What about my pain!?

nrsang97, BSN, RN · Jan 2, 2009

This is something we all deal with no matter what department we work in. I have had a pt go bad when I worked med surg and I had a pt waiting for something and trying to explain that someone else had a emergency was pointless.

One night we had a room that had the pt in bed 1 have some kind of distress after receiving dilaudid for the first time (this was a few years ago I think it was resptiory or possible seizure). We were attending to her and the pt in bed 2 starts LOUDLY demanding dilaudid too for her finger cellulitis. Then she started screaming for her nurse and her vicodin. I went over to her and explained that her nurse had to stay with her room mate and that she would give her the med as soon as we had stabilized her room mate, but she told me and I quote "Listen you fat bi%%% go back on the other side of the curtain. I want my nurse and MY VICODIN NOW!" I ripped the curtain closed and told her (this is the first time I have ever yelled back at a pt.) in on uncertain terms she can yell scream and demand all she wants that the other pt was priority and she was not being forgotten. I also told her she will treat all staff with respect. I had backup from the house PA who also told her that airway issues come before anyone who needed a pain pill. The pt in bed one was transferred to the ICU for monitoring and the pt in bed two finally got her vicodin. I just cannot fathom why when you can actually see and hear someone having a medical problem more serious than your own that you can't possibly be patient for a few minutes.

I was inpatient one time. I was in for asthmatic bronchitis. I was having difficulty breathing, and they sent me for a stat CT of the chest. There was a pt who was waiting for a CT of the chest too. I was watching him and afraid he would code. They sent me to the ER and then ER was backed up and they sent me to another scanner along with that pt. We were in the elevator together and waited at the other scanner. They were calling for me first. I told the CT tech that he needed to go NOW before me or we would probably code him. He was breathing so hard. ( I couldn't believe they sent him without a nurse and monitor from a where ever he came from he looked like he had a fresh pacer put in) He couldn't even do the scan. The CT techs had to send him back. I couldn't consciously go in before him since he was so much sicker than I was. I would have wanted someone to do the same for me. I think even if I wasn't a nurse yet I would have let him go first.

nursemary9, BSN, RN · Jan 2, 2009

Sorry Hon,

These days it's all about patient satisfaction.

There is NO excuse for a pt. being kept waiting that long for a pain med---CODE or NO CODE!!

Are you saying that 100% of your staff was involved in the code situation????????????

When we have a code, there is ALWAYS one RN who will kind of look after the other pt's.

After all, who knows, you could even have a second code---who would take care of that pt??

No, I really think that someone should have helped that patient.

The patient could have been more understanding, but so could the staff.

nrsang97, BSN, RN · Jan 2, 2009

Sorry Hon,
These days it's all about patient satisfaction.
There is NO excuse for a pt. being kept waiting that long for a pain med---CODE or NO CODE!!
Are you saying that 100% of your staff was involved in the code situation????????????
When we have a code, there is ALWAYS one RN who will kind of look after the other pt's.
After all, who knows, you could even have a second code---who would take care of that pt??
No, I really think that someone should have helped that patient.
The patient could have been more understanding, but so could the staff.

Mary,

Are you responding to me or the OP? The situation I described the pt only waited a additional 15-20 minutes for the med. However she didn't start asking for pain meds until the pt in bed one had distress following administration of her pain med.

The OP works in the ER so that is a totally different situation. They could have had 3 or 4 ambulances show up at once with a coding pt and that can take a lot of staff.

I also believe that if their ear hurt for 2 weeks why didn't they go to their own MD. I only use the ER if I can't get into my doctor office or I can't get to urgent care because they are closed.

Pepperlady · Jan 3, 2009

Many years ago I was working in an ER at a different facility. I had one man with his child waiting to be seen by the doctor for an ear ache (I think that was it), a code came in and we got him into the nearest bay and pulled the curtains. I can still remember what happened next as if it were yesterday, the man that was waiting with his child, whipped open the curtains and stated loudly "I was here first", and I turned, placed my index finger on his chest, didn't say a word, and backed him back up to his assigned chair and he sat down, I then picked up his child, put him on his dads lap and turned and left. Not a word came out of my mouth because it was not going to be nice or therapeutic for anyone but myself if I did.

wonderbee, BSN, RN · Jan 3, 2009

I understand. Patients are angry they are kept waiting. It's always the nurses' faults. Pain does that to people, makes them impatient and after an hour or more, it's all about them. Human nature. Always was this way, always will be. Just keep on moving. Don't take it personally. When the day's over, shake it off your feet and take a hot bath and take care of yourself. It's how we survive.

flightnurse2b, LPN · Jan 3, 2009

Sorry Hon,
These days it's all about patient satisfaction.
There is NO excuse for a pt. being kept waiting that long for a pain med---CODE or NO CODE!!
Are you saying that 100% of your staff was involved in the code situation????????????
When we have a code, there is ALWAYS one RN who will kind of look after the other pt's.
After all, who knows, you could even have a second code---who would take care of that pt??
No, I really think that someone should have helped that patient.
The patient could have been more understanding, but so could the staff.

with all due respect, i think if you worked in the emergency dept you would think differently. yes, it is possible on a med/surg, psych or oncology floor, but more times impossible in the ER. priorities are different because they have to be.

for example, the ED i came from was 72 beds. each nurse had 5 pts or so with the nurses in trauma at 3. there were on a good night, 3-4 techs (licensed paramedics) and 2 monitor technicians. say for instance a car accident comes in with four passengers, one in cardiac arrest, one with c-spine injury, one with a pneumothorax and one with a fx of the tib/fib..... in addition to the patients already IN the emergency room for CP, ear pain,hangnails, pregnancy tests, sniffles, headaches, CVAs and lacerations, you have 25 in the waiting room with similar complaints. if someone at that moment the rig wheels in signs in triage with stable vital signs, no blood and 2 wks of ear pain, they're sure as heck going to wait. not because they aren't important---because there are 50-100 people who are also sick, some sicker, being treated. the critical patients must be stablized, the stable ones transfered or taught and discharged, and the people waiting in the waiting room taken back in order of need.

food for thought. :)

Pepperlady · Jan 3, 2009

with all due respect, i think if you worked in the emergency dept you would think differently. yes, it is possible on a med/surg, psych or oncology floor, but more times impossible in the ER. priorities are different because they have to be.

Absolutely that 2 weeks of ear pain with normal vitals is going to be waiting in my ER too and we are not that big. This patient is going to be CTAS 4 or 5 and is going to wait to see a doctor. To suggest that we are not being understanding or helpful because the patient has to wait for pain management is to suggest that I give that patient a priority over a patient in cardiac arrest .

At the triage desk we often hear complaints of waiting when a patient is having pain, but I am going to suggest that most patients are there with pain issues or some sort or another and I am a trained professional who is given the task of who has pain that needs immediate treatment (chest pain) and pain that can wait (ear pain)

tencat · Jan 3, 2009

Sorry Hon,
These days it's all about patient satisfaction.
There is NO excuse for a pt. being kept waiting that long for a pain med---CODE or NO CODE!!
Are you saying that 100% of your staff was involved in the code situation????????????
When we have a code, there is ALWAYS one RN who will kind of look after the other pt's.
After all, who knows, you could even have a second code---who would take care of that pt??
No, I really think that someone should have helped that patient.
The patient could have been more understanding, but so could the staff.

I surely hope you are kidding........There surely IS an excuse for a patient who is not dying in front of me and has enough urine and vinegar to CUSS out a nurse about needing meds RIGHT NOW to shut her pie hole and deal with it. Pain isn't going to kill someone. Not breathing or funky heart rates have a tendency to make one expire.

Oh wait, I guess the dead patient CAN'T tweak the almightly Press-Ganey scores...my bad...better let's make sure the live conscious one is placated at the expense of the unconscious, possibly dead one, because after all it's all about making management happy, isn't it? :nono:

ThrowEdNurse, BSN, RN · Jan 3, 2009

To all ed pts: No one has every died from the discomfort of pain. People die from the medical condition causing the pain. Ergo, we don't care about your generic, non-life threatening pain. As long as there is a pt who has a complaint that is life threatening, your long term pain is not a priority. We see pts who are sickest first. Pain does not equal sick. Pain sucks. We know. Losing your license over delaying the care of someone dying to treat someone else's pain sucks more. You will wait. Triage works. It's there for a reason. It's not random. Get over yourself.

Pepperlady · Jan 3, 2009

I am apologizing for my use of the word "suggest" in my post, I have no idea why I did that or where it comes from!! LOL

I_LOVE_TRAUMA, RN · Jan 3, 2009

If it were me, that other patient with the boo-boo on her finger would have waited a LOOOOONG time for any pain meds from me-probably would have waited until the next shift arrived. That "pain is what ever the patient says it is" theory is crap. Pain does suck, I know, but if your ever-increasing "need" for the drugs turns you into something that is so uncaring and inhumane, you don't deserve any special, caring treatment (or any treatment at all) from me, I really don't care if your finger falls off! Sounds like maybe that finger cellulitis had eaten away at this patient's brain! This new way we have led our patiets to believe that they deserve to be totally pain free bothers me a lot. Last night I assessed my patient who had ran from the cops, and crashed his car at 100+MPH. He had several broken ribs, a bruised sternum, pulmonary contusions, and a bad tib-fib. Despite elephant doses of dilaudid he still was upset because his pain had gone from a 12/10 to a 2-3/10, he felt that he should be totally pain free after what his self destructive behavior had caused. I tried to explain to him that he was going to have some pain for the next few weeks-it is expected with his injury-and that any more pain meds would interfere with his breathing. He just told me that I was a b***H and that it was my job to make him comfortable-some people! We have pain when we are sick/injured-suck it up at least a little!