Unsatisfied Patient

No doctor is available at all? An on call service? While it may not be life threatening, telling someone to wait seven+ hours while in pain doesn't seem a reasonable option. And if the doctor has admitted someone with nothing ordered for pain, not even a tylenol, then I don't really feel badly waking them up.

I don't really think it's entirely about customer satisfaction, either. It's about treating someone as we would want to be treated. We as nurses are there to advocate for our patients. And pain, while it may be subjective, deserves to be treated. 

Can't you wake a doctor up? I would not want to be in pain all night long. While not "life threatening" it can certainly alter vital signs and rest patterns.

39 minutes ago, summertx said:

Hi, I just had a question. If you had a patient who ask for pain medication at 1am (LTC) and they don't have anything ordered and they continually complain and say they are 'hurting so bad they can't go to bed'. Then they get angry and threaten to complain.  But it is not life threatening. No reasoning, no reassurance. The doctors are not available at this time to contact and really probably should have been addressed on day shift if this was so bad. So all of a sudden you're getting this complaint. 

What would you do in this situation in this day and age of customer satisfaction? This is a situation where you can't do to much about it given that doctor are not really awake at this time for a non emergency. Thoughts?

I would look for a work-a-round, and if there wasn't one, I would call. If the doctor didn't call back, at least I tried.

I also tend to look for possible problems as soon as I get a patient (especially an admit). I ask for "small" orders routinely to avoid "nuisance" calls when I can.

1 hour ago, summertx said:

If you had a patient who ask for pain medication at 1am (LTC) and they don't have anything ordered and they continually complain and say they are 'hurting so bad they can't go to bed'. Then they get angry and threaten to complain.  But it is not life threatening. No reasoning, no reassurance. The doctors are not available at this time to contact and really probably should have been addressed on day shift if this was so bad. So all of a sudden you're getting this complaint. 

My thought process:

Either the patient has this pattern previously or doesn't. If s/he does, then I would consider whatever plan of care had been in place and follow it if it can help handle the problem or contact the physician if it can't. If the patient doesn't have any previous pattern like this, I.e. this is a completely new situation for this patient, it's worth careful evaluation and notifying a provider that it is going on.

I have never worked as a nurse in LTC but it seems like if there is no one on call for patient concerns and changes in conditions, you facility isn't providing the care it is required to provide.

44 minutes ago, JBMmom said:

I don't really think it's entirely about customer satisfaction, either.

This.

Just because there are some aspects of customer service and patient satisfaction that have been taken too far, a patient's reasonable request for assistance with comfort or their change in condition is not merely a matter of customer service. The role of nursing was about all of these things way before any "leaders" weighed in.

1 hour ago, summertx said:

This is a situation where you can't do to much about it given that doctor are not really awake at this time for a non emergency.

Again, if this is a new situation with this patient I would tend toward the side of saying you are not completely qualified to evaluate it independently. Therefore I wouldn't worry about whether or not it technically qualifies as an emergency and I would call people under the simple premise of change in condition. And...if it isn't a new thing for the patient then they can still chat on the phone about it at 0100 because the patient still needs a proper plan of care.

Don't forget about other measures besides medications that you might be able to use to mitigate the pain.

23 hours ago, JBMmom said:

No doctor is available at all? An on call service? While it may not be life threatening, telling someone to wait seven+ hours while in pain doesn't seem a reasonable option. And if the doctor has admitted someone with nothing ordered for pain, not even a tylenol, then I don't really feel badly waking them up.

I don't really think it's entirely about customer satisfaction, either. It's about treating someone as we would want to be treated. We as nurses are there to advocate for our patients. And pain, while it may be subjective, deserves to be treated. 

I completely agree. The reality is that the NP who is the on call practitioner doesn't answer their phone or texts that late. It's time and again that this happens. I recently sent a patient out of HR over 140. Was she there to answer? No. Are these doctors available when you need them? No. Do these doctors document in their progress notes 'skin is intact' when there's a stg 3? Yes. Do they do assessments for pain when they walk in the door? No, they are all 'fine, with no complaints of pain'. 

Don't ask if there's another nurse, there is another nurse, they're there but it's like having no nurse because he's doesn't even take care of his own patients. I am through with these on-calls and doctors who know full well they should have done an assessment yesterday. 

I can't help but hope these people learn how it feels to be on the end of such lousy care.....

But I know that is wrong of me.

1 hour ago, summertx said:

The reality is that the NP who is the on call practitioner doesn't answer their phone or texts that late.

I worked in long-term care for five years, I can completely understand your frustrations. As crappy as I thought some of the care was from the medical director (as you mentioned, the five minute assessment with a complete charting of things like intact skin), I never experienced providers that just didn't answer the phone overnight. This is medical negligence because the facility commits to providing medical care 24/7. You need to contact either the medical director or the ombudsman. If you have concerns about your job, there are confidential ways to report issues like that. While not addressing pain overnight might not be a medical emergency, there may very well be a medical emergency at some point that requires a provider's response. 

I will always say it, the people that work in long-term care, and do a good job of providing care, are the least appreciated and most underpaid medical providers out there. I credit my five years there with the development of my assessment skills and the ability to manage time and not be overwhelmed with a large patient load. When my eight hour shift had two med passes and a treatment pass for 30 patients, transitioning to acute care with eight patients overnight, wasn't nearly as intimidating.

Good luck to you @summertx!

4 hours ago, summertx said:

I completely agree. The reality is that the NP who is the on call practitioner doesn't answer their phone or texts that late. It's time and again that this happens. I recently sent a patient out of HR over 140. Was she there to answer? No. Are these doctors available when you need them? No. Do these doctors document in their progress notes 'skin is intact' when there's a stg 3? Yes. Do they do assessments for pain when they walk in the door? No, they are all 'fine, with no complaints of pain'. 

Don't ask if there's another nurse, there is another nurse, they're there but it's like having no nurse because he's doesn't even take care of his own patients. I am through with these on-calls and doctors who know full well they should have done an assessment yesterday. 

While you cannot force a NP or Dr to return call, you need to get the call out there. If there's a complaint to state, the response " I didn't call because they don't answer " will definitely not cut it. Call, call 2 or 3 times and document it. Cover your behind. If I went into an LTC and my mom told me she c/o pain and nothing done, I would go to the DON and start there. If I wasn't satisfied, state would get a call. And if no documentation, or apathetic response,  someone would definitely be in trouble. 

3 hours ago, Hoosier_RN said:

While you cannot force a NP or Dr to return call, you need to get the call out there. If there's a complaint to state, the response " I didn't call because they don't answer " will definitely not cut it. Call, call 2 or 3 times and document it. Cover your behind. If I went into an LTC and my mom told me she c/o pain and nothing done, I would go to the DON and start there. If I wasn't satisfied, state would get a call. And if no documentation, or apathetic response,  someone would definitely be in trouble. 

 I can't believe these places don't get shut down. 

5 hours ago, summertx said:

 I can't believe these places don't get shut down. 

Why? Because a Dr or NP, or even staff nurse, refuse to do their job? How fair would it be to the people who actually do their job? You do your part and document. Let the person who isn't doing their part get what's coming to them. 

Never heard of such a thing - if whoever was on call didn't answer/return call I would be calling the medical director and if they yelled at me, got mad, whatever then too bad - they can take it up with the negligent party who didn't answer the phone. These clinicians are responsible for the patients 24\7.

I am also wondering why this patient suddenly had pain? It sounds like this pain is acute, no chronic, what is causing it? Is there an injury or underlying issue? Is it musculoskeletal pain or some other kind of pain? Does everyone with no contraindication have an order for Tylenol? Were other interventions tried?

What would I do?  I would assess the pain, page the on-call and document document document.  If no response, I would go above his/her head to the medical director (yes, at night) and notify the DON.  This is their responsibility to follow up on these issues of providers not calling back.  This is ridiculous for you and for the patient.