 says her wrist hurts.

Me: Okay, when I'm done getting report, I'll check on her.

10 min. later

CNA: She says her wrist is really sore, did you get her anything?

I'm in front of the MAR, checking her PRNs, checking for scheduled pain meds, I'd just checked her chart and the nursing notes to see if this was a reoccuring complaint/issue.

I reply, No, I haven't, why don't you offer her an ice pack?

CNA: Well, I think she really wants pain meds, you should really get her something.

Now why didn't I think of that? Gee, was it because I was getting report on the rest of my pts? Maybe it was because I was then making sure there was something I could offer the pt. in pain. Maybe she should have offered her the ice pack until I got there!!

Just one example of many, of course on a subacute wing we get lots and lots of pain issues, and this CNA saint makes sure all of us heartless nurses (who tend to sit at the nurse's station doing "nothing") get on top of things.

accessqueen · May 2, 2009

I go into patients' rooms to put in PICC lines. I get told about the patients' pain all the time. I then take this info to the nurse. The nurse may or may not want to hear it, but it is my duty to report it. And I have had many situations where the nurse said she would do something, but I am at the bedside for an hour and nothing gets done. When I get back to the nurse I hear "oops, I got busy and forgot!' If I, or the CNA, or whoever is told about pain, we cannot very well say to the patient, gee sorry about your pain but I can't tell the nurse because she may get irritated." I'm glad those annoying CNA's are patient advocates, better than the apathetic ones who don't care enough about the patient to go hunt down the nurse. The CNA is coming to you cause she's hearing it from the patinet.

AngelfireRN, MSN, RN, APRN · May 2, 2009

Oh, I so know what you mean. Had one like that when I worked agency. We had a lady that we just could NOT handle, she was all over the place, trying to get out of bed, noncompliant, went in at one point (she was on 5 minute checks) and found that she had scaled the bedrails and plopped herself in the chair, with her catheter tubing stretched tighter than a bowstring.

Finally, doc orders her moved to the unit, and says not to give her anything to sedate her, since she is acting so crazy, he wants to observe her himself, and is on the way. The CNA that helped me move her had been on me all night, "She needs something. Why don't you get her something?"

Finally, on our way to the unit, she mouths off, "I should have given her something myself, since you won't. She's suffering."

Mind you this woman did not know she was in the world, and was giving no indication of pain, just extreme confusion. I guess the fact that CNA could not access the Pyxis and the need for a doc's order just evaded her completely, otherwise I have no idea HOW she planned to go about her "mission of mercy".

Flatbelly · May 2, 2009

Can't speak for all CNAs in the world, but can explain myself. I sometimes do it because the pt is making it impossible for me to do my job. I've actually had this situation today. Instead of assisting the pts that really needed my help, I ran in and out of the room of a whining bimbo (let's call her Lucy), who complained she had a headache and needed a Tylenol AT ONCE. I understood, pain is no fun, but the RNs answer the call lights only when the CNAs can't, meaning I'm in Lucy's room every 5 minutes, explaining I can't give her anything and the nurse knows about her pain - she has to be patient and wait. Well guess what, Lucy didn't give a RA of what I said, and kept pushing that call light button every time as soon as I left her room.

I nearly kicked poor Lucy in the butt, I was so mad. I finally jumped to the RN and told her to give the damn bimbo the damn Tylenol, because I'm not able to take care of two of her other pts until Lucy shuts up. I actually used those words (I feel a bit ashamed now) but at least they worked.

I do agree however that treating the RNs as heartless ******* is unprofessional. Most units in my hospital are understaffed, it's not the nurse's fault she can't run to every pt every time the pt requests it.

cjcsoon2bnp, MSN, RN, NP · May 2, 2009

You know what bugs me? You have a clock watching, narcotic loving type patient who is, well, whiney and somewhat manipulative. He's been on the light frequently.
So, you're super busy and along comes one of the ancillary personnel who comes to you with an accusatory tone of voice, informing you that one of your patients is "in a lot of pain", as if they are the big patient advocate and you are the neglectful, hard hearted nurse.
The 'patient advocate' then plops herself down somewhere, after sending you scurrying.
That bugs me...

I understand where your coming from but as a CNA I have a slightly different perspective...

I know about that patient in 520, I know he is probably addicted to his narcotics. He watches the clock and counts down the minutes until his next dose like he won't be able to take another breath until he gets those pain meds. When I came on my shift he told me that those two Percocet the last nurse gave him were like baby aspirin and he will be ready for something stronger soon. I also know that when I come into the room or even walk by the room he calls out for me and begs me for his pain medication. He tells me that he's in so much pain he won't make it and that there is no way I can wash him up, make his bed, take his blood pressure or even empty his catheter bag until I tell the nurse that he needs his pain meds. I know that when I go to the nurses desk to tell you, the nurse, about his pain that you are busy and have a million things on your mind but I know that its my job to tell you about any pain that my patient reports to me and once I tell you then I can go back to doing what I need to do. Please just do us both a favor and say "Thank you, I will take care of it." and let us both move on with what we need to do. I won't come back to you in five minutes and harass you about the patients pain meds. but when I go back to that patient an hour later and the patient is still in pain, furious and says you never even came to see him then don't be angry if I come back to you to remind you about our patient's pain. I don't think your a cold-hearted nurse and I'm certainly not a saintly CNA, but lets not forget that we're not here to pass judgment on our patients we're here to take care of them, even if we think that some of them are just drug-seeking, manipulative clock-watchers.

!Chris :specs:

vashtee, RN · May 2, 2009

You know what bugs me? You have a clock watching, narcotic loving type patient who is, well, whiney and somewhat manipulative. He's been on the light frequently.
...

I had one this week like this. She was on the call light every 5 minutes to remind me that her pain meds were due in 40 minutes, then 35, then 30, etc., etc. :angryfire

UM Review RN, ASN, RN · May 2, 2009

Especially irritating is the manipulative type who enlists any passerby to her aid. Visitors, housekeepers, lab techs, anyone will do --

How many times and to how many different people do I have to explain that I gave the med 30 minutes ago and the doc is refusing to order more? That I asked for a PCA or a patch or something.

But no. I'm just the big ole meanie who's too lazy to care. :cool:

Virgo_RN, BSN, RN · May 2, 2009

Yup. Or the patient who is already so sedated that you know if you give them anything more, you'll send them into respiratory arrest, while you've got another patient getting blood, one with a zillion IV meds, and a new admit with a CBG of 40. You explain to the CNA that the patient has had everything they can have, they cannot have anything more, and you've already spoken with the doctor about it, yet they continue to track you down to inform you of the patient's requests for more pain meds.

Magsulfate, BSN, RN · May 2, 2009

I understand where your coming from but as a CNA I have a slightly different perspective...
I know about that patient in 520, I know he is probably addicted to his narcotics. He watches the clock and counts down the minutes until his next dose like he won't be able to take another breath until he gets those pain meds. When I came on my shift he told me that those two Percocet the last nurse gave him were like baby aspirin and he will be ready for something stronger soon. I also know that when I come into the room or even walk by the room he calls out for me and begs me for his pain medication. He tells me that he's in so much pain he won't make it and that there is no way I can wash him up, make his bed, take his blood pressure or even empty his catheter bag until I tell the nurse that he needs his pain meds. I know that when I go to the nurses desk to tell you, the nurse, about his pain that you are busy and have a million things on your mind but I know that its my job to tell you about any pain that my patient reports to me and once I tell you then I can go back to doing what I need to do. Please just do us both a favor and say "Thank you, I will take care of it." and let us both move on with what we need to do. I won't come back to you in five minutes and harass you about the patients pain meds. but when I go back to that patient an hour later and the patient is still in pain, furious and says you never even came to see him then don't be angry if I come back to you to remind you about our patient's pain. I don't think your a cold-hearted nurse and I'm certainly not a saintly CNA, but lets not forget that we're not here to pass judgment on our patients we're here to take care of them, even if we think that some of them are just drug-seeking, manipulative clock-watchers.
!Chris

From a nurses perspective, I more than likely already know about the patient's pain, but maybe I can't give him more narcotics because it is not time, or I have much much worse things to deal with. This kind of patient is not satisfied with his dose of pain meds and will tell anyone and everyone how terrible his nurse is because this nurse can't give him the really good stuff anytime he wants it... like anytime he OPENS HIS EYES. This kind of patient has severe pain even blinking his eyes.

As long as he is conscious, he is in pain. Even if he is slurring his speech and can barely stay awake, he is in such severe pain that he is about to die and will tell ANYONE that will listen about how bad he feels and how the nurse is treating him so badly and ignoring him. When in fact it is the opposite. He acts like this to get attention and get more narcotics because the nurse will get tired of it and eventually call the doctor and ask to increase the pain meds. It works. It happens more than any nurse would like to think. This kind of behaviour is how he gets what he wants.

This kind of patient takes up more of the nurses time, and gets much more attention than the less verbally abusive, non narcotic seeking patient. This patient has already run the nurse ragged. And that is why you get the reaction that you do from his nurse. She is worn out from trying to get his pain under control. SHe is at her wits end with this patient.

We, as nurses, assess our patients all day long. We do the best we can, and give narcotics when needed. It is the exception, not the rule, to deny a patient their narcotics. Only a mean, cold blooded nurse would do that. ANd personally, I have never met one. Most nurses want to give the narcotics to this kind of patient, but we can NEVER SATISFY HIM.

In turn, he makes us out to be lazy, uncaring and mean to everyone that comes into his room. Like I said, this behaviour works, and it plays on our compassion.

FireStarterRN, BSN, RN · May 2, 2009

I wasn't talking about truly helpful people, but about the ones that approach you a way or tone of voice that indicates that you are obviously not doing your job, but thanks to them the patient will get what he needs. They don't come and ask you in a collaborative manner "Is Mr Pita due for pain meds?" or "What's the plan regarding Mr Pita's pain". Instead they feed into the patient's manipulative efforts by loudly informing you at the nursing station, in an accusatory voice, that your poor patient is in pain.