So, yes, I had another one of those days where............things just kept going wrong. None of my meds were in place to be given at the right times............but I dealt with it. There were some errors made by the shift before me that required me to spend time sifting through the mess of "who ordered what" in order to make sure...........what was ordered was really.........well, what was ordered. I handled that fine, no hitch. Had a very needy pt. in the room next to my assigned patients who didn't feel her nurse was up to snuff in fetching her all the things she wanted and decided to recruit me as her Denny's waiter to fill in the gaps. I kept my professional face on despite having much more pressing things to attend to and made her happy. I had a very complicated D/C that needed to be completed by noon (the pt. scheduled herself for things to do starting at 2pm), and made sure it got done.........................only to have the room filled up MINUTES after that pt leaves............filled with a very heavy post-op pt. Said post-op pt. had a spouse who was very afraid for her and very concerned about her well being..................and needed a little bit of attention himself. I made sure he got it and that she was comfortable, all the while completing the mess of an admit that was half done by "same day" before she was rushed off to surgery (because the float nurse was at lunch). I haven't even mentioned the dressing change with the lady who could barely move and was in a lot of pain nor the older gentleman who wanted to talk about baseball all DAYANDNIGHT.................
I'm not tooting my horn or throwing the poor me's out there. Just saying.........the recipe for disaster was there, with a ingredients very fresh and oven warmed up ready to bake. But I handled it without getting attitude or letting care drop off (or so I thought).
It came to the end of the day. Family members are leaving, going home...........some thanking me on the way out. I'm all caught up.........charts are neat and tidy with all orders taken off correctly, meds passed, pt's comfortable, "I"s dotted and "T"s crossed etc etc......................so I feel pretty good. Don't even mind the fact I am working all weekend.
Then the daughter in law of my one problem pt. steps out into the hall to create a scene. Yes, she's a former nurse (of course) and oh..............this is just unforgivable. See, I gave her mother her Zosyn two hours late. How is she going to get any better with care like that? And to boot, I tried to give her mother heparin in her IV instead of SQ like it was ordered. Am I trying to kill her now?
OK. Back up the truck, lets look at the facts: Said mother (the pt) was just one of those "I am in control" types. She wasn't happy unless she was sure you understood this................and, well, I thought I had heeded to her this boundary as she desired it so. She commented to me as I took her antibiotics in that the night nurse had been very late with said antibiotic during the night. I looked at the documented time of administration............it was about an hour late. Pt. wanted this one I was giving held for an extra half hour...........so the were not too close. OK. You da boss.........gotcha. Came back and administered antibiotic half an hour later as directed........saw no reason not to do it this way if thats what made her happy.
Guess that request was not enough of flexing the muscles though. I took the next Q6 antibiotic in later on in the day and...........well, no way, she wasn't having it. Wasn't willing to take it until 10 pm (it is now quarter till four.............antibiotic due at 4). I went through why I didn't think skipping a dose would help her and all.......................talked her into letting me hang it at 6pm. OK, its late as heck but she got the dose and its sooo much better than 10pm.
Six o'clock rolls round..............I'm going in to give now VERY late Zosyn and guess who is there. The daughter in law. She is livid because her mother's antibiotic is late. Seems mommy changed her story on why she did not have it running already when daughter in law got there.............told her I was busy and she missed the dose, had not seen me all day. Then, to add logs to the fire, made up this story about me trying to put heparin in her IV................
She succeeded in getting the spotlight off herself and onto me. Daughter pranced around like she owned the place with this "Alice in Wonderland" Queen "off with their heads" attitude. I explained what had gone one, but of course she wasn't hearing it.
So, now I'm fired by one pt...........on an assignment I spent the day making everything right on. Yes, I'll be on a different assignment tomorrow, daughter in law does not trust me to care for her mother soooo.............
I'm sure I'll be in the manager's office defending myself come Monday.
So is this how we are graded? A day in which I have to work miracles just for simple care to be given and............one oddball makes the whole day an epic fail?
Shesh..................."Team Nurse Burnout 45, Team Eriksoln 10".
Yeah but ... we can explain how busy we are etc etc in Australia and expect them to understand.
We are still allowed to (politely) tell our p'ts to behave
However the US seems to be a different kettle of fish. I'm sure the p'ts there don't even want to know the nurse has other p'ts or is having a particularly demanding day ..let that slip and the p't gives her/him a poor score and/or makes a complaint.
Then it could be all downhill from there.
After receiving a complaint by a pt once... I was told to never tell a patient that I have other patients. Makes it sound like I'm too busy for them. Instead I'm supposed to say (in my best Stepford voice) "What do you need? I have the time." The joke is that I really don't have the time, and that management on that floor just kept adding more non-nursing type things to our responsibilities until we barely had time to do an assessment or pass meds. This is why I transferred to the ED... which compared to the med/surg floor I was on is much less hectic even on a bad day.
She refused her heparin too, and I think she came up with that story in anticipation of me telling her daughter in law she refused it.
When I have pts refusing meds like that I usually politely suggest that they would be more comfortable recovering at home (sign out AMA)... I've not once had anyone actually do it, but it gives the patient perspective about why they are admitted to the hospital and the importance of following the plan of care.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i enjoy your posts erik but find them a bit long. maybe keep it shorter next time?
don't worry, everyone has bad days. quietly take the daughter somewhere & explain how busy and caught up you are - tell her what you said on here, re tidying up after the last shift etc. no-one is perfect and you are not superman, though people - for some weird reason i've never figured out - expect nurses to be miraculously wonderful 24/7.
she is just another member of the public who does not appreciate any care that is given to them or their family.
i enjoy erik's posts. they may be long -- some of them -- but he makes appropriate use of paragraphs and punctuation so they're easy to read. that post was long enough to express the full flavor of his day.
as far as the d-i-l "firing' you . . . i've noticed that family members who feel compelled to "fire" nurses aren't really the kind i enjoy dealing with anyway, so maybe being fired is a good thing. hope tomorrow is better.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
when i discuss issues with my nurses, i don't ask them to defend themselves. i know all my nurses must work extremely hard to provide 1st rate care.
but when we don;t meet expectations, i'm there to investigate and seek a resolution. i just want openness and honesty
i'd suggest printing out your post...highlight the most pertinent parts..."this is what happened,"
have a good weekend & know that your efforts are appreciated by the majority of your other patients
i'd suggest that printing up your post is a really bad idea . . . no need for your manager to follow you on an!! copy and paste it into another document and print that out.
Yes, that's definitely one of the things about bedside nursing that I do NOT miss -- you can do a million things right, and nobody cares, but do one thing wrong -- or not even wrong, but in a way that somebody somewhere doesn't like -- and you hear about it.
The only thing I would have done different than you -- and this is NOT meant as a criticism -- but I would not have agreed to hang the antibiotics 2 hours late just to make a pt happy. I would have explained that they had the right to refuse a medication, but that if she did, I would have to notify the doctor, who would most likely want to come and have a talk with her about it. I would also explain why it's so important for abx to be on time. Then, if she still refused, I would have documented it as such and notified the doctor.
But again, that's not a criticism -- sorry you had such an annoying ending to what sounds like an otherwise stellar shift.
On our unit if a pt says to hang the abx 2 hours late, we document the time they refused and then we come back 2 hours later to administer it. If we don't do exactly as the patients request the NM writes you up period. We also notify the MDs. We had a similar situation with a family and after just about anyone who has ever worked with (nurse and docs) them attempted to educate them on the importance of antibiotic timing, they fired every single attending we have from working with their relative and brought in their own private doctor. Doctors are now limited as to their power in some facilities. Their careers in Press Ganey oriented hospitals are also dependant on Press Ganey scores. 1 bad score and 4 good ones = 80%. Physicians who get a score of 80% or under 4x within the year have their contracts terminated with the hospital. Nurses are terminated right along with them.
Most of our calls to physicians sound like this Doc: "pt such and such? sigh give them 2-4 mgs of morphine q 6 hours"
Floor Nurse: "Doc they want q 4"
Doc X: "make it q 4 then sigh" Nurse: "also they don't want their ABX at this time"
Doc X"sigh please ask pharmacy to retime it whatever time the patient wants" Nurse: "oh and Doc they are upset, they just told the NM they want to see you again before noon or they are going to sue"
Doc X: "but I was just there at 8am and explained everything to them for over an hour" Floor Nurse: "I'm just letting you know"
Doc X "sigh, let your NM know I'll be back to your floor in 30 mins"
5 mins later NM "I just put a phone call in to dr X and he/she better be here inn 5 mins" FLoor Nurse "I just spoke to Dr X they will be here again in 5 mins" NM "well they better be because I"m calling their supervisor, in fact I'm calling their supervisor right now anyways because the patient says they will sue if Dr X ever lectures them again"
Patients and families like this are unfortunately a dime a dozen. They have big egos and even bigger insecurity issues so they lie, create drama, etc. all to get the attention they lack in real life. Don't take it personally. They would have done this to any other nurse same as they did to you. It's who they are and won't be changing no matter how good the care and how professional you are.
Be thankful they "fired" you. That can be a gift from God. I feel for the next nurse as chances are good they are in for a long unpleasant shift.
Thank You to everyone for hearing my rant and giving me support. It really got me down.
I feel like no matter how well we do our jobs, there is something we can always tweak to improve things. I've been focusing on being more patient centered lately. I've been so impressed with the good results too. I spend an extra five minutes talking to the patients and hearing them out...........and everything runs so much smoother because they know I am on their side.
Its been a long time since I had someone openly have a problem with me. Actually, this is my first time since getting away from full time nights. I was going along, feeling so happy about the way things were going then...........BAM.............I run into the "immovable object".
What gets my goat in the end is how much "tongue biting" I did and how much I insisted things be kept "right" for the pt.........by letting her have her way.........only to turn out to be the bad guy anyway. Ah well. I can hang my hat on the fact that everything was done to make things right for her..........its not as if I walked away just cause I didn't want to be bothered or something.
The fact that word came out this week that cut backs are on their way didn't help either. For the first time, the cut backs will include nursing. Its just such a bad time to have people complaining about you.
The really sad thing is that although I'm sure darling DIL is thinking that her behaviors are going to get her MIL better care, the exact opposite is true. No one is going to want to put up with that BS and will be avoiding that room like MIL has SARS or H1N1.
I just got myself fired by a pt's wife, for ridiculously stupid reasons. So I'm totally feeling for you...my eval is right around the corner, and although I have no concerns re: job security, the timing still reeks.
Best of luck, keep that game face on, and hopefully the next several shifts you have will be better.
It's total tripe that these p'ts can dictate medical care. If a p't dictates that their antibiotics should have a different timing to what the Dr ordered ....sign the AMA #2 form.
This new AMA #2 should stand-up legally beautifully. It can help reducing some of the direct and indirect cost involved in accommodating entitled ridiculous p'ts and reduce the incidence of stupid lawsuits.
These costs are passed on the the p't and it would be nice if that impact of silly behaviour (satisfying need for control by overly entilted self centred family and p'ts) on healthcare costs could be highlighted...... yep, show the impact of this on their bills.
Just have to place the info out there in the few media sources - that's all, it will get around.
Hospitals collectively; and doctor and nurse groups, need to get a backbone.
Then, to add logs to the fire, made up this story about me trying to put heparin in her IV................
Doctors are now limited as to their power in some facilities. Their careers in Press Ganey oriented hospitals are also dependant on Press Ganey scores. 1 bad score and 4 good ones = 80%. Physicians who get a score of 80% or under 4x within the year have their contracts terminated with the hospital. Nurses are terminated right along with them. 
KyPinkRN
283 Posts
After receiving a complaint by a pt once... I was told to never tell a patient that I have other patients. Makes it sound like I'm too busy for them. Instead I'm supposed to say (in my best Stepford voice) "What do you need? I have the time." The joke is that I really don't have the time, and that management on that floor just kept adding more non-nursing type things to our responsibilities until we barely had time to do an assessment or pass meds. This is why I transferred to the ED... which compared to the med/surg floor I was on is much less hectic even on a bad day.