worried nurse at ltc

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Specializes in Oncology, Medical Surgical, Tele, Hospic.

So my first three months into ltc and i feel horrible. i had a pt come in from the hospital who was just d/c from iv diladud and tylenol. upon taking over the shift i find that the only pain medication ordered on discharge is tylenol and tramadol. so the man is 0x1 and is moaning in pain. when he is changed he screams worse. so i decided to give him the prn tramadol and his tylenonol. i tried to get something stronger but the dr wasnt going to order anything stronger. i let my shift supervisor know upon reassessment and hour later he is still in pain, so i call the on call doctor and she orders another 50mg one time now of tramadol wich seems to be effective on the faces pain scale. i go back into the room to check and he is quiet. before he has his 5am change i give him another prn tramadol. at the end of the shift when i leave he is quiet but moans ocasionally.

so i get called in to the facility to fill out a comment for investigation and told the family has pulled him out of the rehab and into another facility due to the fact and state they felt that his pain was treated horribly. they find out this informaltion through his roomate who is a young man who is on a methadone regiment and hates roomates.

I feel horrible right now. I did everything i thought i could do, and i wouldnt leave anyone in pain . i feel like i am going to loose my license. i also realize that my documentation is really lacking.

Any advice please help :(

Robert

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Specializes in critical care, ER,ICU, CVSURG, CCU.

assessment document, document, document i am not trying to beat you up you will not in all likelyhood "loose your license" our documentation makes and breaks us....if you did what you said, you did fairly well...but if your documenttation does not support your actions.....and you may appear complacent..... I am a DON in LTC, I know my nurses are running like crazy, and see them doing "right things" but frequently their documentation, looks otherwise..... i just flat out take different situations say chest oain, one is sending to ER, and verbaly walk them thru what to do, and how to dicunent, sometimes I just do the documentation, and try to always praise when they handke a preplexing situation, chart well etc..... sometimes I may ask them to read my charting on an incident etc..... might even engage in hiw would you have handled? senarios....you are a young nurse I know you want to do the right things, and you will. please try to make anything that is wrong or in error, as a learning opportunity... keep us posted. Best of luck to you.

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Specializes in NICU, Peds, Med-Surg.

Aww....hugs! Don't worry, you did the correct things! As as Sallyrnrrt said---document, document, document! You called the doc, (did you chart that? I hope so!) Even more importantly, did you CHART the times you checked on him, he was quiet with even resps, etc?

You did what you could and his pain wasn't handled HORRIBLY" , as his family states. (ughhhh....don't get me started on families that believe everrrything that other residents and/or a roomate says.....!!!:banhappy:) This is NOT something where you would lose your license......not for one incident like this.....!!! Hugs!:)

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Specializes in critical care, ER,ICU, CVSURG, CCU.

thanks nervous, defunit 1 on, i hope things are going better for you :sarcastic:

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Specializes in VA, Ortho, Med/Surg.

This is exactly why I want out of nursing. One wrong move and you kill someone or you lose your license for something. Too nerve wracking for me.

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Specializes in critical care, ER,ICU, CVSURG, CCU.

didi, some one has to care for "the human condition" we do experience a lot of "no good deed goes unpunished " :roflmao:

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Specializes in Gerontology, Med surg, Home Health.

You can't and won't lose your license because one family complains that their family member was in pain. It seems, by what you posted, that you did everything you could. I would, in the future, calling the medical director of the facility if the covering doctor won't order medication the resident needs. I've done it before. Sometimes the covering doc gets angry but I have to do what I have to do to get the patient what they need. AND...shame on the HOSPITAL for discharging someone without sufficient pain medications.

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Was just in a similar situation. Palliative patient who was not happy with his diagnosis and complained about every aspect of his care. Management knew he complained about everything but when he complained about me, next thing I know I am gone. License now under review. Malicious managers will do whatever they can do to remove staff they don't like. I don't think my competence was the problem, nor my patient care. Sometimes patients take out their frustrations on us and don't care if they are destroying your career. Document everything, and if you think you have a problem patient or if you are experiencing issues with a coworker or manager, document even more. Create a paper trail, you may need to protect your license when you least expect it.

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Specializes in LTC.
You can't and won't lose your license because one family complains that their family member was in pain. It seems, by what you posted, that you did everything you could. I would, in the future, calling the medical director of the facility if the covering doctor won't order medication the resident needs. I've done it before. Sometimes the covering doc gets angry but I have to do what I have to do to get the patient what they need. AND...shame on the HOSPITAL for discharging someone without sufficient pain medications.

I've done the same thing for a CHF patient. Long story short, the attending doc had a "triage nurse" who would not allow me to get a STAT CXR because "they just had one a month ago." ??? Anyway, I called the house doc and obtained orders and the pt was subsequently hospitalized for 4 days on IV Lasix. I caused the whole building to be in-serviced on "proper procedure for securing orders." I.e., don't go over the attending MD's head. I'd do it again, and again if that's what needed to happen for my resident.

To the OP: Relax, you'll be fine. Every day is a learning experience. Like others stated before, document you're butt off. That's what saves us or hangs us in the long run.

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If you document on the PQRST each time and the effectiveness of each prn medicaiton, there should be a pattern as to if the medication is working effectivenly or not. What type of pain was the pt experiencing? It could be something very serious. The doctor should've altered his prn pain medications completely if the pain was unrelieved; pain is whatever the pt says it is! sounds like a bad dr.

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