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?
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.
If she doesnt have pain relief, then it’s safe to assume it’s new pain. Which should be assessed when it’s that bad. You have no idea what the cause is, and potentially could be life threatening.
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.
To be fair as long time nurse to NP, I am sure the doctors are aware of skin wounds but updating assessments is fraught with copy and paste errors. I thought nursing documentation was tedious, but a provider's is farrrrrr worse.
Yes we have 15 patients and 4-5 that are sinking the drain with multiple consults to be called, stat lab to f/u on, family updates, a ccu transfer, pending H&P admission etc. OH and the discharge summaries which take an hour to write that a SNF needs like yesterday. You just aren't going to spend 20 minutes on an exam or interview.
This is why nurses exist, to report and filter abnormalities/complaints.
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
20 hours ago, Numenor said:
But hey you don't know what you don't know.
Good point! In my NP clinical rotation in the ICU I realized that in order to write a note of the quality that I would want for a patient's chart, it took me almost three hours! I was fortunate that I was usually only responsible for 4-5 patients and only one or two needed a note from scratch, the others had some copy options. I am already anticipating quite a struggle to keep up when I actually go into practice, which I hope will be pretty soon. I am far less critical of our intensivists and consult notes now that I've seen the other side.
Good point! In my NP clinical rotation in the ICU I realized that in order to write a note of the quality that I would want for a patient's chart, it took me almost three hours! I was fortunate that I was usually only responsible for 4-5 patients and only one or two needed a note from scratch, the others had some copy options. I am already anticipating quite a struggle to keep up when I actually go into practice, which I hope will be pretty soon. I am far less critical of our intensivists and consult notes now that I've seen the other side.
You'll get faster and more efficient, at the beginning of my fellowship I was at work till 930pm every night...now I get out on time haha
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.
Nah, it's only human.
Had a lady, of sound mind, literally beg us for bed rails. State still gives us a really hard time in those cases, because the bed rails violate her "right to fall". The very concept of the "right to fall" is beyond absurd to me, and it seems to be a "right" that the state holds so sacrosanct that HCPs and even patients/residents of sound mind rarely succeed in overriding it.
Anyway, I kinda hope whichever state official says that ends up in the exact same situation one day. Begging for bed rails or a seatbelt, of fully sound mind, but being denied it because it "violates the right to fall". Now that one's dark of me. And I do not want for them to actually fall-just to experience a sliver of the fear and dismay our patients/residents go through when they learn their "right" to have a painful, embarrassing, and too often disabling or even fatal accident is held in such esteem by the state that it triumphs over their other basic, intuitive rights.
I don't get it... this is what nurses do. Call and ask the provider for a pain med order. Day or night. No, it's not the last shift's responsibility. No, you can't control if the provider answers your call. Your job is to evaluate the patient, ask for the pain med, and document the response (or the provider's lack of response). If the patient complains about "customer service," so what--you've done your job and you have the documentation to prove it. And of course, if the patient decompensates, follow your facility protocol. Patients have pain. Nurses can't control everything--certainly not responsiveness of providers or appropriateness of orders. You want that kind of control and responsibility, go back to school and be a provider.
Specializes in M/S, LTC, home care, corrections and psych.
Hey, call the doc. Being your patients advocate is priority one. I'm sure that the next time they have an admit to that facility or floor they will put in PRN orders for pain meds rather than risk being awakened for Tylenol at 0200. Don't piss off a night nurse, you won't have a nights rest if you do LOL
Specializes in Mental Health, Gerontology, Palliative.
On 8/5/2021 at 5:04 PM, wernicke said:
Nah, it's only human.
Had a lady, of sound mind, literally beg us for bed rails. State still gives us a really hard time in those cases, because the bed rails violate her "right to fall". The very concept of the "right to fall" is beyond absurd to me, and it seems to be a "right" that the state holds so sacrosanct that HCPs and even patients/residents of sound mind rarely succeed in overriding it.
Our patients are allowed to request an enabler. Often there is no difference structurally between a restraint and enabler, eg one patients bed rails could be a restraint and could be an enabler.
Only a patient can request an enabler.
As for the OP.
Its a good learning curb IMO to ensure that all patients have basic pain medications charted. If there was no previous history of pain I would query acute. Also query whether its more psychological in origin and by spending a bit of time with the patient, maybe use a heat pack or other such non pharmacologial intervention could bring about help.
And of course, call your facilitys doctor. If they arent avaliable try the after hours. And document the hell out of it, including what your assessment was, and what you see needs to be done ISBAR is a great framework
A couple things come to mind (most of which have already been suggested/hinted at)
1. Check to see if there are any standing orders for Tylenol and offer that. Offer any nonpharmacological interventions that are available such as ice or heat.
2. Contact on-call physician. Yes, the providers might not actually be in the building at 1AM but there should be someone on-call all the time, 24/7. Who would you call if someone was experiencing a significant medical decline? Call that person. I've actually had luck with on-call providers before, who will provide various orders to get the person through the night, with the expectation that the primary provider will follow up the next day.
Golden_RN, MSN
573 Posts
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.