I’ve been a nurse for 2 years. I generally think I’m a pretty decent bedside nurse. I’m thorough, I work hard and I care tremendously about people and their health. Lately I’ve been burning out. Tonight I think may be an example of how burnt out I have really become.
Patient is a younger man in his late 20s. Came to our facility for pt/OT after an injury and surgery to both his legs. He’s been with us for a couple weeks. Came to us with massive amounts of pain meds to the point where our doctors were uncomfortable prescribing him that much and scaled him back a bit to OxyContin scheduled and oxycodon PRN.
9pm rolls around and he’s scheduled for his OxyContin. I give it to him at 925pm (I have 30+ patients, so I’m feeling pretty on track here). Facility policy we must wait +1hr before administering the oxycodon. Patient knows this and says he want his oxy at 1030. I tell him I will do my best but to put his call light on.
1000 rolls around and he’s calling for his pain med. It’s early and I am caught up helping other patients so I do not answer him but two CNA tell him I will be there as soon as I can.
By 1030, he is screaming and banging a stick against the wall. He’s calling me all sorts of names and screaming "pain meds, pain meds, pain meds" at the top of his lungs. I wait a little while hoping he will calm down and I can get in there and hand him his meds.
Well, it doesn’t happen.
He gets more verbally aggressive to the point where something tells me - don’t go in there. Just a weird gut feeling of not feeling safe around this man. So I start charting hoping he will tire and calm down. He eventually gets quiet so I pull his meds and walk to his room. As I’m almost there he starts screaming again and banging against the wall. I stand in his door way and tell him point blank: I do not feel safe walking into your room, so I’m not going to be helping you until you can behave in a way that shows me I can feel safe approaching you. Well this made him angry and I walk away. He proceeds to yell and scream for the next hour, calling me everything under the sun. Eventually he chills a bit and the charge nurse goes in and hands him his meds.
I feel like I did the right thing here? But now I’m not sure.
SOOOOOOO his acting out physically is not threatening. WOW. Would YOU walk in there when someone is behaving violently? I don't think so. And he was NOT DUE his pain meds anyhow!
We do not reward this behavior. We get psych consults and medicate on schedule as long as our safety is not in jeopardy We report inadequate pain control to the prescribing physician.
I would not have done any differently so I guess you would report my butt too. So be it.
They think their liver or kidneys are septic tank. 20s of age is young. ?
It seems your pain is not able to be controlled. I'm going to phone the MD and get you sent to the ER to be evaluated just to be sure nothing more serious is happening
Specializes in Infusion Nursing, Home Health Infusion.
Exactly...I was just going to say something much like this but don't need to now! They are way past the point of communicating with the patient that his concerns will be relayed to the provider.The nurse has to have an immediate strategy to deal with his aggressive and childish demanding behavior. I guarantee you he will think twice before having a tantrum especially if you are assigned to him again.Even if you are not, other caregivers will benefit because you drew the line in the sand regarding his behavior.
SOOOOOOO his acting out physically is not threatening. WOW. Would YOU walk in there when someone is behaving violently? I don't think so. And he was NOT DUE his pain meds anyhow!
We do not reward this behavior. We get psych consults and medicate on schedule as long as our safety is not in jeopardy We report inadequate pain control to the prescribing physician.
I would not have done any differently so I guess you would report my butt too. So be it.
On 9/6/2021 at 1:40 AM, Straight No Chaser said:
Mr. So and So,
It seems your pain is not able to be controlled. I'm going to phone the MD and get you sent to the ER to be evaluated just to be sure nothing more serious is happening
Pt would prob like this. Brand new facility to manipulate & badger the staff for meds.
Specializes in Nurse Leader specializing in Labor & Delivery.
On 9/4/2021 at 1:43 PM, FolksBtrippin said:
Generally you are in danger when you have to withhold something someone wants, not when you are giving them what they want.
Also, it is pointless to attempt rationalizations and bargaining with someone who is in that state of mind.
Very good points. I started this thread thinking Morte et al were off their rockers, and now I've come around to their POV.
OP, I think you did what you thought was best/safest/most prudent in the moment. I too think it could have been handled differently which would have been a more positive experience for both you as well as the patient. And I agree with Folks that you would not be in danger by bringing the patient what he was wanting/needing. He was escalating because you were NOT bringing him what he wanted/needed.
EXCELLENT suggestion!! Make that person the first on the med rounds. Everyone's happy.
You can only bring early so often until pyxis locks out as many time what can be pulled. Then someone else is dealing with someone screaming. No easy answer on this one
Specializes in Nurse Leader specializing in Labor & Delivery.
1 hour ago, Hoosier_RN said:
You can only bring early so often until pyxis locks out as many time what can be pulled. Then someone else is dealing with someone screaming. No easy answer on this one
I was speaking more regarding the fact that the first pain med was 25 minutes late due to having 30 patients. If he was first, he would have gotten his med at 9 when it was due, and the whole escalation would not have happened in the first place.
I remember a clock-watcher patient who would get in power struggles with nurses and demand pain meds.
For one of these guys, I started bring his pain medication 10-15 minutes early. It worked so well, less negative energy overall.
I had a patient that started demanding medications early. If a PRN is available every 4 hours, I guess at some point someone felt "well we have an 1 hour window to give meds", and this patient was given then an hour early (so, q3 hours). I would not do that. But, I was always good at bringing the meds at the right time (patients would often call as I was pulling their meds). I will also wake patients up if discussed before. But, I won't give a narcotic "early" since that breaks the "rules" and sets the next nurse up for that timing conflict.
anewsns
437 Posts
This is a very 3-11 shift thing to say, and I appreciate it.